title: Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications.
abstract: BACKGROUND
  Some dental implant failures may be due to bacterial contamination at implant insertion. Infections around biomaterials are difficult to treat and almost all infected implants have to be removed. In general, antibiotic prophylaxis in surgery is only indicated for patients at risk of infectious endocarditis, for patients with reduced host-response, when surgery is performed in infected sites, in cases of extensive and prolonged surgical interventions and when large foreign materials are implanted. To minimise infections after dental implant placement various prophylactic systemic antibiotic regimens have been suggested. More recent protocols recommended short term prophylaxis, if antibiotics have to be used. With the administration of antibiotics adverse events may occur, ranging from diarrhoea to life-threatening allergic reactions. Another major concern associated with the widespread use of antibiotics is the selection of antibiotic-resistant bacteria. The use of prophylactic antibiotics in implant dentistry is controversial.
  
  
  OBJECTIVE
  To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the most effective.
  
  
  METHODS
  The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to 2nd June 2010. Several dental journals were handsearched. There were no language restrictions.
  
  
  METHODS
  Randomised controlled clinical trials (RCTs) with a follow up of at least 3 months comparing the administration of various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc).
  
  
  METHODS
  Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using risk ratios (RRs) for dichotomous outcomes with 95% confidence intervals (CIs). Heterogeneity was to be investigated including both clinical and methodological factors.
  
  
  RESULTS
  Four RCTs were identified: three comparing 2 g of preoperative amoxicillin versus placebo (927 patients) and the other comparing 1 g of preoperative amoxicillin plus 500 mg 4 times a day for 2 days versus no antibiotics (80 patients). The meta-analyses of the four trials showed a statistically significant higher number of patients experiencing implant failures in the group not receiving antibiotics: RR = 0.40 (95% CI 0.19 to 0.84). The number needed to treat (NNT) to prevent one patient having an implant failure is 33 (95% CI 17 to 100), based on a patient implant failure rate of 5% in patients not receiving antibiotics. The other outcomes were not statistically significant, and only two minor adverse events were recorded, one in the placebo group.
  
  
  CONCLUSIONS
  There is some evidence suggesting that 2 g of amoxicillin given orally 1 hour preoperatively significantly reduce failures of dental implants placed in ordinary conditions. No significant adverse events were reported. It might be sensible to suggest the use of a single dose of 2 g prophylactic amoxicillin prior to dental implant placement. It is still unknown whether postoperative antibiotics are beneficial, and which is the most effective antibiotic.
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH.
authors.forename: Marco
authors.initials: M
authors.lastname: Esposito
authors.forename: Helen V
authors.initials: HV
authors.lastname: Worthington
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Loli
authors.forename: Paul
authors.initials: P
authors.lastname: Coulthard
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Grusovin
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D001424:Bacterial Infections / Q000517:prevention & control*; D015921:Dental Implants / Q000009:adverse effects*; D019232:Dental Restoration Failure; D004334:Drug Administration Schedule; D006801:Humans; D007576:Jaw, Edentulous, Partially / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents; D015921:Dental Implants; D000658:Amoxicillin