Routine antibiotic prophylaxis and early implant failure: is there a link?

A systematic search was conducted across multiple databases (PubMed via MEDLINE, Cochrane Library, and Web of Science) up to October 1st, 2023. Manual screening of reference lists was performed, alongside searches in clinical trial registries to ensure comprehensive coverage.

Only randomized controlled trials (RCTs) that compared antibiotic prophylaxis with no antibiotics or placebo in systemically healthy individuals undergoing dental implant surgery were included. Studies with a high risk of bias, non-randomized studies, and those without a placebo or control group were excluded. Studies focusing on medically compromised patients or other implant techniques (such as mini-implants or immediate placement in sites with apical pathology) were also excluded.

Data extraction was carried out independently by two authors, with disagreements resolved through discussion among all review authors. The risk of bias for each included randomized controlled trial (RCT) was evaluated using the Cochrane Risk of Bias tool (RoB-2). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Meta-analyses were conducted using a random-effects model, and heterogeneity was checked with both the I² statistic and Q test.

A total of 1267 studies were initially identified, with seven randomized controlled trials (RCTs) ultimately meeting the inclusion criteria, comprising data from 1,859 participants and 3014 implants. Four studies were high quality, and three were of moderate quality. Meta-analyses of these studies showed no statistically significant association between the use of antibiotic prophylaxis and a reduction in early dental implant failure (RR: 0.66, 95% CI: 0.30-1.47). The number needed to treat (NNT) to prevent one implant failure was 143, indicating a limited effect of antibiotics in preventing early implant failure.

The study concluded that routine antibiotic prophylaxis does not significantly reduce the risk of early implant failure in medically fit patients. Given the very limited benefit and the concern of increasing antibiotic resistance, routine use of antibiotics in dental implant surgery should be avoided.