Does antibiotic prophylaxis at implant placement decrease early implant failures? A Cochrane systematic review.
ABSTRACT CONFLICT-OF-INTEREST STATEMENT: Marco Esposito is the first author of two of the included studies; however, he was not involved in the quality assessment of these trials. This review is based on a Cochrane systematic review entitled 'Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications' published in The Cochrane Library (see http://www.cochrane.org for more information). Cochrane systematic reviews are regularly updated to include new research, and in response to comments and criticisms from readers. If you wish to comment on this review, please send your comments to the Cochrane website or to Marco Esposito. The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane Review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of the review authors, and are not necessarily shared by the Cochrane Collaboration.
To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the most effective.
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to 2 June 2010 for randomised controlled clinical trials (RCTs) with a follow-up of at least 3 months comparing the administration of various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.). Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Meta-analyses were conducted.
Four RCTs were identified: three comparing 2 g of preoperative amoxicillin versus placebo (927 patients) and the other comparing 1 g of preoperative amoxicillin plus 500 mg four times a day for 2 days versus no antibiotics (80 patients). The meta-analyses of the four trials showed a statistically significantly higher number of patients experiencing implant failures in the group not receiving antibiotics: risk ratio=0.40 (95% confidence interval (CI) 0.19 to 0.84). The number needed to treat (NNT) to prevent one patient having an implant failure is 33 (95% CI 17-100), based on a patient implant failure rate of 5% in patients not receiving antibiotics. The other outcomes were not statistically significant, and only two minor adverse events were recorded, one in the placebo group.
There is some evidence suggesting that 2 g of amoxicillin given orally 1 h preoperatively significantly reduce failures of dental implants placed in ordinary conditions. No significant adverse events were reported. It might be sensible to suggest the use of a single dose of 2 g prophylactic amoxicillin prior to dental implant placement. It is still unknown whether post-operative antibiotics are beneficial, and which is the most effective antibiotic.
- SourceAvailable from: Bedrettin Cem Sener06/2012: pages 67-114; , ISBN: 978-953-51-0609-8
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ABSTRACT: To compare the clinical and radiological outcomes of 1- versus 2-stage implant placement. Forty-seven patients were randomly allocated to 1- or 2-stage treatment groups immediately after implant placement. Twenty-nine patients received 38 1-stage early loaded implants and 18 patients received 51 2-stage early loaded implants. Outcome measures were failures of implants and/or prosthesis, complications, pain score, amount of analgesic consumption and periimplant bone level changes at implant loading (12 weeks) and at the 1-year follow-up. After 1 year, no dropout occurred. In the 1-stage group, 2 implants (1 patient) failed to osseointegrate and the implant-supported prosthesis could not be placed, versus none in the 2-stage group. Two complications were reported in the 1-stage group versus only one in the 2-stage group. Pain score measurements, analgesic consumption and peri-implant bone level did not show any significant difference between the two groups. All patients would undergo the same procedures again. The submerged technique is not a prerequisite for osseointegration, though 1-stage implant placement might be at a slightly higher risk for early failures.European Journal of Oral Implantology 01/2011; 4(1):13-20. · 2.57 Impact Factor
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ABSTRACT: In oral implantology, there is no consensus on the most appropriate regimen for antibiotics prescribing, the decision to prescribe antibiotic is usually based on procedure, patient and clinician related factors. The aim of this study was to investigate the rationale of antibiotic prescribing among Jordanian clinicians who practice oral implantology. The target sample for the study was the 250 Jordan Dental Implant Group members. A five page questionnaire contained 41 questions, both closed and open questions were used to collect data. Statistical analysis was performed using SPSS Windows 16.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were generated.The response rate was (70.4%) 176/250. Mean age was 37.2 yrs, 49.4% always prescribe antibiotics mainly oral amoxicillin and amoxicillin with clavulinic acid. Antibiotics prescribing increased with flap raising, multiple implants and sinus or bone augmentation. Patient medical condition, periodontitis and oral hygiene were the most important clinical factors in antibiotic prescribing, non-clinical factors were; reading scientific materials, courses and lectures, knowledge gained during training, and the effectiveness and previous experience with the drug. Wide variations in antibiotics types, routes, dose and duration of administration were found. Recommendations on antibiotic prescribing are needed to prevent antibiotic overprescribing and misuse.BMC Research Notes 01/2011; 4:266.