BACKGROUND:
Surgical site infections are a complication of oral and maxillofacial procedures, with the potential for significant morbidity and mortality. Use of pre-, peri- and post-operative antibiotic prophylaxis to reduce the incidence of surgical site infections must be balanced with considerations of a patients’ risk of antibiotic-related adverse events. This review aims to provide evidence-based recommendations for antibiotic prophylaxis.
METHODS:
Searches were conducted using MEDLINE, the Cochrane Library, EMBASE and PUBMED for maxillofacial procedures including: treatment of dental abscesses, extractions, implants, trauma, temporomandibular joints, orthognathics, malignant and benign tumour removal, and bone grafting, limited to articles published since 2000.
RESULTS:
98 out of 280 retrieved papers were included in the final analysis. Systematic reviews were assessed using AMSTAR criteria. Randomised controlled trials were assessed for bias using Cochrane Collaborative tools. The overall quality of evidence was assessed using GRADE.
CONCLUSIONS:
Prophylactic antibiotic use is recommended in surgical extractions of third molars, comminuted mandibular fractures, temporomandibular joint replacements, clean-contaminated tumour removal, and complex implants. Prophylactic antibiotic use is not routinely recommended in upper or midface fracture facial thirds. Further research is required to provide recommendations in orthognathic, cleft lip, palate, temporomandibular joint surgery, and maxillofacial surgical procedures in medically compromised patients.
Systemic antibiotics are routinely prescribed in implant procedures, but the lack of consensus causes large differences between clinicians regarding antibiotic prophylaxis regimens. The objectives of this systematic review are to assess the need to prescribe antibiotics to prevent early implant failure and find the most appropriate antibiotic prophylaxis regimen. The electronic search was conducted in PubMed/MEDLINE, Scielo and Cochrane Central Trials Database for randomized clinical trials of at least 3 months of follow-up. Eleven studies were included in the qualitative analysis. Antibiotics were found to statistically significantly reduce early implant failures (RR = 0.30, 95% CI: 0.19–0.47, p <0.00001; heterogeneity I2 = 0%, p = 0.54). No differences were seen between preoperative or both pre-and postoperative antibiotic regimens (RR = 0.57, 95% CI: 0.21–1.55, p = 0.27; heterogeneity I2 = 0%, p = 0.37). A single preoperative antibiotic prophylaxis dose was found to be enough to significantly reduce early implant failures compared to no antibiotic (RR = 0.34, 95% CI: 0.21–0.53, p < 0.00001; heterogeneity I2 = 0%, p = 0.61). In conclusion, in healthy patients a single antibiotic prophylaxis dose is indicated to prevent early implant failure.
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 efficacy 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 significantly 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 significant (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.
This study aimed to assess the dosage and types of antibiotics prescribed in oral implant surgery, compare them among the different subpopulations (country and prescription regimens) and against the evidence-based recommended dosage: a 2-gram single preoperative dose of amoxicillin. A meta-analysis of cross-sectional surveys was conducted, which reports the overall dosage (and type) of antibiotics prescribed in combination with implant placement. PubMed, Cochrane, Science, Direct, and EMBASE via OVID were searched until April 2019. Three reviewers independently undertook data extraction and risk of bias assessment. The outcome variable was set on the average of prophylactic antibiotics prescribed per oral implant surgery. Overall, 726 participants from five cross-sectional surveys, representing five different countries were finally included. Amoxicillin was the most prescribed antibiotic. On average, 10,724 mg of antibiotics were prescribed per implant surgery. This average was significantly (p<0.001) higher than 2,000 mg. Overall, amoxicillin doses were significantly higher than 2,000 mg (9,700 mg, p<0.001). All prescribed amoxicillin regimens independently contained more than 2,000 mg, including those comprising only preoperative amoxicillin (2,175 mg, p = 0.006). Exclusive preoperative antibiotic regimens were the only subgroup with prescription dosages below this threshold (p = 0.091). Significant variations in antibiotic prescriptions were found among different countries and antibiotic regimens (p<0.001). In conclusion, the average dose of antibiotics prescribed per oral implant surgery was larger than the evidence-based recommended dose in healthy patients and straightforward conditions. In addition, variations in the average antibiotic dosages were found among different countries and prescription regimens.
AIM: This systematic review of randomized controlled trials (RCTs) aims to answer to the following question: "In patients undergoing dental implant placement, which is the best antibiotic prophylaxis protocol to prevent early failures?".
