Does antibiotic prophylaxis at implant placement decrease early implant failures? A Cochrane systematic review

School of Dentistry, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
European Journal of Oral Implantology (Impact Factor: 3.14). 06/2010; 3(2):101-10.
Source: PubMed


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 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.

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    • "In light of the fact that early implant failures may be attributed to a variety of aspects including host–parasite, surgical or even prosthetic factors, one implant loss in the present study of over 300 implants may have occurred entirely by chance, and hence, a preventive effect of the perisurgical antibiotic regimen may be highly questionable. Because implant survival (incorporation rate) is very high in today's clinical practice, most of the studies addressing this parameter in relation to perioperative antibiotic prophylaxis must be considered as underpowered (Esposito et al. 2010b). Only the meta-analysis of four underpowered studies (Abu-Ta'a Fig. 5. Mean VAS of swelling (Swelling -VAS) from Day 1 toDay 14. et al. 2008;Esposito et al. 2008Esposito et al. , 2010aAnitua et al. 2009) revealed a risk ratio of 0.4 (95% CI: 0.19–0.84) "
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    ABSTRACT: Objectives To determine the effect of various systemic antibiotic prophylaxis regimes on patient-reported outcomes and postsurgical complications in patients undergoing conventional implant installation. Material and methodsThree hundred and twenty-nine healthy adults in need of conventional implant installation were randomly assigned to one of four groups: (i) preoperatively 2g of amoxycillin 1h before surgery (positive control, PC), (ii) postoperatively 2g of amoxycillin immediately following surgery (test 1, T1), (iii) preoperatively 2g of amoxycillin 1h before and 500mg thrice daily on days 2 and 3 after surgery (test 2, T2), (iv) preoperatively 2g of placebo 1h before surgery (negative control, NC). Subjects were examined clinically by blinded examiners over 8weeks after implant installation. In addition, Visual Analogue Scales (VAS) for pain, swelling, bruising and bleeding were obtained over 14days. ANOVA was performed for the VAS. Chi-square tests were applied for postsurgical complications. ResultsAll VAS scores were low for all groups and decreased over time (P<0.001). There were no significant differences for the VAS scores between the various groups at any time point (P>0.05). There was only a significant difference in flap closure at week 4, where NC had 5% of the subjects not achieving complete wound closure compared to 0% for the three other groups (P=0.01), with no other significant differences for any postsurgical complications (P>0.05). Conclusion For standard single implant placement, prophylactic systemic antibiotics either before or after, or before and after the surgical procedure do not improve patient-reported outcomes or prevalence of postsurgical complications.
    No preview · Article · Jan 2013 · Clinical Oral Implants Research
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    • "This pharmacological regimen is based on clinical experience and indirect evidence. In implant dentistry, there is a trend that favor the use of prophylactic antibiotics to reduce infections [23] [24]. With regard to preop or postoperative corticosteroid therapy, a common consensus was reached regarding the use of corticosteroid but not on the dosage due to the heterogeneity of the pharmacological regimens utilized by the different experts. "
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    ABSTRACT: Introduction. Maxillary sinus surgery is a reliable and predictable treatment option for the prosthetic rehabilitation of the atrophic maxilla. Nevertheless, these interventions are not riskless of postoperative complications with respect to implant positioning in pristine bone. Aim. The aim of this paper is to report the results of a clinical consensus of experts (periodontists, implantologists, maxillofacial surgeons, ENT, and microbiology specialists) on several clinical questions and to give clinical recommendations on how to prevent, diagnose, and treat postoperative infections. Materials and Methods. A panel of experts in different fields of dentistry and medicine, after having reviewed the available literature on the topic and taking into account their long-standing clinical experience, gave their response to a series of clinical questions and reached a consensus. Results and Conclusion. The incidence of postop infections is relatively low (2%–5.6%). A multidisciplinary approach is advisable. A list of clinical recommendation are given.
    Full-text · Article · Aug 2012 · International Journal of Dentistry
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    ABSTRACT: Fecha de recibido: 8 de noviembre de 2011 Fecha de aprobación: 10 de enero de 2012 Palabras clave: implante dental; infección; control de infección dental; profilaxis antibiótica. Resumen Introducción. Persiste la controversia en cuanto a la superioridad de la profilaxis sobre el tratamiento antimicrobiano para evitar la infección posquirúrgica. Objetivo. Comparar el control de la infección bacteriana mediante el uso de profilaxis con el tratamiento antimicrobiano en pacientes sometidos a implantes. Materiales y métodos. Los pacientes de la muestra (n=30), con edades entre los 30 y los 70 años de edad, se asignaron aleatoriamente en dos grupos. Quince recibieron profilaxis de 2 g de amoxicilina 30 minutos antes de la cirugía y los restantes recibieron tratamiento de 500 mg de amoxicilina cada ocho horas por siete días. Se valoraron los signos de infección –dolor, rubor, tumefacción y exudación– a los 3, 8 y 15 días después del procedimiento. Una semana después se determinó el número de leucocitos, neutrófilos y linfocitos. Las variables categóricas se compararon mediante la prueba de ji al cuadrado y razón de verosimilitud. Los contrastes numéricos se valoraron mediante la prueba t de Student, según la validación de los supuestos de normalidad y homocedasticidad (α=0,05, en todos los casos). Resultados. La proporción de infección fue menor en el grupo de profilaxis que en el grupo de tratamiento. El grupo de profilaxis tuvo una menor proporción de signos y síntomas de infección (6,7 % Vs. 13,3 %), sin alcanzar significancia estadística (p=0,27). El promedio de la fracción de leucocitos, linfocitos y neutrófilos en el cuadro hemático, estuvo dentro del rango de normalidad en los dos grupos (p=0,79, p=0,91 y p=0,82, respectivamente). Conclusiones. La menor proporción de infección confirma los resultados previamente publicados, que sustentan la superioridad de la profilaxis antibiótica sobre el tratamiento antibiótico para prevenir las infecciones posquirúrgicas.
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