By Marco Esposito, Maria Gabriella Grusovin, Helen V Worthington
Dental implant failures can be attributed to bacterial contamination at implant insertion, which is difficult to treat and often requires removal. Antibiotic prophylaxis is generally only recommended 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 minimize infections after dental implant placement. More recent protocols recommend short-term prophylaxis if antibiotics are used. Adverse events may occur with the administration of antibiotics, ranging from diarrhoea to life-threatening allergic reactions. Another major concern associated with the widespread use of antibiotics is the selection of antibiotic-resistant bacteria.
This study aimed to assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic or placebo administration and determine the most effective type, dosage, and duration. Six randomised controlled clinical trials (RCTs) were included, comparing 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.
The meta-analyses of the six trials showed a statistically significant higher number of participants experiencing implant failures in the group not receiving antibiotics. 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, with no statistically significant differences for infections or adverse events. No conclusive information can be derived from these studies.
Research Summary Written By: Tamara Al-Sabah, University of Manchester – BDS4