Title	A Regimen of Postoperative Antibiotics and Chlorhexidine Rinses Can Increase The Success Rate of Implant Osseointegration Following Ridge Preservation
Clinical Question	In patients undergoing implant placement following ridge preservation, does the use of post operative antibiotics and chlorhexidine rinse increase the success rate of implant osseointegration compared to no antibiotic/chlorhexidine use?
Clinical Bottom Line	Both pre- and postoperative antibiotics and chlorhexidine use increase the success rate of implant osseointegration following bone graft placement.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 14676756 Lindeboom/2003 20 patients undergoing a graft procedure Randomized Controlled Trial Key results None of the patients that received the 2 grams of pheneticillin one hour before surgery developed infection. In the patients receiving the placebo, two developed an infection in the receptor and donor sites and one in the donor site alone. All patients were prescribed postoperative analgesics and 0.2% chlorhexidine rinse. (P<.05) 24183737 El-Kholey/2014 80 patients undergoing implant placement Randomized Controlled Trial Key results Two groups received either a preoperative single dose of 1g amoxicillin and no postoperative administration. In the second group, the patients were given 1g of amoxicillin preoperative and then continued the regimen for 3 days postoperatively. The sites were evaluated at 3 days, 7 days, 12 days post operation for “pain, swelling, wound dehiscence, and pus formation.“ All patients were given 12% chlorhexidine rinse pre and post operatively for 5 days, as well as 500mg of paracetamol 4 times daily as needed. All implants integrated successfully and there was no statistically significant difference between pre and postoperative administration of antibiotics (p=1.0).
Evidence Search	"Dental Implants"[Mesh] AND "Anti-Bacterial Agents"[Mesh] (((((("Alveolar Ridge Augmentation*/methods"[MAJR]) AND "Anti-Bacterial Agents/therapeutic use"[MAJR]) AND "Bone Transplantation*/methods"[MAJR]) AND "Maxilla/surgery"[MeSH Terms]) AND "Penicillins"[MAJR]) AND "Surgical Wound Infection/prevention and control"[MeSH Terms]) AND "Antibiotic Prophylaxis"[MAJR]
Comments on The Evidence	Validity: The cited articles are both randomized control trials, one was double blind (Lindeboom, van den Akker), while the other (El-Kholey) was single blind. The groups were similar at the start and all were treated equally. Compliance was seen in the two studies as well as no recall bias. No funding bias was reported.
Applicability	The subjects are representative of the patient pool (variations in age and health) and the treatment options are easily attainable. The results were very promising, even though the sample sizes were small in scale, and at the very least laid the foundation for further research on the subject.
Specialty	(General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords	Antibiotics Chlorhexidine Implants Bone Graft
ID#	3080
Date of submission	04/05/2016
E-mail	grantmr@livemail.uthscsa.edu
Author	Michael Grant
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Kevin Gureckis, DMD
Faculty mentor e-mail	gureckis@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