title: Complex systematic review - Perioperative antibiotics in conjunction with dental implant placement.
abstract: OBJECTIVE
  The aim of this study was to revisit the available scientific literature regarding perioperative antibiotics in conjunction with implant placement by combining the recommended methods for systematic reviews and complex systematic reviews.
  
  
  METHODS
  A search of Medline (OVID), The Cochrane Library (Wiley), EMBASE, PubMed and Health technology assessment (HTA) organizations was performed, in addition to a complementary hand-search. Selected systematic reviews and primary studies were assessed using GRADE and AMSTAR, respectively. A meta-analysis was performed.
  
  
  RESULTS
  The literature search identified 846 papers of which 10 primary studies and seven systematic reviews were included. Quality assessment of the systematic reviews revealed two studies of moderate risk of bias and five with high risk of bias. The two systematic reviews of moderate risk of bias stated divergent numbers needed to treat (NNT) to prevent one patient from implant failure. Four of the primary studies comparing antibiotic prophylaxis with placebo were estimated to be of low, or moderate, risk of bias and subjected to meta-analysis. The NNT was 50 (pooled RR 0.39, 95% CI 0.18, 0.84; P = 0.02). None of these four studies individually show a statistical significant benefit of antibiotic prophylaxis. Furthermore, narrative analysis of the studies eligible for meta-analysis reveals clinical heterogeneity regarding intervention and smoking.
  
  
  CONCLUSIONS
  Antibiotic prophylaxis in conjunction with implant placement reduced the risk for implant loss by 2%. However, the sub-analysis of the primary studies suggests that there is no benefit of antibiotic prophylaxis in uncomplicated implant surgery in healthy patient.
authors.affiliation: Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.|Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden.
authors.forename: Bodil
authors.initials: B
authors.lastname: Lund
authors.affiliation: Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Hultin
authors.affiliation: Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.|Swedish Council on Health Technology Assessment, Stockholm, Sweden.|Department of Periodontology, Faculty of Odontology, Malmo University, Malmo, Sweden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Tranaeus
authors.affiliation: Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.|Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden.
authors.forename: Aron
authors.initials: A
authors.lastname: Naimi-Akbar
authors.affiliation: Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.|Department of Periodontology, Faculty of Odontology, Malmo University, Malmo, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Klinge
mesh_terms: D019072:Antibiotic Prophylaxis; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*
chemical_list: D015921:Dental Implants
keywords: antibiotic prophylaxis; complex systematic review; dental implant surgery; knowledge gap; systematic review