Prophylactic Antibiotics and Implant Surgery

A prospective double-blind randomized controlled trial tested the effect of prophylactic antibiotics on postoperative morbidity and osseointegration of dental implants. This study was conducted by Drs. Nolan et al of the Dublin Dental University Hospital and was first published online in Clinical Oral Implant Research on February 13, 2013.
The trial involved 55 subjects scheduled for implant surgery. Patients were randomly assigned to the antibiotic (test group) and placebo (control group). The test group (27 patients) received 3 grams amoxicillin one hour preoperatively, and the control group (28 patients) received placebo capsules one hour preoperatively. No postoperative antibiotics were prescribed. Pain diaries and interference with daily activities diaries were kept by the patients for one week postoperatively. Signs of postoperative morbidity (swelling, bruising, suppuration, and wound dehiscence) were recorded by the principal investigators at day 2 and day 7 following the operation.
Osseointegration was assessed at second stage surgery or 3 to 4 months postoperatively. The results of this study suggest that the use of prophylactic preoperative antibiotics may result in higher dental implant survival rates (100% versus 82%). Five implant failures, one in each of 5 patients, were reported in the placebo group and none in the antibiotic group (P = .0515). No significant differences were found for most of the signs of postoperative morbidity 2 and 7 days postoperatively. Only bruising at 2 days following the operation appeared to be higher in the placebo group (P = .0511). Postoperative pain (P = .01) and interference with daily activities (P = .01) appeared to be significantly lower for the antibiotic group after 7 days. Those patients with implant failure reported higher pain (based on the VAS scores) after 2 days (P = .003) and after 7 days (P = .0005), higher pain (based on the amount of analgesics used) after 7 days (P = .001) and higher interference with daily activities (based on the VAS scores) after 2 days (P = .005).
The study concludes that the use of prophylactic antibiotics for dental implant surgery may be justified, as it appears to improve implant survival in the short term and also results in less postoperative pain and interference with daily activities. Implant survival may especially benefit from prophylactic antiobiotics when the surgical procedure is prolonged due to its difficulty, high number of implants placed, or operator’s inexperience.
(Source: Nolan R, Kemmoona M, Polyzois I, Claffey N. The influence of prophylactic antibiotic administration on post-operative morbidity in dental implant surgery. A prospective double blind randomized controlled clinical trial. Clinical Oral Implant Research; DOI: 10.1111/clr.12124; published online February 13, 2013; John Wiley & Sons A/S, Blackwell Publishing Ltd)
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