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Antibiotic Prophylaxis for Implant Placement: a Systematic Review of Effects on Reduction of Implant Failure

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Antibiotic Prophylaxis for Implant Placement: a Systematic Review of Effects on Reduction of Implant Failure OPEN | VERIFIABLE CPD PAPER RESEARCH Antibiotic prophylaxis for implant placement: a systematic review of effects on reduction of implant failure Andy (Seongju) Kim,1 Nancy Abdelhay,2 Liran Levin,3 John D. Walters4 and Monica P. Gibson*3 Key points Importance of antibiotic prophylaxis in preventing Different types of antibiotics used for prophylaxis. Future considerations in antibiotic use for implant failure. preventing early implant failure. Abstract Introduction Despite excellent reviews in the past several years, the use of antibiotics as prophylaxis for implant placement remains controversial. Aim To assess the literature on the effcacy of prophylactic antibiotics prescribed prior to and immediately following implant surgery (PIFS). Outcomes Whether administration of antibiotics reduced implant failure and post-operative complications. Design Databases searched were PubMed and Medline via Ovid (1946 to February 2018), Cochrane Library (Wiley) and Google Scholar. Materials and methods Quality assessment, meta-analysis with a forest plot and incorporated assessment of heterogeneity. A two-tailed paired t-test was performed, analysing differences in mean failure rates between groups. Results Fourteen publications were collected; 5,334 implants were placed with pre-operative antibiotics, 82 implants with antibiotics PIFS and 3,862 placed with no antibiotics. The overall risk ratio (RR) was 0.47 (95% CI 0.39–0.58), with the implant failure rates signifcantly affected by pre-operative intervention (Z = 7.00, P <0.00001). The number needed to treat (NNT) was 35 (95% CI 26.3–48.2). The difference between mean failure rates was statistically signifcant (P = 0.0335). Conclusion Administering prophylactic antibiotics reduced the risk of implant failures. Further investigations are recommended to establish a standardised protocol for the proper use of antibiotic regimen. Introduction outlines long-term studies showing the efcacy the major disadvantages of these sequelae is of a single-dose antibiotic in reducing early the loss of hard and sof tissue at the implant Antibiotic prophylaxis is standard practice implant failure, the use of antibiotic prophylaxis site, which renders signifcant challenges to for numerous surgical procedures in and choice of agent remain controversial. the surgeon for future implant placements. A immunocompromised patients and in patients The primary concern involves conflicting retrospective analysis by Pyysalo et al., in 2014, with signifcant co-morbidities.1 Since most viewpoints that antibiotic prophylaxis may or demonstrated fewer numbers of early implant patients undergoing dental implant placement may not be as efective as traditionally believed. failures among those that were placed under are relatively healthy and do not have signifcant Xu et al. expressed concerns about the difculty antibiotic treatments.5 medical risk factors, the use of antibiotic of limited information available to practitioners Despite these reviews, implant placement prophylaxis for healthy patients has not become for stringent control of post-operative protocols presently still lack guidelines that standard practice. Although current literature complications following implant procedures.2 would ensure consistent and successful post- Furthermore, current literature demonstrates implant wound healing.2 1Department of Dentistry, Faculty of Medicine and Dentistry, significant variability among practitioners’ Te Canadian Dental Association (CDA) University of Alberta, Canada; 2Department of Dentistry, antibiotic prescribing patterns, prompting the has emphasised the importance of prophylactic Faculty of Medicine and Dentistry, University of Alberta, Canada; 3Division of Periodontology, Department of need to assess how varying interventions afect antibiotics in managing the risk of infections Dentistry, Faculty of Medicine and Dentistry, University of the overall success of implant operations.3 associated with surgical procedures.6 The Alberta, Canada; 4Division of Periodontology, College of Dentistry, The Ohio State University, United States. Dental implants generally exhibit high conficting viewpoints are related to concerns *Correspondence to: Monica P. Gibson initial success rates, but failures occur that over-prescribing antibiotics can promote Email address: [email protected] occasionally.3 Implant failures during the early the development of antibiotic-resistant Refereed Paper. wound-healing period involve infammatory bacteria.1,3,7 Moreover, different regimens Accepted 12 June 2020 breakdown at the surgical site, causing tissue outlined in the literature regarding antibiotic