Major evidence and guidelines for antibiotic therapy in implant dentistry: a systematic review

Abstract

Introduction: Dentistry was favored by the discovery of osseointegration, which has become important in the treatment of partially and edentulous patients. Initially, osseointegration was used only to treat edentulous patients in the maxilla and mandible, using a single type of implant, prosthetic abutment, and rehabilitation protocol. However, as the applications of osseointegration evolved, complications also increased, which became more numerous and are no longer the result of surgical and mechanical problems of the components of a single care protocol, requiring more research, studies, and care. In this scenario, the use of antibiotics in implantology is very common and the abuse of antibiotics is more and more frequent. The rational use of antibiotics in the oral implantology process needs the support of evidence-based medicine. The prophylactic use of antibiotics in dental implantology was reviewed in the present study, including the summary of different risks of infection, such as peri-implantitis and maxillary sinusitis after lifting the maxillary sinus floor. Objective: To carry out a systematic review of the literature on the real effects of antibiotic therapy on implantology, especially in the pre-procedure phase. The present study was based on studies of guidelines, with emphasis on the German directive. Main findings and conclusion: The current evidence of antibiotic prophylaxis from oral and maxillofacial surgery was summarized by the planned German S3 guideline “antibiotic prophylaxis in surgery”. Perioperative prophylactic antibiotics can reduce SSI in major procedures, such as head and neck cancer surgery, and prophylaxis is only beneficial for 24 hours. In orthognathic surgery, preoperative antibiotics can reduce SSI with good quality evidence, but it benefits prolonged therapy, and which regimen is most effective remains uncertain. In traumatology, perioperative antibiotic prophylaxis for mandibular fractures and Lefort-1/2 can reduce the SSI, but antibiotic regimens should not be prolonged in the postoperative period by 24 hours. For dentoalveolar surgery, the evidence is more ambivalent. For dental implants, perioperative antibiotics as single injection prophylaxis before placement can reduce dental implant failure, but not SSI. For the removal of third molars, antibiotic therapy in the perioperative period is of uncertain benefit for healthy patients, but it was not possible to obtain evidence to evaluate antibiotic therapy for patients with pre-existing conditions.