MATERIALS AND METHODS: The MEDLINE, SCOPUS, CENTRAL and Web of Knowledge electronic databases were searched in duplicate for RCTs up to July 2017. Additional relevant literature was identified through 1) hand-searching on both relevant journals and on reference lists, and 2) searching in databases for grey literature. A Network Meta-analysis (NMA) was conducted and the probability that each protocol is the "Best" was estimated.
RESULTS: Nine RCTs were included, with a total of 1,693 participants. Due to the few events reported, it was not possible to conduct a NMA for adverse events, therefore it was conducted only for implant failures (IF). The protocol with the highest probability (32.5%) of being the "Best" one to prevent IF was the single dose of 3g of amoxicillin administered 1-h pre-operatively. Even if the single pre-operative dose of 2g of amoxicillin is the most used, it achieved only a probability of 0.2% to be the "Best" one.
CONCLUSIONS: Basing on the available RCTs, the use of antibiotic prophylaxis is protective against early implant failures, but there is still insufficient evidence to confidently recommend a specific dosage. The use of post-operative courses does not seem however to be justified by the available literature. This article is protected by copyright. All rights reserved.
OBJECTIVES: The purpose of the present systematic review and meta-analysis is to determine the efficacy of antibiotic prophylaxis and specific antibiotic regimens in dental implant placement for prevention of post-operative infection (POI) in overall healthy patients.
MATERIALS AND METHODS: Electronic database and manual searches were independently conducted to identify randomized controlled trials (RCTs). Publications were selected on basis of eligibility criteria and then assessed for risk-of-bias using the Cochrane Handbook. The primary outcome was POI (total, early, and late). Wound dehiscence, pain, and adverse events were studied as secondary outcomes. Random-effects meta-analysis was conducted for risk ratios of dichotomous data. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.
RESULTS: With duplicates removed, 1022 abstracts were screened and 22 full-text articles assessed; 10 RCTs of 1934 total patients were included. Meta-analysis did not detect statistically significant differences in total (P = 0.82), early (1-2 week post-op) (P = 0.57), or late (3-4 months post-op) (P = 0.66) POIs, wound dehiscence (P = 0.31), and adverse events (P = 0.21), between antibiotic and no-antibiotic groups. Confounding variables identified.
CONCLUSION: The results of this systematic review suggest that antibiotic prophylaxis may not be indicated for prevention of POIs following dental implant placement in overall healthy patients. These findings and in light of antibiotic-associated risks for individual and public health demand revaluation of routine prescription of antibiotic prophylaxis in dental implant placement procedures.
CLINICAL RELEVANCE: It is up to the clinicians to evaluate the benefits (or lack thereof) of antibiotic prophylaxis for each patient given medical history and surgical complexity, until new evidence becomes available.
BACKGROUND: In this systematic review and meta-analysis, the authors examine the efficacy of antibiotic prophylaxis (AP) and specific antibiotic regimens for prevention of dental implant failure in patients who are healthy overall.
TYPES OF STUDIES REVIEWED: The authors independently conducted electronic database and manual searches to identify randomized controlled trials (RCTs). The authors selected articles on the basis of eligibility criteria and assessed for risk of bias by using the Cochrane Handbook. Implant failure was the primary outcome studied; perimucositis or implantitis, prosthetic failure, and adverse events were secondary outcomes studied. The authors conducted random effects meta-analysis for risk ratios of dichotomous data and used OpenMeta[Analyst] (Center for Evidence Synthesis, Brown School of Public Health) for qualitative assessment of administration schedules.
RESULTS: With duplicates removed, the authors screened 1,022 abstracts, reviewed 21 full-text articles, and included 8 RCTs that included 2,869 implants in 1,585 patients. Meta-analysis results indicated that AP resulted in a statistically significantly lower number of implant failures for all regimens combined (implant, P = .005; patient, P = .002), as well as preoperative (implant, P = .01; patient, P = .007), pre- and postoperative (implant, P = .04), and postoperative AP only (implant, P = .02), compared with no antibiotics. The authors found no statistically significant differences in analysis of comparative antibiotic treatments or secondary outcomes. The authors identified confounding variables.
CONCLUSIONS AND PRACTICAL IMPLICATIONS: Although meta-analysis results suggested that AP may reduce implant failure, definitive conclusions cannot be achieved yet. The overall nonsignificant differences reported in individual trials, limitations discussed, implant infection outcomes, and antibiotic-associated risks must be considered. Thus, the results for implant failure outcomes may not warrant the indiscriminate use of antibiotics in patients who are healthy who are receiving dental implants. Investigators must conduct large-scale RCTs to determine the efficacy of AP and various regimens, independent of confounding variables.
