Antibiotic prophylaxis may not be indicated for prevention of dental implant infections in healthy patients. A systematic review and meta-analysis
- 460 Downloads
The purpose of the present systematic review and meta-analysis is to determine the efficacy of antibiotic prophylaxis and specific antibiotic regimens in dental implant placement for prevention of post-operative infection (POI) in overall healthy patients.
Materials and methods
Electronic database and manual searches were independently conducted to identify randomized controlled trials (RCTs). Publications were selected on basis of eligibility criteria and then assessed for risk-of-bias using the Cochrane Handbook. The primary outcome was POI (total, early, and late). Wound dehiscence, pain, and adverse events were studied as secondary outcomes. Random-effects meta-analysis was conducted for risk ratios of dichotomous data. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.
With duplicates removed, 1022 abstracts were screened and 22 full-text articles assessed; 10 RCTs of 1934 total patients were included. Meta-analysis did not detect statistically significant differences in total (P = 0.82), early (1–2 week post-op) (P = 0.57), or late (3–4 months post-op) (P = 0.66) POIs, wound dehiscence (P = 0.31), and adverse events (P = 0.21), between antibiotic and no-antibiotic groups. Confounding variables identified.
The results of this systematic review suggest that antibiotic prophylaxis may not be indicated for prevention of POIs following dental implant placement in overall healthy patients. These findings and in light of antibiotic-associated risks for individual and public health demand revaluation of routine prescription of antibiotic prophylaxis in dental implant placement procedures.
It is up to the clinicians to evaluate the benefits (or lack thereof) of antibiotic prophylaxis for each patient given medical history and surgical complexity, until new evidence becomes available.
KeywordsAmoxicillin Antibiotic prophylaxis Complications Dental implants Post-operative infection
We are grateful to Mr. Richard McGowan (NYU Health Sciences Library liaison to the NYU Dentistry) for his assistance with the electronic database search process.
Our appreciation extends to Dr. Analia Vietz-Keenan (NYU Dentistry Department of Oral and Maxillofacial Pathology, Radiology, & Medicine) and Dr. Malvin N. Janal (NYU Dentistry Department of Epidemiology and Health Promotion) for sharing with us their expert opinions on evidence based dentistry and statistical analyses of results.
We thank fellow researchers, Dr. Eduardo Anitua, Dr. Alfonso Caiazzo, Dr. Khalid E. El-Kholey, Dr. Marco Esposito, and Dr. Ioannis Polyzois (Nolan 2012 group), for kindly providing clarification with regard to study design and/or results.
I. Khouly and R. S. Braun contributed to study conception and design, acquisition of data, analysis and interpretation, and drafted the manuscript. L. Chambrone contributed to study analysis, interpretation of data, and critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of the work.
This systematic review received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
The authors of this paper declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors. Ethical approval is not required.
For this type of study, formal consent is not required.
- 1.Peterson LJ (1990) Antibiotic prophylaxis against wound infections in oral and maxillofacial surgery. J Oral Maxillofac Surg 48(6):617–620Google Scholar
- 2.Burke JF (1961) The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery 50:161–168Google Scholar
- 3.Woods RK, Dellinger EP (1998) Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 57(11):2731–2740Google Scholar
- 4.Olson M, O'Connor M, Schwartz ML (1984) Surgical wound infections. A 5-year prospective study of 20,193 wounds at the Minneapolis VA Medical Center. Ann Surg 199(3):253–259Google Scholar
- 5.Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH (1993) Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg (Chicago, Ill : 1960) 128(1):79–88Google Scholar
- 6.Esposito M, Grusovin MG, Worthington HV (2013) Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. The Cochrane database of systematic reviews (7):Cd004152. doi: https://doi.org/10.1002/14651858.CD004152.pub4
- 13.Park J, Tennant M, Walsh L, Kruger E (2018) Is there a consensus on antibiotic usage for dental implant placement in healthy patients? Aust Dent J 63(1):25–33Google Scholar
