Preoperative antibiotics may decrease dental implant failure

Assorted pills

The aim of this review was to assess whether patients undergoing dental implants who receive peri-operative antibiotics have lower failure rather than those not who do not receive antibiotics.

The authors searched medline  for studies in English with test and control groups . Antibiotic use was classified as a single preoperative dose, a single preoperative dose and multiday postoperative therapy, and no antibiotic therapy. The primary and secondary outcome variables were  implant failure and postoperative infection. Case series and case reports were excluded as were studies reporting growth factor use at the implant sites.

Eight studies met the inclusion criteria, 3 randomized controlled trails, 3 prospective cohort and 2 retrospective cohorts.

  •  Two studies assessed the effect of a single preoperative antibiotic dose and reported a reduction in implant failure by 1.3% to 2% compared with no antibiotics use.
  • Two studies compared the effect of pre- and postoperative antibiotics and noantibiotic use and found a 4.2% decrease to 1.1% increase in the failure rates when antibiotics were used.
  • Four studies considered the effect of different antibiotic regimens. Only 2 studies found a statistically significant reduction in implant failure (2.5% to 5.4%) when a single preoperative antibiotic dose was used in conjunction with multiday treatment, compared with postoperative multiday treatment only.
  • Four studies analyzed the rate of postoperative infection, which was 0.6% to 3% when no antibiotics were used, 0.6% when preoperative antibiotics alone were used, and 0.8% to 1% when preoperative and postoperative antibiotics were given.

The authors concluded:-

A single dose of preoperative antibiotic therapy may slightly decrease the failure rate of dental implants. However, the current data do not support the routine use of postoperative antibiotics, which can be tailored by the clinician to the patient’s specific needs.

Sharaf B, Jandali-Rifai M, Susarla SM, Dodson TB. Do perioperative antibiotics decrease implant failure? J Oral Maxillofac Surg. 2011 Sep;69(9):2345-50. Epub 2011 Jun 15. Review. PubMed PMID: 21676512.

Comment

This review only used a single database so may not have identified all the relevant studies a Cochrane Review which was last updated in 2010 is available.

Esposito M, Worthington HV, Loli V, Coulthard P, Grusovin MG. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. Cochrane Database Syst Rev. 2010 Jul 7;(7):CD004152. Review.PubMed PMID: 20614437.

The Cochrane Review concluded:-

 There is some evidence suggesting that 2 g of amoxicillin given orally 1 hour preoperatively significantly reduce failures of dental implants placed in ordinary conditions. 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 is the most effective antibiotic.

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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