Antibiotic prophylaxis at dental implant placement: Which is the best protocol? A systematic review and network meta-analysis
Corresponding Author
Mario Romandini
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Institute of Dentistry and Maxillofacial, Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
PhD Candidate and Postgraduate Student in the EFP Program in Periodontology at Complutense University, Madrid, Spain
Correspondence
Mario Romandini, Giovanni XXIII square, 24 - 74123 Taranto - Italy.
Email: [email protected]
Search for more papers by this authorIlaria De Tullio
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Search for more papers by this authorFrancesca Congedi
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Search for more papers by this authorMattia D‘Ambrosio
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Unit of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Search for more papers by this authorCiro Quaranta
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Search for more papers by this authorJacopo Buti
Unit of Periodontology, Eastman Dental Institute - University College London, London, UK
Search for more papers by this authorGiorgio Perfetti
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Search for more papers by this authorCorresponding Author
Mario Romandini
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Institute of Dentistry and Maxillofacial, Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
PhD Candidate and Postgraduate Student in the EFP Program in Periodontology at Complutense University, Madrid, Spain
Correspondence
Mario Romandini, Giovanni XXIII square, 24 - 74123 Taranto - Italy.
Email: [email protected]
Search for more papers by this authorIlaria De Tullio
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Search for more papers by this authorFrancesca Congedi
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Search for more papers by this authorMattia D‘Ambrosio
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Unit of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Search for more papers by this authorCiro Quaranta
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Search for more papers by this authorJacopo Buti
Unit of Periodontology, Eastman Dental Institute - University College London, London, UK
Search for more papers by this authorGiorgio Perfetti
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
Search for more papers by this authorAbstract
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 (i) handsearching on both relevant journals and reference lists, and (ii) 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 3 g of amoxicillin administered 1 hr pre-operatively. Even if the single pre-operative dose of 2 g 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. Whenever an antibiotic prophylaxis is needed, 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. Prospero registration number: CRD42015029708.
Supporting Information
| Filename | Description |
|---|---|
| jcpe13080-sup-0001-TableS1-S6.docxWord document, 49.6 KB | |
| jcpe13080-sup-0002-AppendixS1-S6.docxWord document, 27.4 KB | |
| jcpe13080-sup-0003-AppendixS7.docxWord document, 424.3 KB |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- Abu-Ta'a, M., Quirynen, M., Teughels, W., & van Steenberghe, D. (2008). Asepsis during periodontal surgery involving oral implants and the usefulness of peri-operative antibiotics: A prospective, randomized, controlled clinical trial. Journal of Clinical Periodontology, 35, 58–63.
- Anitua, E., Aguirre, J. J., Gorosabel, A., Barrio, P., Errazquin, J. M., Roman, P., … Orive, G. (2009). A multicentre placebo-controlled randomised clinical trial of antibiotic prophylaxis for placement of single dental implants. European Journal of Oral Implantology, 2, 283–292.
- Arduino, P. G., Tirone, F., Schiorlin, E., & Esposito, M. (2015). Single preoperative dose of prophylactic amoxicillin versus a 2-day postoperative course in dental implant surgery: A two-centre randomised controlled trial. European Journal of Oral Implantology, 8, 143–149.
- Ata-Ali, J., Ata-Ali, F., & Ata-Ali, F. (2014). Do antibiotics decrease implant failure and postoperative infections? A systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery, 43, 68–74. https://doi.org/10.1016/j.ijom.2013.05.019
- Buti, J., Glenny, A. M., Worthington, H. V., Nieri, M., & Baccini, M. (2011). Network meta-analysis of randomised controlled trials: Direct and indirect treatment comparisons. European Journal of Oral Implantology, 4, 55–62.
- Caiazzo, A., Casavecchia, P., Barone, A., & Brugnami, F. (2011). A pilot study to determine the effectiveness of different amoxicillin regimens in implant surgery. Journal of Oral Implantology, 37, 691–696. https://doi.org/10.1563/AAID-JOI-D-09-00134.1
- Chaimani, A., & Salanti, G. (2015). Visualizing assumptions and results in network meta-analysis: The network graphs package. Stata Journal, 15, 905–950. https://doi.org/10.1177/1536867X1501500402
- Chrcanovic, B. R., Albrektsson, T., & Wennerberg, A. (2014). Prophylactic antibiotic regimen and dental implant failure: A meta-analysis. Journal of Oral Rehabilitation, 41, 941–956. https://doi.org/10.1111/joor.12211
- El-Kholey, K. E. (2014). Efficacy of two antibiotic regimens in the reduction of early dental implant failure: A pilot study. International Journal of Oral and Maxillofacial Surgery, 43, 487–490. https://doi.org/10.1016/j.ijom.2013.09.013
- Esposito, M., Cannizzaro, G., Bozzoli, P., Checchi, L., Ferri, V., Landriani, S., … Felice, P. (2010). Effectiveness of prophylactic antibiotics at placement of dental implants: A pragmatic multicentre placebo-controlled randomised clinical trial. European Journal of Oral Implantology, 3, 135–143.
