Dental Implants are now widely used to replace missing teeth. Some dental implant losses a may be due to infection at insertion. Consequently, a range of antibiotic regimes have been suggested, although in general antibiotics should be reserved for those patients at great risk, if the surgery is in an infected site, is extensive and prolonged.

The aim of this review was to investigate whether there are any positive effects of prophylactic antibiotic regimen on implant failure rates and post-operative infection when performing dental implant treatment in healthy individuals

Methods

Searches were conducted in PubMed, Web of Science, and the Cochrane Oral Health Group Trials Register This was supplemented by a hand search of dental implant related journals. Human clinical studies that compared implant failure/survival rates in any group of patients receiving versus not receiving antibiotic prophylactic regimen for the placement of implants were considered. For this review implant failure was defined as the complete loss of the implant.  Study quality was assessed.

Results

• 14 studies were included (8 randomised controlled trials [RCTs], 4, Controlled clinical trials [CCTs] and two retrospective studies)
• 7 studies were considered to be a high risk of bias, 1 at moderate risk and 6 at low risk.
• Meta-analysis found a significant lower risk of failure in the antibiotic group, RR of 0·55 (95% CI 0·41-0·75) (P = 0·0002).
• The number needed to treat (NNT) to prevent one patient having an implant failure was 50 (95% CI 33-100).
• There were no apparent significant effects of prophylactic antibiotics on the occurrence of post-operative infections in healthy patients receiving implants (P = 0·520).
• A sensitivity analysis did not reveal difference when studies judged as having high risk of bias were not considered

Conclusions

The authors concluded

There is evidence suggesting that a prophylactic antibiotic regimen significantly reduces failures of dental implants placed in ordinary conditions. However, there were no apparent significant effects of prophylactic antibiotics on the occurrence of post-operative infections in healthy patients receiving implants.

Commentary

The questions address by this review was also the topic of the 2013 Cochrane review by Esposito et al. While this review included controlled trials and retrospective studies the Cochrane review was typically restricted to RCTs . The findings of both reviews are similar in that antibiotics seem successful at reducing early failure of implants. The Cochrane review concluded:-

Scientific evidence suggests that, in general, antibiotics are beneficial for reducing failure of dental implants placed in ordinary conditions. Specifically 2 g or 3 g of amoxicillin given orally, as a single administration, one hour preoperatively significantly reduces failure of dental implants. No significant adverse events were reported. It might be sensible to suggest the use of a single dose of 2 g prophylactic amoxicillin prior to dental implant placement. It is still unknown whether postoperative antibiotics are beneficial, and which antibiotic is the most effective.

Links

Chrcanovic BR, Albrektsson T, Wennerberg A. Prophylactic antibiotic regimen and dental implant failure: a meta-analysis. J Oral Rehabil. 2014 Jul 8. doi: 10.1111/joor.12211. [Epub ahead of print] PubMed PMID: 25040894.

Esposito M, Grusovin MG, Worthington HV. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD004152. DOI: 10.1002/14651858.CD004152.pub4.

Dental Elf – 2^nd Aug- 2013- Review suggests that antibiotics are beneficial for reducing failure of dental implants