Background: Prophylactic antibiotic prescription following dental extraction remains common despite growing global concern regarding antimicrobial resistance and uncertainty regarding clinical benefit. Contemporary randomized controlled trials (RCT) provide an opportunity to reassess this practice under modern clinical conditions. Objective: To evaluate RCTs published between 2016 and 2025 assessing the effectiveness of prophylactic systemic antibiotics in preventing postoperative complications following dental extraction. Methods: A systematic review restricted to RCTs was conducted using data extracted from the PubMed and Scopus databases. Eligible studies included healthy patients undergoing dental extraction, comparing prophylactic antibiotics with placebo or no antibiotic therapy. Outcomes assessed included postoperative infection, alveolar osteitis, wound healing, postoperative morbidity, and adverse effects. Evidence synthesis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and Consolidated Standards of Reporting Trials (CONSORT) methodological guidance. Results: Nine RCTs involving 3,059 participants were included. Infection rates following routine dental extraction were consistently low across all studies. Most trials demonstrated no statistically significant reduction in postoperative infection or alveolar osteitis with antibiotic administration. The largest triple-blind RCT reported absence of major infections irrespective of antibiotic use. Antibiotic-related adverse effects occurred more frequently among intervention groups. Conclusion: Randomized evidence published between 2016 and 2025 does not support routine prophylactic antibiotic administration following uncomplicated dental extraction in healthy individuals. Selective prescribing consistent with antimicrobial stewardship principles is recommended.