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Title Evidence Suggests Preoperative Antibiotic Use Reduces Dental Implant Failures
Clinical Question For a patient requiring implant placement, does the use of preoperative antibiotics decrease the likelihood of implant failure as opposed to not using any antibiotics?
Clinical Bottom Line Routine use of a single preoperative antibiotic dose 1 hour before the procedure can reduce early implant failures; however, no significant benefit was found in giving any postoperative antibiotics.
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) 20614437Eposito/2010 Patients undergoing dental implant treatmentMeta-Analysis
Key resultsMeta-analysis reveals patients that received short-term antibiotics experienced fewer implant failures than groups that did not receive antibiotics. The RR = 0.40, with a 95% CI of 0.19 to 0.84, and thus is statistically significant. NNT calculates that number of patients given antibiotics to prevent 1 implant failure is 33 (95% CI 17 to 100).
#2) 21676512Sharaf/2011Patients undergoing dental implant treatmentSystematic Review
Key resultsGroups receiving single preoperative antibiotic dose as opposed to no antibiotics had an absolute risk reduction (ARR) of 3.8% (P=.06) and 2.7% (P=.09), with NTT of 27 and 37.Groups that receive perioperative (pre op and post op) antibiotics had an ARR 1.6% (P = >0.5) (using single post op dose instead of multi-dose) and 4.2% (P = .025) (using multi-dose instead of no treatment), with an NNT of 62 and 24. Groups receiving perioperative antibiotics as compared to post operative antibiotics showed a ARR of 2.5% (P=.001) and 5.4% (P<.05), with NNT of 40 and 19. Two studies reported an ARI associated with using perioperative antibiotics as opposed to just preoperative or no antibiotics. These were not statistically significant (P = .56 and P = .427).
Evidence Search "Antibiotic Prophylaxis"[Mesh] AND "Dental Implants"[Mesh]
Comments on
The Evidence
The review done by Eposito has high level of validity. It used 4 RCTs covering 1007 patients, and took steps to do comprehensive trial search and to assess for study validity. A meta-analysis was done that revealed statistically and clinically significant results. The review done by Sharaf has more questionable validity. RCTs, prospective, and retrospective studies were included, which bring in potential biases and confounding factors. Though a comprehensive search was done for these trials, it is hard to tell if they have been assessed for validity. 8 trials in all with 3766 patients were used, but no meta-analysis was done, and many of the trials had P values above .05, indicating they are not statistically significant. There also appeared to be an error, where they have mixed up % failures in one of the trials.
Applicability These studies are representative of uncomplicated implant patients in clinic, and antibiotic treatment is very feasible. There are no significant adverse events reported or differences in infection levels, and the benefits include a possible reduction in implant failures. Discussion is needed with patients concerning antibiotic resistance, however, these studies have shown a single preoperative antibiotic dose is not associated with increased antibiotic resistant bacteria.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Mini dental implants Prophylaxis Oral surgery Implantology Implant outcomes Implant Implantology Oral implantology
ID# 2211
Date of submission: 04/05/2012spacer
E-mail cleggs@livemail.uthscsa.edu
Author Sarah Lee Clegg
Co-author(s) e-mail
Faculty mentor/Co-author Gregory Spackman, DDS, MBA
Faculty mentor/Co-author e-mail spackman@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?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Analyssa Dominguez & Shanna Rafford (San Antonio) on 11/28/2017
A PubMed search conducted in November 2017 found two more recent systematic reviews. In Esposito/2013 PMID: 23904048) evidence that was gathered from 6 RCTs, including 1162 participants, supports the conclusion of this CAT. More specifically it was determined that 2 g or 3 g of amoxicillin given orally, as a single administration, 1 hour preoperatively significantly reduces failure of dental implants. A second systematic review, Lund/2015 (PMID: 26080862), which identified 846 papers, 10 of which were primary studies and 7 that were systematic reviews, determined that antibiotic prophylaxis in conjunction with implant placement reduced the risk for implant loss by 2%. Although this supports the conclusion of this CAT, it was determined that there was no benefit of antibiotic prophylaxis in uncomplicated implant surgery in healthy patients.

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