28 July 2020

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Antibiotic prophylaxis in implant surgery, is it necessary?

Giulia Palandrani

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There is still no accordance on the antibiotic prophylaxis regimen to prevent failures or postoperative infections in healthy patients undergoing standard implant surgery.

Some authors proposed single-dose administration preoperatively; others suggested the preoperative dose, followed by postoperative administration twice a day; others suggested only postoperative administration. 

Considering the growing problem of antimicrobial resistance with progressive loss of antibiotic efficacy and the increasing number of dental implants placed every year, it is mandatory to identify a common strategy on antibiotic prescription. 

The aim of the present systematic review was to evaluate if an antibiotic prophylaxis regimen reduces early implant failure and postoperative infection in healthy patients undergoing implant surgery. 

Materials and methods
An electronic database search (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library) until June 30, 2019 was performed. Studies were included if the following inclusion criteria were met: Randomized clinical trials (RCTs).
At least 20 patients included
Antibiotic therapy clearly described 

The following studies were also excluded: 

• Studies on mini-implants and/or orthodontic mini screws 

• Studies without a placebo or “no-antibiotic” group 

• Studies including patients for whom prophylaxis was prescribed due to their medical history (eg, endocarditis)

• Studies investigating local  antibiotic therapy 

Results
A total of nine studies including 1,984 patients and 3,588 implants were selected: 885 patients (1,617 implants) received no antibiotics or placebo therapy before the implant surgery; 1,099 patients (1,971 implants) were placed with an antibiotic therapy.
Different antibiotic prophylactic therapies were applied:
- Placebo or no antibiotic ;
- 3 g amoxicillin before surgery;
- 2 g amoxicillin or 600 mg clindamycin before surgery;
- 2 g amoxicillin postsurgery;
- 2 g amoxicillin before surgery and 1 × 2 × 7 postsurgery;
- Amoxicillin 1×2×7 postsurgery 

The most used was 2 gr of amoxicillin before surgery (791 patients and 1,533 implants). 

A meta-analysisand a trial sequential analysis (TSA) were performed for the outcome early implant failure at both implant level and patient level.
The percentage of implant failure was 1.82 and 7.24 at the patient level in the antibiotics and no-antibiotics groups, respectively. The percentage of implant failure was 1.22 and 4.19 at the implant level in the antibiotics and no-antibiotics groups, respectively. 

Seventy-one implants failed in 46 patients in the placebo/ no-antibiotic groups, and 23 implants failed in 20 patients in the 2 g of amoxicillin before implant surgery. Zero failures were detected in the other groups.

Conclusions
This systematic review and meta-analysis indicates that an antibiotic prophylaxis  administered before or after the surgery prevents early implant failures in healthy patients. No information can be provided on peri-implant infections. Limitations of the present study are represented by the high heterogeneity of the included studies and different antibiotic protocols used.

For additional information: The Use of Antibiotics in Implant Therapy: A Systematic Review and Meta-Analysis with Trial Sequential Analysis on Early Implant Failure.