Clinical Oral Investigations

, Volume 23, Issue 4, pp 1525–1553 | Cite as

Antibiotic prophylaxis may not be indicated for prevention of dental implant infections in healthy patients. A systematic review and meta-analysis

  • Ismael KhoulyEmail author
  • Rosalie S. Braun
  • Leandro Chambrone



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.

Clinical relevance

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.


Amoxicillin 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.

Author contribution

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.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Ethical approval is not required.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ismael Khouly
    • 1
    • 2
    Email author
  • Rosalie S. Braun
    • 3
  • Leandro Chambrone
    • 4
    • 5
    • 6
  1. 1.Bluestone Center for Clinical ResearchNew York University College of DentistryNew YorkUSA
  2. 2.Department of Oral and Maxillofacial SurgeryNew York University College of DentistryNew YorkUSA
  3. 3.New York University College of DentistryNew YorkUSA
  4. 4.Unit of Basic Oral Investigation (UIBO), School of DentistryEl Bosque UniversityBogotaColombia
  5. 5.MSc Dentistry ProgramIbirapuera UniversitySao PauloBrazil
  6. 6.Department of Periodontics, College of DentistryThe University of IowaIowa CityUSA

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