Effects of combined probiotics and antibiotics administration in impacted third molar surgery: a randomized controlled trial

The surgical extraction of impacted third molars is a standard procedure often accompanied by antibiotic administration to prevent postoperative infectious complications. However, systemic antibiotic therapy is associated with adverse effects, particularly gastrointestinal disturbances, and contributes to the growing concern of antibiotic resistance. Probiotics have been proposed as a potential adjunct to counteract these effects and improve treatment tolerability. This randomized controlled pilot study aimed to evaluate the impact of combining probiotics with antibiotics on postoperative outcomes in patients undergoing third molar extraction. Forty-two adult patients were enrolled and randomly assigned to one of four groups receiving either Amoxicillin, Amoxicillin/Clavulanic Acid, or the same antibiotics in combination with a probiotic formulation containing Bifidobacterium breve PRL2020. The final analysis included 32 patients who completed all phases of the study. Clinical and subjective data were collected through structured questionnaires administered preoperatively, 14 days, and 2 months postoperatively. Patients treated with the combined probiotic-antibiotic regimen reported significantly fewer gastrointestinal side effects, including nausea, diarrhea, and abdominal pain, than those receiving antibiotics alone. Urogenital symptoms, such as candidiasis and cystitis, were also absent in the probiotic groups. Fatigue was reported equally across all groups, with no statistically significant differences. At the two-month follow-up, most symptoms had resolved in all patients, although residual gastrointestinal and urogenital disturbances were more prevalent in those who had not received probiotics. These findings suggest that adding Bifidobacterium breve PRL2020 to standard antibiotic therapy may reduce antibiotic-associated side effects and enhance overall patient tolerance to postoperative treatment. The results support the consideration of integrated therapeutic protocols in clinical practice, particularly for patients with a history of dysbiosis or poor antibiotic tolerance.