With the increasing popularity of dental implants and the difficulties of managing infections around them it is important to know whether the use of prophylactic antibiotics is beneficial or not.
This review is an update of a Cochrane review originally published in 2008 and last updated in 2010. The aim of the review was to assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic or placebo administration and, if antibiotics are beneficial, to determine which type, dosage and duration is the most effective.
Searches were conducted in Cochrane Oral Health Group’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase with no restrictions. Randomised controlled trials that compares various prophylactic regimens to no antibiotics with at least 3 months follow up were included. The usually Cochrane Collaboration methodological approaches were used.
- Six trials with 1162 participants were included.
- Three trials were considered to be at low risk of bias and three at high risk of bias.
- While there were variations in the dosage regimens all the included trials used amoxicillin.
- Meta-analyses of the six trials showed a statistically significant higher number of participants experiencing implant failures in the group not receiving antibiotics (RR 0.33; 95% CI 0.16 to 0.67, P value 0.002)
- The number needed to treat to prevent one person having an implant failure is 25 (95% CI, 14 to 100), based on an implant failure rate of 6% in participants not receiving antibiotics
- There was borderline statistical significance for prosthesis failures (RR 0.44; 95% CI 0.19 to 1.00),
- No statistically significant differences for infections (RR 0.69; 95% CI 0.36 to 1.35), or adverse events (RR 1; 95% CI 0.06 to 15.85) (only two minor adverse events were recorded, one in the placebo group).
The authors 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.
Comment
This latest update of the review included two additional trials. One of these we highlighted previously (Dental Elf 26th Feb 2013). Earlier that month (Dental Elf 13th Feb 2013) we had highlighted another study that suggested that antibiotics did not have a positive effect. This study was excluded from the update, as the follow-up period was too short at just 8 weeks, although it is included in the discussion. The overall quality of the evidence was graded as moderate. This means that further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Links
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.
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