- 15.Termine N, Panzarella V, Ciavarella D, Lo Muzio L, D'Angelo M, Sardella A, Compilato D, Campisi G (2009) Antibiotic prophylaxis in dentistry and oral surgery: use and misuse. Int Dent J 59(5):263–270Google Scholar
- 19.Quirynen M, De Soete M, van Steenberghe D (2002) Infectious risks for oral implants: a review of the literature. Clin Oral Implants Res 13(1):1–19Google Scholar
- 20.Shehab N, Patel PR, Srinivasan A, Budnitz DS (2008) Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis 47(6):735–743Google Scholar
- 21.Ziment I, Barrett VD, Beall GN, Glassock RJ, Locks MO, Lubran M, Nelson JR, Reisner RM, Tanaka KR (1972) Complications of antibiotic therapy. Paper presented at the Teaching Conference in Infectious Diseases, University of California, Los Angeles. Harbor General Hospital, Torrance, November 1972Google Scholar
- 22.Viola M, Quaratino D, Gaeta F, Valluzzi RL, Caruso C, Rumi G, Romano A (2005) Allergic reactions to antibiotics, mainly betalactams: facts and controversies. Eur Ann Allergy Clin Immunol 37(6):223–229Google Scholar
- 23.New HC (1979) Prophylaxis—has it at last come of age? J Antimicrob Chemother 5(4):331Google Scholar
- 24.Andersson DI, Hughes D (2011) Persistence of antibiotic resistance in bacterial populations. FEMS Microbiol Rev 35(5):901–911Google Scholar
- 28.Arason VA, Kristinsson KG, Sigurdsson JA, Stefansdottir G, Molstad S, Gudmundsson S (1996) Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study. BMJ (Clinical research ed) 313(7054):387–391Google Scholar
- 30.Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm : AJHP 70(3):195–283. https://doi.org/10.2146/ajhp120568 Google Scholar
- 32.WHO (2014) Antimicrobial resistance: global report on surveillance. http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf?ua=1
- 33.Tan WC, Ong M, Han J, Mattheos N, Pjetursson BE, Tsai AY-M, Sanz I, Wong MCM, Lang NP, on Behalf of the ITIASG (2014) Effect of systemic antibiotics on clinical and patient-reported outcomes of implant therapy—a multicenter randomized controlled clinical trial. Clin Oral Implants Res 25(2):185–193. https://doi.org/10.1111/clr.12098 Google Scholar
- 34.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clinical research ed) 339:b2700. https://doi.org/10.1136/bmj.b2700 Google Scholar
- 36.Higgins JP (2011) Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. wwwcochrane-handbookorgGoogle Scholar
- 37.Alsaadi G, Quirynen M, Michiles K, Teughels W, Komarek A, van Steenberghe D (2008) Impact of local and systemic factors on the incidence of failures up to abutment connection with modified surface oral implants. J Clin Periodontol 35(1):51–57. https://doi.org/10.1111/j.1600-051X.2007.01165.x Google Scholar
- 38.Dent CD, Olson JW, Farish SE, Bellome J, Casino AJ, Morris HF, Ochi S (1997) The influence of preoperative antibiotics on success of endosseous implants up to and including stage II surgery: a study of 2,641 implants. J Oral Maxillofac Surg 55(12 Suppl 5):19–24Google Scholar
- 40.Escalante MG, Eubank TD, Leblebicioglu B, Walters JD (2015) Comparison of azithromycin and amoxicillin before dental implant placement: an exploratory study of bioavailability and resolution of postoperative inflammation. J Periodontol 86(11):1190–1200. https://doi.org/10.1902/jop.2015.150024 Google Scholar
- 41.Larsen P, McGlumphy E (1993) Antibiotic prophylaxis for placement of dental implants. J Oral Maxillofac Surg 51:194Google Scholar
- 43.Morris HF, Ochi S, Plezia R, Gilbert H, Dent CD, Pikulski J, Lambert PM (2004) AICRG, part III: the influence of antibiotic use on the survival of a new implant design. J Oral Implantol 30(3):144–151. https://doi.org/10.1563/1548-1336(2004)30<144:apitio>2.0.co;2 Google Scholar
- 45.Binahmed A, Stoykewych A, Peterson L (2005) Single preoperative dose versus long-term prophylactic antibiotic regimens in dental implant surgery. Int J Oral Maxillofac Implants 20(1):115–117Google Scholar
- 46.Karaky AE, Sawair FA, Al-Karadsheh OA, Eimar HA, Algarugly SA, Baqain ZH (2011) Antibiotic prophylaxis and early dental implant failure: a quasi-random controlled clinical trial. Eur J Oral Implantol 4(1):31–38Google Scholar
- 47.Abu-Ta'a M, Quirynen M, Teughels W, van Steenberghe D (2008) Asepsis during periodontal surgery involving oral implants and the usefulness of peri-operative antibiotics: a prospective, randomized, controlled clinical trial. J Clin Periodontol 35 (1):58–63. doi: https://doi.org/10.1111/j.1600-051X.2007.01162.x
- 48.Anitua E, Aguirre JJ, Gorosabel A, Barrio P, Errazquin JM, Roman P, Pla R, Carrete J, de Petro J, Orive G (2009) A multicentre placebo-controlled randomised clinical trial of antibiotic prophylaxis for placement of single dental implants. Eur J Oral Implantol 2(4):283–292Google Scholar
