Is Antibiotic Prophylaxis Necessary before Dental Implant Procedures in Patients with Orthopaedic Prostheses? A Systematic Review

Abstract

As the population ages, more and more patients with orthopaedic prostheses (OPs) require dental implant treatment. Surveys of dentists and orthopaedic surgeons show that prophylactic antibiotics (PAs) are routinely prescribed with a very high frequency in patients with OPs who are about to undergo dental procedures. The present study aims to determine the need to prescribe prophylactic antibiotic therapy in patients with OPs treated with dental implants to promote their responsible use and reduce the risk of antimicrobial resistance. An electronic search of the MEDLINE database (via PubMed), Web of Science, LILACS, Google Scholar, and OpenGrey was carried out. The criteria used were those described by the PRISMA® Statement. No study investigated the need to prescribe PAs in patients with OPs, so four studies were included on the risk of infections of OPs after dental treatments with varying degrees of invasiveness. There is no evidence to suggest a relationship between dental implant surgeries and an increased risk of OP infection; therefore, PAs in these patients are not justified. However, the recommended doses of PAs in dental implant procedures in healthy patients are the same as those recommended to avoid infections of OPs.

Antibiotics in Dentistry: A Narrative Review of the Evidence beyond the Myth

“…Responses were more heterogeneous for the need or not of antibiotic prophylaxis for adult extractions with comorbidities, complex or multiple extractions, drainage abscesses, and implant placement, while more appropriate choices were reported for deciduous tooth extractions and simple extractions in healthy adult subjects [70,72]. Antibiotics were commonly prescribed to prevent infection at the surgical site or to reduce bacteremia [70,74]. Dosages also varied significantly [70].…”

“…Most studies support preoperative prophylactic antibiotic administration in oral and maxillofacial surgery in patients with serious underlying diseases or immunocompromised patients, such as those undergoing radiotherapy or chemotherapy [74,80,126]. However, using antibiotics beyond the first 24 h is of little value in head and neck surgery alone, as SSIs occur in less than 1% of cases, no significant reduction in SSIs in clean head and neck surgery with antibiotic prophylaxis could be observed, and an effective duration could not be determined [118,127].…”