The use of systemic antibiotics during dental implant placement has been controversial, with some authors claiming higher survival rates with peri-operative antibiotic use.  The aim of this multi-centre trial was to assess the effect of various systemic antibiotic prophylaxis regimes on patient- reported outcomes and postsurgical complications in patients undergoing conventional implant placement.

Following establishment of periodontal and endodontic health, health adults ≥ 19 years of age, preferably light or non-smokers with no antibiotic allergies requiring a single tooth implant without the need of simultaneous bone augmentation were recruited.  They were randomised to one of four groups

1. (n=81); 2 g of amoxicillin preoperatively, 1 h prior to conventional implant placement.
2. (n=82); 2 g of amoxicillin immediately postoperatively.
3. (n=86); 2 g of amoxicillin preoperatively, 1 h prior to implant placement and 500 mg three times a day (8 hourly) on days 2 and 3.
4. (n=80); 2 g of a placebo preoperatively, 1 h prior to implant placement without any antibiotics.    Medications were prescribed by a clinical co-ordination to blind investigators, examiners and surgeons.

Participants were examined clinically at 1, 2, 4, and 8 weeks after implant placement for postoperative complications (flap closure, pain, swelling, suppuration, and implant stability) and visual analogue scales (VAS) on a score of 0-10 were obtained from the patients from day 1 through 7 and day 14 for pain, swelling, bruising and bleeding.

• There were no significant differences for the VAS scores between the various groups at any time point (P > 0.05).
• There was only a significant difference in flap closure at week 4, where group 4 had 5% of the subjects not achieving complete wound closure compared to 0% for the three other groups (P = 0.01), with no other significant differences for any postsurgical complications (P > 0.05).
• One implant was lost in group 4 after 8 weeks.

The authors concluded

For standard single implant placement, prophylactic systemic antibiotics either before or after the surgical procedure do not improve patient-reported outcomes or prevalence of post-surgical complications.

Comment

The authors point out that the participants in this study required straightforward treatments. As a result they caution extrapolation to patients requiring more advanced placement or those with poorer oral health status. The 2010 Cochrane review by Espositio et al is noted in the discussion by the authors. This included four randomised trials and found:-

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.

The duration of this new trial at 8 weeks is shorter than all four of the trials included in the Cochrane review the shortest of which was 12 weeks.

Links

Tan WC, Ong M, Han J, Mattheos N, Pjetursson BE, Tsai AY, Sanz I, Wong MC, Lang NP; on Behalf of the ITI Antibiotic Study Group. Effect of systemic antibiotics on clinical and patient-reported outcomes of implant therapy – a multicenter randomized controlled clinical trial. Clin Oral Implants Res. 2013 Jan 24. doi: 10.1111/clr.12098. [Epub ahead of print] PubMed PMID: 23347336.

Esposito M, Worthington HV, Loli V, Coulthard P, Grusovin MG. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD004152. DOI: 10.1002/14651858.CD004152.pub3.