The effect of preoperative clindamycin in reducing early oral implant failure: a randomised placebo-controlled clinical trial

Abstract

Objectives To assess the effect of preoperative oral clindamycin in reducing early implant failure in healthy adults undergoing conventional implant placement. Materials and methods We conducted a prospective, randomised, double-blind, placebo-controlled clinical trial in accordance with the ethical principles and Consolidated Standards of Reporting Trials statement. We included healthy adults who underwent a single oral implant without previous infection of the surgical bed or the need for bone grafting. They were randomly treated with a single dose of oral clindamycin (600 mg) 1 h before surgery or a placebo. All surgical procedures were performed by one surgeon. A single trained observer evaluated all patients on postoperative days 1, 7, 14, 28, and 56. Early dental implant failure was defined as the loss or removal of an implant for any reason. We recorded the clinical, radiological, and surgical variables, adverse events, and postoperative complications. The study outcomes were statistically analysed to evaluate differences between the groups. Furthermore, we calculated the number required to treat or harm (NNT/NNH). Results Both the control group and clindamycin group had 31 patients each. Two implant failures occurred in the clindamycin group (NNH = 15, p = 0.246). Three patients had postoperative infections, namely two placebo-treated and one clindamycin-treated, which failed (relative risk: 0.5, CI: 0.05–5.23, absolute risk reduction = 0.03, confidence interval: − 0.07–0.13, NNT = 31, CI: 7.2–∞, and p = 0.5). One clindamycin-treated patient experienced gastrointestinal disturbances and diarrhoea. Conclusions Preoperative clindamycin administration during oral implant surgery in healthy adults may not reduce implant failure or post-surgical-complications. Clinical relevance Oral clindamycin is not efficacy. Trial registration The present trial was registered (EudraCT number: 2017-002,168-42). It was approved by the Committee for the Ethics of Research with Medicines of Euskadi (CEIm-E) on 31 October 2018 (internal code number: 201862) and the Spanish Agency of Medicines and Medical Devices (AEMPS) on 18 December 2018.

Self‐reported allergy to penicillin and clindamycin administration may be risk factors for dental implant failure: A systematic review, meta‐analysis and delabeling protocol

“…When patients requiring dental implants present with penicillin allergy, the normal course of action taken by most clinicians has been to give a substitute antibiotic, usually clindamycin (Deniz‐Sungur et al, 2020; Ireland et al, 2012; Santamaria Arrieta et al, 2022; Segura‐Egea et al, 2017; Yingling et al, 2002). Indeed, the recently published Consensus Report by the Italian Academy of Osseointegration recommends the administration of 600 mg of clindamycin, 1 h before the intervention in straightforward cases, in patients with penicillin allergy (Caiazzo et al, 2021).…”

“…However, the consensus report on preventive antibiotic therapy with dental implants from Spanish Society of Implants does not recommend the same (Salgado‐Peralvo, Garcia‐Sanchez, et al, 2022). This regimen emerged as the most used among clinicians in the United Kingdom (Ireland et al, 2012) Spain (Camacho‐Alonso et al, 2019) and Belgium (Santamaria Arrieta et al, 2022). Despite the widespread use of clindamycin as a substitute, current evidence is based only on retrospective studies about the clinical efficacy of clindamycin and only one randomized clinical trial has been published on this topic.…”

“…Despite the widespread use of clindamycin as a substitute, current evidence is based only on retrospective studies about the clinical efficacy of clindamycin and only one randomized clinical trial has been published on this topic. (Romandini et al, 2019; Salgado‐Peralvo et al, 2021; Salgado‐Peralvo, Pena‐Cardelles, et al, 2022; Santamaria Arrieta et al, 2022). Arrieta et al found that pre‐operative 600 mg clindamycin did not reduce implant failure or post‐surgical complications; however, patients allergic to clindamycin were originally excluded and allergy testing was not performed on included patients (Santamaria Arrieta et al, 2022).…”

“…(Romandini et al, 2019; Salgado‐Peralvo et al, 2021; Salgado‐Peralvo, Pena‐Cardelles, et al, 2022; Santamaria Arrieta et al, 2022). Arrieta et al found that pre‐operative 600 mg clindamycin did not reduce implant failure or post‐surgical complications; however, patients allergic to clindamycin were originally excluded and allergy testing was not performed on included patients (Santamaria Arrieta et al, 2022). Similarly, clindamycin use was ineffective in third molar surgery patients (Arteagoitia et al, 2022), while exhibiting a higher adverse‐effects profile (Arteagoitia et al, 2022; Azher & Patel, 2021).…”

“…Similarly, clindamycin use was ineffective in third molar surgery patients (Arteagoitia et al, 2022), while exhibiting a higher adverse‐effects profile (Arteagoitia et al, 2022; Azher & Patel, 2021). The American Dental Association advised against the use of clindamycin in patients with penicillin allergy due to serious reported adverse effects, such as pseudomembranous colitis induced by C. difficile (Azher & Patel, 2021; Santamaria Arrieta et al, 2022). Moreover, Salomo‐Coll et al (2018) reported that penicillin allergic patients treated with clindamycin had a fourfold higher risk of implant failure; Basme and Mitch reported in 2021 that the use of clindamycin after socket graft and ridge augmentation procedures was associated with a higher rate of infection and complications (Basma & Misch, 2021).…”