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
PubMed ID Author / Year Patient Group Study type (level of evidence) 18545045 Resnik/2008 Adults indicated for dental implants and/or bone grafting procedures Practice Guideline Key results Antibiotic 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. 14676756 Lindeboom/2003 Adults (N=20) indicated for bone grafting prior to implant placement Randomized Controlled Trial Key results No 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	(General Dentistry) (Oral Surgery) (Periodontics)
Keywords	bone grafting; oral antibiotic prophylaxis
ID#	2804
Date of submission	02/17/2015
E-mail	SchweersBC@livemail.uthscsa.edu
Author	Brian Schweers
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Luis C. Yepes, DDS
Faculty mentor e-mail	yepes@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available