https://doi.org/10.1038/s41415-020-1649-9 scarring and poor osseointegration.4 One of type, dosage and the time of administration BRITISH DENTAL JOURNAL | VOLUME 228 NO. 12 | JUNE 26 2020 943 © The Author(s), under exclusive licence to British Dental Association 2020 RESEARCH Fig. 1 PRISMA fow diagram of literature search strategy, including identifcation, and further assessed. Te two review authors screening, eligibility examination and fnal inclusion. The number of records identifed independently carried out secondary screening during initial search represents the sum of all papers collected through each electronic of the remaining records, involving assessment database of study methods, results and discussions. Final selection of studies was made by discussion between authors under population, 386# of records identified 2# of additional records through database searching identified through manual intervention, comparison and outcome (PICO)- Pubmed = 271 retrieving based inclusion/exclusion criteria. Medline via Ovid = 11 Google Scholar = 100 Cochrane = 4 Inclusion and exclusion criteria (PICO) Te population of interest included all patients in need of implant placement and patients referred/scheduled for implant surgery. 181# of records after duplicates removed General inclusion criteria were medically and orally healthy adults (>19 years of age) 181# of records screened 148# of records excluded who were non-smokers or light smokers (<5 cigarettes a day), had no existing periodontal disease or oral infections, and had no 33# of full-text articles assessed for eligibility 19# of full-text articles procedures that required antibiotic dosage excluded with reasons before implant treatments. Interventions were standard oral implant 14# of studies included in quantitative procedures in conjunction with a single-dose synthesis (meta-analysis) antibiotic administered pre-operatively or immediately following surgery (PIFS). Comparison involved the effects of pre- operative antibiotics and PIFS versus the efects have all contributed to heterogeneity in surgery. We also aim to examine how current of no antibiotics/placebo on implant failure antibiotic prescribing patterns.8 For instance, viewpoints on antibiotic practices in implant rates. Experimental studies directly pertaining Ata-Ali et al. described antibiotic prophylaxis dentistry compare to the observed success to implant failures in the presence/absence as necessary to provide pre-operative rates of implants with or without the use of of antibiotic prophylaxis were examined for protection against infections and reduce the antibiotics. data extraction. Included study types were frequency of implant failures.9 Escalante et al. randomised controlled trials (RCTs), clinically also supported the benefts of prophylactic Materials and methods controlled trials (CCTs) and prospective/ antibiotic practices in implant surgery, retrospective clinical studies (PCS/RCS). For reducing the possibility of developing post- Search strategy meta-analysis, included study designs were operative infections at the surgical site.4 Ahmad A literature search was conducted in February RCTs and CCTs. and Saad, however, suggested that practitioners 2018, across the four electronic databases: Outcomes of interest were implant failure must administer prophylactic antibiotics with PubMed and Medline via Ovid (1946 to rates with or without different types of caution and only when determined to be February 2018), Cochrane Library (Wiley, prophylactic antibiotics. appropriate, not merely as a general measure.1 February 2018) and Google Scholar. No time or Subsequently, patients were excluded if Over-prescription of antibiotics may not only language restrictions were applied to attain the they possessed present medical conditions promote the emergence of antibiotic-resistant maximum number of results regarding implant requiring antibiotic administration, were microorganisms; it could also induce toxic dentistry. Manual record searching across immunodeficient, had allergies to certain efects and hypersensitivity reactions.10 dental journals and other relevant databases antibiotics, were non-adults (<19 years of A considerable number of studies have generated additional literature more specifc to age), were pregnant, or have had prosthetic previously reported ambivalent results, the review focus. Several keywords were used procedures or endocarditis treatment causing many to question the benefit of during the search process, generating records previously (P). Treatment groups that antibiotic prophylaxis. Limited evaluations pertaining to dental implants and implant involved long-term administration of post- on the importance of prophylactic antibiotics failures. A detailed summary of search method operative antibiotics (duration of 2–7 days warrant further research, as the practice and keywords is shown in Appendix 1. following surgery)
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