- 49.Arduino PG, Tirone F, Schiorlin E, Esposito M (2015) Single preoperative dose of prophylactic amoxicillin versus a 2-day postoperative course in dental implant surgery: a two-centre randomised controlled trial. Eur J Oral Implantol 8(2):143–149Google Scholar
- 52.Esposito M, Cannizzaro G, Bozzoli P, Consolo U, Felice P, Ferri V, Landriani S, Leone M, Magliano A, Pellitteri G, Todisco M, Torchio C (2008) Efficacy of prophylactic antibiotics for dental implants: a multicentre placebo-controlled randomised clinical trial. Eur J Oral Implantol 1(1):23–31Google Scholar
- 53.Esposito M, Cannizzaro G, Bozzoli P, Checchi L, Ferri V, Landriani S, Leone M, Todisco M, Torchio C, Testori T, Galli F, Felice P (2010) Effectiveness of prophylactic antibiotics at placement of dental implants: a pragmatic multicentre placebo-controlled randomised clinical trial. Eur J Oral Implantol 3(2):135–143Google Scholar
- 54.Nolan R, Kemmoona M, Polyzois I, Claffey N (2014) The influence of prophylactic antibiotic administration on post-operative morbidity in dental implant surgery. A prospective double blind randomized controlled clinical trial. Clin Oral Implants Res 25(2):252–259. https://doi.org/10.1111/clr.12124 Google Scholar
- 55.Moslemi N, Shahnaz A, Bahador A, Torabi S, Jabbari S, Oskouei ZA (2016) Effect of postoperative amoxicillin on early bacterial colonization of peri-implant sulcus: a randomized controlled clinical trial. J Dentistry (Tehran, Iran) 13(5):309–317Google Scholar
- 56.Kashani H, Dahlin C, Alse'n B (2005) Influence of different prophylactic antibiotic regimens on implant survival rate: a retrospective clinical study. Clin Implant Dent Relat Res 7(1):32–35Google Scholar
- 59.Esposito M, Grusovin MG, Loli V, Coulthard P, Worthington HV (2010) Does antibiotic prophylaxis at implant placement decrease early implant failures? A Cochrane systematic review. Eur J Oral Implantol 3(2):101–110Google Scholar
- 60.Quirynen M, Vogels R, Alsaadi G, Naert I, Jacobs R, Steenberghe D (2005) Predisposing conditions for retrograde peri-implantitis, and treatment suggestions. Prädisponierende Faktoren für die retrograde Peri-Implantitis und Vorschläge zur Behandlung. Clin Oral Implants Res 16(5):599–608. https://doi.org/10.1111/j.1600-0501.2005.01147.x Google Scholar
- 61.McAllister B, Masters D, M Meffert R (1992) Treatment of implants demonstrating periapical radiolucencies, vol 4Google Scholar
- 62.Scarano A, Di Domizio P, Petrone G, Iezzi G, Piattelli A (2000) Implant periapical lesion: a clinical and histologic case report. The Journal of oral implantology 26(2):109–113. https://doi.org/10.1563/1548-1336(2000)026<0109:iplaca>2.3.co;2 Google Scholar
- 63.Sadig W, Almas K (2004) Risk factors and management of dehiscent wounds in implant dentistry. Implant Dent 13(2):140–147Google Scholar
- 65.Rizzo S, Zampetti P, Rodriguez YBR, Svanosio D, Lupi SM (2010) Retrospective analysis of 521 endosseous implants placed under antibiotic prophylaxis and review of literature. Minerva Stomatol 59(3):75–88Google Scholar
- 66.Chen Z, Chen D, Zhang S, Tang L, Li Q (2017) Antibiotic prophylaxis for preventing dental implant failures and postoperative infection: a systematic review of randomized controlled trials. Am J Dent 30(2):89–95Google Scholar
- 67.Petty W, Spanier S, Shuster JJ, Silverthorne C (1985) The influence of skeletal implants on incidence of infection. Experiments in a canine model. The Journal of bone and joint surgery American 67(8):1236–1244Google Scholar
- 69.D'Ercole S, Tete S, Catamo G, Sammartino G, Femminella B, Tripodi D, Spoto G, Paolantonio M (2009) Microbiological and biochemical effectiveness of an antiseptic gel on the bacterial contamination of the inner space of dental implants: a 3-month human longitudinal study. Int J Immunopathol Pharmacol 22(4):1019–1026. https://doi.org/10.1177/039463200902200417 Google Scholar
- 70.Lambert PM, Morris HF, Ochi S (1997) The influence of 0.12% chlorhexidine digluconate rinses on the incidence of infectious complications and implant success. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 55(12 Suppl 5):25–30Google Scholar
- 71.Young MP, Korachi M, Carter DH, Worthington HV, McCord JF, Drucker DB (2002) The effects of an immediately pre-surgical chlorhexidine oral rinse on the bacterial contaminants of bone debris collected during dental implant surgery. Clin Oral Implants Res 13(1):20–29Google Scholar