Background: The prevention of post-operative infection following periodontal surgery is often the basis for antibiotic prescription. The inherent risks of unwarranted antibiotic use and lack of guidelines for procedures involving bone grafts create additional difficulties in decision making for practitioners. This study aims to evaluate practitioners' self-reported practices in antibiotic prescribing for periodontal surgeries with and without bone grafting.

Methods: A 15-question anonymous survey using Qualtrics software was distributed to California periodontists via email. The survey included questions about prescribing practices for specific periodontal procedures, rationale questions for choosing to prescribe or not to prescribe antibiotics, demographic and dental practice information. Results were analyzed using McNemar tests and logistic regression.

Results: 100 practitioners responded to the survey. Practitioners were significantly less likely to report prescribing antibiotics for traditional periodontal surgeries involving no bone grafting compared to socket preservation, guided tissue regeneration (GTR), guided bone regeneration (GBR) and sinus augmentation (p<0.0001). Practitioners were significantly more likely to report prescribing antibiotics with more complex procedures involving bone grafting, such as GBR and sinus augmentation, when compared to socket preservation (p<0.0001). Seventy-five percent of practitioners responded that they would follow guidelines for antibiotic prescription with bone

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grafting procedures if they were developed and endorsed by the American Academy of Periodontology.

Conclusions: Practitioners are more likely to prescribe antibiotics when a bone graft is used and as the complexity of the bone-graft procedure increases. Based on these results and the willingness of practitioners to adopt evidence-based guidelines, the establishment of guidelines for practitioners on the appropriate use of antibiotics would be of benefit to the periodontal practicing community.