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Title Antibiotic Prophylaxis with Bone Grafting Procedures Reduces Risk of Postoperative Complications
Clinical Question In patients indicated for bone grafting, does oral antibiotic prophylaxis decrease risk of postoperative complications, including infections?
Clinical Bottom Line Antibiotic prophylaxis decreases the risk of postoperative complications including infection following a bone grafting or implant procedure, but various situational factors must be taken into account.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18545045Resnik/2008Adults indicated for dental implants and/or bone grafting proceduresPractice Guideline
Key resultsAntibiotic prophylaxis prior to dental implant and bone grafting procedures reduces post-operative complications but various clinical and patient factors must be taken into special consideration. Amoxicillin is suggested to be considered first due to its cost and antimicrobial activity towards the oral flora. Cephalexin and clindamycin should be considered as alternatives.
#2) 14676756Lindeboom/2003Adults (N=20) indicated for bone grafting prior to implant placementRandomized Controlled Trial
Key resultsNo infections were seen in the pheneticillin group. Five out of 10 patients who received the placebo developed an infection at the donor and/or receptor site.
Evidence Search prophylactic[All Fields] AND ("anti-bacterial agents"[Pharmacological Action] OR "anti-bacterial agents"[MeSH Terms] OR ("anti-bacterial"[All Fields] AND "agents"[All Fields]) OR "anti-bacterial agents"[All Fields] OR "antibiotic"[All Fields]) AND dental[All Fields] AND ("wound infection"[MeSH Terms] OR ("wound"[All Fields] AND "infection"[All Fields]) OR "wound infection"[All Fields] OR ("wound"[All Fields] AND "infections"[All Fields]) OR "wound infections"[All Fields]) Additional search criteria: ("bone transplantation"[MeSH Terms] OR ("bone"[All Fields] AND "transplantation"[All Fields]) OR "bone transplantation"[All Fields] OR ("bone"[All Fields] AND "grafting"[All Fields]) OR "bone grafting"[All Fields]) AND ("mouth"[MeSH Terms] OR "mouth"[All Fields] OR "oral"[All Fields]) AND ("antibiotic prophylaxis"[MeSH Terms] OR ("antibiotic"[All Fields] AND "prophylaxis"[All Fields]) OR "antibiotic prophylaxis"[All Fields])
Comments on
The Evidence
Validity: The practice guidelines in the Resnik 2008 article did not specifically mention the search criteria used for the supporting data but did have a multitude of studies which showed reasonable conclusions and did not have any competing interests. The Lindeboom 2003 study was double-blinded, had similar groups at the start who were treated in the same manner, had adequate follow up with acceptable compliance, greater than 80% completion rates, and recall bias was nonapplicable. Competing interests were not specifically stated but are unlikely. Perspective: Prescribing antibiotics could lead to the development of antibiotic resistant bacteria, secondary infections, toxicity of antibiotics, and adverse reactions. Adverse reactions only occur in a small (6%-7%) number of cases, of which >99.9% are not life threatening. From the 2003 randomized clinical trial, further studies of a larger sample size would be beneficial to evaluate the conclusions drawn. The Lindeboom 2003 study also did not have the ideal surgical technique of drilling into the recipient graft site to promote healing/integration. The benefits of using antibiotics prophylactically include improving the patient’s health and decreasing complications, including infection, thus enhancing the preservation of bone for implant placement. These guidelines should be a starting point because each case requires special consideration. The recommended dosage and class of antibiotic would benefit further by studies to evaluate the most effective antibiotic with lowest risk of negative effects to the patient.
Applicability With the potential for decreased postoperative complications outweighing the potential harm to the patient, it is reasonable to highly consider providing oral prophylactic antibiotics to bone graft patients if appropriate considerations are taken into account. Amoxicillin is suggested to be considered first due to its cost and antimicrobial activity towards the oral flora. Cephalexin and clindamycin should be considered as alternatives if the patient has an allergy to penicillin. Considerations of local, systemic, surgical, and procedural factors need to be taken into account for dosage and timing of antibiotics. The subjects in the Lindeboom 2003 study were seen preoperatively and regularly postoperatively by a dental hygienist to ensure adequate oral hygiene. Patients also received postoperative analgesics and 0.2% chlorhexidine mouth rinses three times a day prescribed.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords bone grafting; oral antibiotic prophylaxis
ID# 2804
Date of submission: 02/17/2015spacer
E-mail SchweersBC@livemail.uthscsa.edu
Author Brian Schweers
Co-author(s) e-mail
Faculty mentor/Co-author Luis C. Yepes, DDS
Faculty mentor/Co-author e-mail yepes@uthscsa.edu
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