A Systematic Review and Meta-Analysis Evaluating Antibiotic Prophylaxis in Dental Implants and Extraction Procedures

Abstract

Background and objectives: The use of antibiotic prophylaxis in extraction and implant dentistry is still controversial, with varying opinions regarding their necessity. The overuse of antibiotics has led to widespread antimicrobial resistance and the emergence of multi drug resistant strains of bacteria. The main aim of this work was to determine whether there is a genuine need for antibiotic prophylaxis in two common dental procedures; dental implants and tooth extractions. Methods: Electronic searches were conducted across databases such as Cochrane Register of Controlled Trials, the UK National Health Service, Centre for reviews, Science Direct, PubMed and the British Dental Journal to identify clinical trials of either dental implants or tooth extractions, whereby the independent variable was systemic prophylactic antibiotics used as part of treatment in order to prevent postoperative complications such as implant failure or infection. Primary outcomes of interest were implant failure, and postoperative infections which include systemic bacteraemia and localised infections. The secondary outcome of interest was adverse events due to antibiotics. The Critical Appraisal Skills Programme tool was used to assess the risk of bias, extract outcomes of interest and to identify studies for inclusion in the meta-analysis. Results: Seven randomised clinical trials (RCTs) were included in the final review comprising n = 1368 patients requiring either tooth extraction(s) or dental implant(s). No statistically significant evidence was found to support the routine use of prophylactic antibiotics in reducing the risk of implant failure (p = 0.09, RR 0.43; 95% CI 0.16–1.14) or post-operative complications (p = 0.47, RR: 0.74; 95% CI 0.34–1.65) under normal conditions. Approximately 33 patients undergoing dental implant surgery need to receive antibiotics in order to prevent one implant failure from occurring. Conclusions: There is little conclusive evidence to suggest the routine use of antibiotic prophylaxis for third molar extractive surgery in healthy young adults. There was no statistical evidence for adverse events experienced for antibiotics vs. placebo. Based on our analysis, even if financially feasible, clinicians must carefully consider the appropriate use of antibiotics in dental implants and extraction procedures due to the risk of allergic reactions and the development of microbial drug resistance.

How to Manage Impacted Third Molars: Germectomy or Delayed Removal? A Systematic Literature Review

“…On the other hand, a longer surgical procedure implies a higher dose of anesthesia and is more often associated with delayed onset infections on mandibular third molar sites. However, to avoid these complications, methods of drug premedication and telephone monitoring of patients have recently been proposed [39,40].…”

Profilaxis antibiótica en Implantología Oral. Revisión crítica de la literatura.

“…Por otro lado, Singh-Gill y cols. 19 determinaron un riesgo relativo de complicaciones posoperatorias de 0,74 inherente a la profilaxis antibiótica en implantología oral, es decir, que el uso preventivo de antibióticos probablemente reduce el riesgo de complicaciones tras la cirugía implantológica en un 26 %.…”

“…Según diversas revisiones sistemáticas, no existe un beneficio añadido en la prescripción profiláctica de antibióticos en pacientes sanos, con casos de implantes favorables y una adecuada calidad ósea del lecho quirúrgico 4,5,7,19 . Únicamente el estudio de Chen y cols.…”

“…21 mostró resultados positivos en estos pacientes en cuanto a la reducción del fracaso del tratamiento implantológico e infecciones posoperatorias, lo cual está en discordancia con el resto de literatura disponible. En general, no existe una evidencia significativa que apoye la profilaxis antibiótica de manera rutinaria con el fin de prevenir el fracaso temprano y las infecciones posoperatorias de implantes dentales 19 .…”

“…La amoxicilina es el antibiótico más comúnmente recetado por dentistas debido a su gran absorción 51 y a su efectividad contra la mayor parte de los patógenos orales 56 , seguido de la clindamicina en pacientes alérgicos a penicilinas 51 (aproximadamente el 10 % de la población presenta alergia a penicilinas 57 ). Sin embargo, la evidencia disponible no se ha decantado sobre qué antibiótico destinado a estos fines es el más efectivo 19 . En general, los diferentes estudios analizan la efectividad de diversas posologías de amoxicilina y, únicamente en pacientes alérgicos, emplean clindamicina, pero no existe evidencia que analice específicamente el uso de clindamicina como antibiótico profiláctico en implantología oral.…”