Prophylactic Antibiotic Use
for Dental Implant Surgery
Replacing missing teeth with implants has become a very predictable procedure and the overall success rate is more than 94%. Still early implant failure can have many different causes including surgical trauma, lack of primary stability and infection during or after surgery. There still remains the question if antibiotic prophylaxis can prevent infections and make implants more successful.
The most recent studies suggest reducing the amount of antibiotics prescribed, when possible, to avoid bacterial resistance and the side effects due to taking antibiotics. Less than 10% of patients who took antibiotics reported some kind of side effect
In the medical and dental fields, antibiotic prophylaxis before surgery is a common practice. This includes having the patient take an antibiotic one to two hours before the planned procedure. The literature shows that it helps to prevent infection post operatively. In contrast, other studies showed that postoperative antibiotic use had very minor effects in preventing infection after surgery.
In 1970, the Branemark group introduced a novel implant placement technique. In their protocol, they recommended antibiotic prophylaxis before surgery and postoperatively for 10 days.
In a survey regarding the antibiotic regimen of 102 board certified periodontists practicing in the U.S., it showed that 72% of them use antibiotics when placing implants. Of this 72%, 55.3% prescribed antibiotics as prophylaxis before implant placement, and 43.6 % post-operatively.
Nolan et al. studied the effects of prophylactic antibiotics in patients that received dental implants. They gave 3 grams of amoxicillin 1 hour before surgery to a test group of 27 patients and a placebo to a control group of 28 patients. They reported that the prophylactic antibiotic group had a 100% implant success rate while the rate of success for the placebo group was 82%. They concluded that antibiotic prophylaxis before dental implant treatment is justified, as it improves implant survival.
Sharaf et al. looked at three different antibiotic groups: one single prophylactic dose, a single prophylactic dose followed by several days of antibiotics post-surgery, and a control group with no use of antibiotics. They found that a single dose of antibiotic prophylaxis may significantly reduce the rate of failing implants, but they failed to show any benefit for the routine use of antibiotic therapy post-surgery.
Esposito et al evaluated six different studies in a Cochrane review. Their results showed that 2 grams of amoxicillin taken before implant surgery significantly decreased the rate of implant failures in the short term. However, the benefit of post-surgical antibiotic use is still questionable.