Cochrane Database Syst Rev. 2013 Jul 31;7:CD004152. doi: 10.1002/14651858.CD004152.pub4.
Abstract
BACKGROUND:
Some
dental implant failures may be due to bacterial contamination at
implant insertion. Infections around biomaterials are difficult to
treat, and almost all infected implants have to be removed. In general,
antibiotic prophylaxis in surgery is only indicated for patients at risk
of infectious endocarditis; with reduced host-response; when surgery is
performed in infected sites; in cases of extensive and prolonged
surgical interventions; and when large foreign materials are implanted. A
variety of prophylactic systemic antibiotic regimens have been
suggested to minimise infections after dental implant placement. More
recent protocols recommended short-term prophylaxis, if antibiotics have
to be used. Adverse events may occur with the administration of
antibiotics, and can range from diarrhoea to life-threatening allergic
reactions. Another major concern associated with the widespread use of
antibiotics is the selection of antibiotic-resistant bacteria. The use
of prophylactic antibiotics in implant dentistry is controversial.
OBJECTIVES:
To
assess the beneficial or harmful effects of systemic prophylactic
antibiotics at dental implant placement versus no antibiotic or placebo
administration and, if antibiotics are beneficial, to determine which
type, dosage and duration is the most effective.
SEARCH METHODS:
We
searched the Cochrane Oral Health Group's Trials Register (to 17 June
2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The
Cochrane Library 2013, Issue 5), MEDLINE via OVID (1946 to 17 June
2013) and EMBASE via OVID (1980 to 17 June 2013). There were no language
or date restrictions placed on the searches of the electronic
databases.
SELECTION CRITERIA:
Randomised controlled
clinical trials (RCTs) with a follow-up of at least three months, that
compared the administration of various prophylactic antibiotic regimens
versus no antibiotics to people undergoing dental implant placement.
Outcome measures included prosthesis failures, implant failures,
postoperative infections and adverse events (gastrointestinal,
hypersensitivity, etc).
DATA COLLECTION AND ANALYSIS:
Screening
of eligible studies, assessment of the risk of bias of the trials and
data extraction were conducted in duplicate and independently by two
review authors. Results were expressed as risk ratios (RRs) using a
random-effects model for dichotomous outcomes with 95% confidence
intervals (CIs). Heterogeneity, including both clinical and
methodological factors, was to be investigated.
MAIN RESULTS:
Six
RCTs with 1162 participants were included: three trials compared 2 g of
preoperative amoxicillin versus placebo (927 participants), one
compared 3 g of preoperative amoxicillin versus placebo (55
participants), one compared 1 g of preoperative amoxicillin plus 500 mg
four times a day for two days versus no antibiotics (80 participants),
and one compared four groups: (1) 2 g of preoperative amoxicillin; (2) 2
g of preoperative amoxicillin plus 1 g twice a day for seven days; (3) 1
g of postoperative amoxicillin twice a day for seven days, and (4) no
antibiotics (100 participants). The overall body of evidence was
considered to be of moderate quality. The meta-analyses of the six
trials showed a statistically significant higher number of participants
experiencing implant failures in the group not receiving antibiotics (RR
0.33; 95% CI 0.16 to 0.67, P value 0.002, heterogeneity: Tau(2) 0.00;
Chi(2) 2.87, df = 5 (P value 0.57); I(2) 0%). The number needed to treat
for one additional beneficial outcome (NNTB) to prevent one person
having an implant failure is 25 (95% CI 14 to 100), based on an implant
failure rate of 6% in participants not receiving antibiotics. There was
borderline statistical significance for prosthesis failures (RR 0.44;
95% CI 0.19 to 1.00), with no statistically significant differences for
infections (RR 0.69; 95% CI 0.36 to 1.35), or adverse events (RR 1; 95%
CI 0.06 to 15.85) (only two minor adverse events were recorded, one in
the placebo group). No conclusive information can be derived from the
only trial that compared three different durations of antibiotic
prophylaxis since no event (implant/prosthesis failures, infections or
adverse events) occurred in any of the 25 participants included in each
study group. There were no trials that evaluated different antibiotics
or different antibiotic dosages.
AUTHORS' CONCLUSIONS:
Scientific
evidence suggests that, in general, antibiotics are beneficial for
reducing failure of dental implants placed in ordinary conditions.
Specifically 2 g or 3 g of amoxicillin given orally, as a single
administration, one hour preoperatively significantly reduces failure of
dental implants. 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 postoperative antibiotics are beneficial, and which antibiotic
is the most effective.
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