Effect of Intraoperative Tetracycline on Postoperative Pain After Mandibular Molar Extraction

Surgical extraction of mandibular molars is one of the most frequently performed procedures in oral and maxillofacial surgery and is commonly associated with postoperative pain, inflammation, and delayed patient recovery. The intensity of postoperative pain is influenced by tissue trauma, inflammatory mediator release, and bacterial colonization of the extraction socket. Although systemic analgesics are routinely prescribed to control postoperative pain, their prolonged use may be associated with adverse effects. Therefore, adjunctive local therapies that can reduce postoperative pain while minimizing systemic medication use are of clinical interest.

Tetracycline is a broad-spectrum antibiotic with additional anti-inflammatory properties. Besides inhibiting bacterial protein synthesis, tetracycline suppresses matrix metalloproteinases, reduces inflammatory cytokine activity, and promotes wound healing. Local application of tetracycline directly into the extraction socket may provide sustained antimicrobial and anti-inflammatory effects at the surgical site, thereby reducing postoperative pain without increasing systemic drug exposure.

Previous clinical studies have reported beneficial effects of locally applied tetracycline in reducing postoperative pain and improving socket healing following dental extractions. However, evidence from the local population remains limited. Differences in patient characteristics, surgical techniques, and healthcare settings necessitate evaluation of this intervention within the Pakistani population.

This study is designed as a prospective, parallel-group, randomized controlled trial conducted at the Department of Oral and Maxillofacial Surgery, CMH Lahore Medical College and Institute of Dentistry, Lahore. Seventy-four patients requiring surgical extraction of mandibular molars will be enrolled after providing written informed consent. Participants will be randomly allocated in a 1:1 ratio to either the intervention group or the control group.

Participants in the intervention group will receive 250 mg tetracycline mixed with 0.5 mL sterile saline and placed directly into the extraction socket before wound closure. Participants in the control group will undergo the same surgical procedure without placement of any intrasocket medicament. All surgical procedures will be performed by the same surgeon using a standardized surgical protocol. Postoperative management, including analgesics and oral hygiene instructions, will be identical for both groups.

The primary outcome is postoperative pain measured using the 10-point Visual Analog Scale (VAS) at 24 hours, 48 hours, and 7 days following surgery. Secondary analyses will compare pain scores between treatment groups over time while accounting for demographic and clinical variables.

The results of this trial will provide evidence regarding the effectiveness of intraoperative local tetracycline application as an adjunctive measure for postoperative pain control following mandibular molar extraction. If effective, this simple, inexpensive intervention may improve patient comfort, facilitate recovery, and potentially reduce reliance on systemic analgesic medications.

Inclusion criteria

Adults aged 18 to 60 years. Male and female participants. Patients requiring surgical extraction of a mandibular molar. American Society of Anesthesiologists (ASA) Physical Status I or II. Able and willing to provide written informed consent and comply with study follow-up.

Exclusion criteria

Pregnant or lactating women. Patients with systemic conditions that contraindicate oral surgery (e.g., uncontrolled diabetes mellitus or immunosuppressive disorders).

Current use of antibiotics or medications that may interfere with wound healing (e.g., anticoagulants or bisphosphonates).

Known allergy or hypersensitivity to tetracycline or related antibiotics. Requirement for simultaneous extraction of adjacent teeth. Presence of active oral infection, including pericoronitis, at the surgical site.

Severely compromised oral hygiene that may affect postoperative healing. Individuals who are unable to cooperate with the study procedures or attend follow-up visits because of physical or cognitive impairment.