Title Effect of Postoperative Amoxicillin on Dental Implant Failure Rates Remains Unknown
Clinical Question For patients receiving dental implants, does the use of preoperative and postoperative amoxicillin reduce implant failure rates compared to the use of preoperative amoxicillin alone?
Clinical Bottom Line There is insufficient evidence to suggest that the use of postoperative amoxicillin reduces dental implant failure rates when used in conjunction with prophylactic amoxicillin.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25040894Chrcanovic/201414 studies/14,872 implantsMeta-Analysis
Key resultsAntibiotic prophylaxis in healthy patients significantly reduced the risk of implant failure by 45% (RR = 0.55, p = 0.0002, 95% CI 0.41-0.75). The number of patients receiving preoperative antibiotics (NNT) to prevent one implant failure was 50 (95% CI 33-100). Only four studies clearly reported the use of pre- and postoperative amoxicillin, but the effect of postoperative amoxicillin on implant failure was not specifically addressed in this meta-analysis.
23904048Esposito/20136 RCTs/1,162 participantsMeta-Analysis
Key resultsThe prophylactic use of antibiotics in healthy patients significantly reduced the risk of implant failure rates (RR = 0.33, p = 0.002, 95% CI 0.16-0.67). The number of patients receiving preoperative antibiotics for one other beneficial outcome (NNTB) to prevent one implant failure was 25 (95% CI 14-100). Two studies employed pre- and postoperative amoxicillin, but the specific effect of postoperative amoxicillin on implant failure was not considered in this meta-analysis.
26021225Arduino/2015360 participants/567 implantsRandomized Controlled Trial
Key resultsNo significant differences in implant failure rates were observed between participants who did and did not receive postoperative amoxicillin. Five patients in both treatment groups had implant failures by six months post-loading (p = 1.0000, 95% CI -0.0384-0.0438).
Evidence Search "Antibiotic Prophylaxis" OR “Postoperative Antibiotic” OR “Amoxicillin” [All Fields] AND "Dental Implant" OR “Dental Implant Failure” [All Fields]
Comments on
The Evidence
Both meta-analyses reinforce previously described benefits of the prophylactic use of antibiotics on implant survival without major adverse effects. Four unique RCTs that used pre- and postoperative amoxicillin were collectively identified. Because implant failure was followed up to six months among these trials and the Arduino et al. (2015) study, the implant failure rate is likely underestimated. Chrcanovic et al. (2014) examined RCTs, CCTs and retrospective studies in their meta-analysis and reported several patient- and treatment-related confounding factors. Its broad eligibility criteria helped surface clinically relevant articles in an area of limited study. Esposito et al. (2013) compared RCTs exclusively. Interestingly, Esposito et al. (2013) considered two studies (Caiazzo, 2011 and Abu-Ta’a, 2008) at high risk of bias that Chrcanovic et al. (2014) did not. Large sample sizes and thorough quality assessments can be appreciated in both meta-analyses. Arduino et al. (2015) used an inadequate sample size and lacked measures of quality assessment. This study also reported adverse events exclusively in the test group that received postoperative amoxicillin. There was also no standardization in postoperative amoxicillin dosing and duration among the studies included. This evidence does not support the adjunctive use of postoperative amoxicillin to reduce dental implant failure rates. Further investigation is required before recommending the use of amoxicillin after dental implant placement.
Applicability These findings are applicable to any provider who places dental implants. However, study patients were healthy and do not adequately represent those with systemic complications commonly treated in clinic. Obtaining a detailed medical history for each patient is therefore important. Clinicians should evaluate cost, patient compliance, and risks of antimicrobial resistance, anaphylaxis and other adverse events before prescribing antibiotics. Currently, the effect of postoperative amoxicillin on dental implant failure rates remains unknown.
Specialty (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Antibiotics, Amoxicillin, Prophylaxis, Postoperative, Implant, Implant Failure
ID# 3276
Date of submission 12/11/2017
E-mail saltz@uthscsa.edu
Author Adam Saltz, DMD, MPH
Co-author(s) e-mail
Faculty mentor
Faculty mentor e-mail
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
None available