Antibiotic use at dental implant placement

Cochrane Oral Health Groups Trial Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID and EMBASE via OVID. Databases were searched with no language or date restrictions.

Two authors independently reviewed the titles and the abstracts for inclusion. Disagreements were resolved by discussion. If needed, a third author was consulted. Included were randomised clinical trials with a follow-up of at least three months which evaluated the use of prophylactic antibiotic compared to no antibiotic or a placebo and examined different antibiotics of different doses and durations in patients undergoing dental implant placement. The outcomes were implant failure (considered as implant mobility, removal of implant due to bone loss or infection) and prosthesis failure (prosthesis could not be placed).

Standard Cochrane methodology procedures were followed. Risk of bias was completed independently and in duplicate by two review authors. Results were expressed as risk ratios (RRs) using a random-effects model for dichotomous outcomes with 95% confidence intervals (CI). The statistical unit was the participant and not the prosthesis or implant. Heterogeneity including both clinical and methodological factors was investigated.

Six randomised clinical trials with 1162 participants were identified for the review. Three trials compared 2 g of preoperative amoxicillin versus placebo (927 participants). One trial compared 3 g of preoperative amoxicillin versus placebo (55 participants). Another trial compared 1 g of preoperative amoxicillin plus 500 mg four times a day for two days versus no antibiotic (80 participants). An additional trial compared four groups: (1) 2 g of preoperative amoxicillin; (2) 2 g of preoperative amoxicillin plus 1 g twice a day for seven days; (3) 1 g of postoperative amoxicillin twice a day for seven days and (4) no antibiotics (100 participants). The overall body of the evidence was considered moderate.The meta-analysis of the six trials showed a statistically significant higher number of implant failures in the group not receiving antibiotics, RR= 0.33 (95% CI; 0.16 to 0.67) P = 0.0002.The number needed to treat for one additional benefit outcome (NNTB) to prevent one person having an implant failure is 25 (95% CI; 14 to 100) based on an implant failure of 6% in participants not receiving antibiotics.There was borderline statistical significance for prosthesis failures (RR= 0.44 (95%CI; 0.19 to 1.00) with no statistically significant differences for infections or adverse events. No conclusive information for the different durations of antibiotics could be determined.

There is statistically significant evidence suggesting that a single dose of 2 g or 3 g of amoxicillin given orally is beneficial in reducing dental implant failure in ordinary conditions. No significant adverse events were reported. It is still unknown whether post-operative antibiotics are beneficial and which antibiotic is more effective.