J Am Dent Assoc. 2019 Apr 19. pii: S0002-8177(18)30725-6. doi: 10.1016/j.adaj.2018.10.015. [Epub ahead of print]
Abstract
BACKGROUND:
In
this systematic review and meta-analysis, the authors examine the
efficacy of antibiotic prophylaxis (AP) and specific antibiotic regimens
for prevention of dental implant failure in patients who are healthy
overall.
TYPES OF STUDIES REVIEWED:
The authors
independently conducted electronic database and manual searches to
identify randomized controlled trials (RCTs). The authors selected
articles on the basis of eligibility criteria and assessed for risk of
bias by using the Cochrane Handbook. Implant failure was the primary
outcome studied; perimucositis or implantitis, prosthetic failure, and
adverse events were secondary outcomes studied. The authors conducted
random effects meta-analysis for risk ratios of dichotomous data and
used OpenMeta[Analyst] (Center for Evidence Synthesis, Brown School of
Public Health) for qualitative assessment of administration schedules.
RESULTS:
With
duplicates removed, the authors screened 1,022 abstracts, reviewed 21
full-text articles, and included 8 RCTs that included 2,869 implants in
1,585 patients. Meta-analysis results indicated that AP resulted in a
statistically significantly lower number of implant failures for all
regimens combined (implant, P = .005; patient, P = .002), as well as
preoperative (implant, P = .01; patient, P = .007), pre- and
postoperative (implant, P = .04), and postoperative AP only (implant,
P = .02), compared with no antibiotics. The authors found no
statistically significant differences in analysis of comparative
antibiotic treatments or secondary outcomes. The authors identified
confounding variables.
CONCLUSIONS AND PRACTICAL IMPLICATIONS:
Although
meta-analysis results suggested that AP may reduce implant failure,
definitive conclusions cannot be achieved yet. The overall
nonsignificant differences reported in individual trials, limitations
discussed, implant infection outcomes, and antibiotic-associated risks
must be considered. Thus, the results for implant failure outcomes may
not warrant the indiscriminate use of antibiotics in patients who are
healthy who are receiving dental implants. Investigators must conduct
large-scale RCTs to determine the efficacy of AP and various regimens,
independent of confounding variables.
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