- Esposito, M., Cannizzaro, G., Bozzoli, P., Consolo, U., Felice, P., Ferri, V., … Torchio, C. (2008). Efficacy of prophylactic antibiotics for dental implants: A multicentre placebo-controlled randomised clinical trial. European Journal of Oral Implantology, 1, 23–31.
- Esposito, M., Grusovin, M. G., & Worthington, H. V. (2013) Interventions for replacing missing teeth: Antibiotics at dental implant placement to prevent complications. Cochrane Database Systematic Review (13): Cd004152.
- Harbarth, S., Samore, M. H., Lichtenberg, D., & Carmeli, Y. (2000). Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation, 101, 2916–2921. https://doi.org/10.1161/01.CIR.101.25.2916
- Higgins, J.P.T., Altman, D.G., & Sterne, J.A.C. (2011). Chapter 8: Assessing risk of bias in included studies. In J.P.T. Higgins, S. Green (Eds.), Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). (updated March 2011). The Cochrane Collaboration. Retrieved from http://www.handbook.cochrane.org
- Higgins, J.P.T., & Green, S. (2011). Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0) (updated March 2011). The Cochrane Collaboration. Retrieved from http://www.handbook.cochrane.org.
- Hutton, B., Salanti, G., Caldwell, D. M., Chaimani, A., Schmid, C. H., Cameron, C., … Moher, D. (2015). The prisma extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Annals of Internal Medicine, 162, 777–784. https://doi.org/10.7326/M14-2385
- Jackson, D., Barrett, J. K., Rice, S., White, I. R., & Higgins, J. P. (2014). A design-by-treatment interaction model for network meta-analysis with random inconsistency effects. Statistics in Medicine, 33, 3639–3654. https://doi.org/10.1002/sim.6188
- John, M. T., Michalowicz, B. S., Kotsakis, G. A., & Chu, H. (2017). Network meta-analysis of studies included in the Clinical Practice Guideline on the nonsurgical treatment of chronic periodontitis. Journal of Clinical Periodontology, 44, 603–611. https://doi.org/10.1111/jcpe.12726
- Klinge, B., Flemming, T., Cosyn, J., De Bruyn, H., Eisner, B. M., Hultin, M., … Schliephake, H. (2015). Te patient undergoing implant therapy. Summary and consensus statements. The 4th eao consensus conference 2015. Clinical Oral Implants Research, 26(Suppl 11), 64–67. https://doi.org/10.1111/clr.12675
- Lefebvre, C., Manheimer, E., & Glanville, J. (2011). Chapter 6: Searching for studies. In J.P.T. Higgins & S. Green (Eds.), Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). (updated March 2011). The Cochrane Collaboration. Retrieved from http://www.handbook.cochrane.org.
- Lund, B., Hultin, M., Tranaeus, S., Naimi-Akbar, A., & Klinge, B. (2015). Complex systematic review - perioperative antibiotics in conjunction with dental implant placement. Clinical Oral Implants Research, 26(Suppl 11), 1–14. https://doi.org/10.1111/clr.12637
- McGowan, K., McGowan, T., & Ivanovski, S. (2018). Optimal dose and duration of amoxicillin-plus-metronidazole as an adjunct to non-surgical periodontal therapy: A systematic review and meta-analysis of randomized, placebo-controlled trials. Journal of Clinical Periodontology, 45, 56–67. https://doi.org/10.1111/jcpe.12830
- Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The prisma statement. BMJ, 339, b2535. https://doi.org/10.1136/bmj.b2535
- Moslemi, N., Karami, Z., Miandoab, A. S., Masoumi, S., Shayesteh, Y. S., Karimi, A., & Ghoncheh, Z. (2015). The efficacy of long-term post-operative antibiotic therapy versus placebo on dental implants. Thrita, 4(3), e30678.
10.5812/thrita.30678 Google Scholar
- Newell, D. J. (1992). Intention-to-treat analysis: Implications for quantitative and qualitative research. International Journal of Epidemiology, 21, 837–841. https://doi.org/10.1093/ije/21.5.837
- Nolan, R., Kemmoona, M., Polyzois, I., & Claffey, N. (2014). The influence of prophylactic antibiotic administration on post-operative morbidity in dental implant surgery. A prospective double blind randomized controlled clinical trial. Clinical Oral Implants Research, 25, 252–259. https://doi.org/10.1111/clr.12124
- Salanti, G., Ades, A. E., & Ioannidis, J. P. (2011). Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: An overview and tutorial. Journal of Clinical Epidemiology, 64, 163–171. https://doi.org/10.1016/j.jclinepi.2010.03.016
- Salanti, G., Del Giovane, C., Chaimani, A., Caldwell, D. M., & Higgins, J. P. (2014). Evaluating the quality of evidence from a network meta-analysis. PLoS ONE, 9, e99682. https://doi.org/10.1371/journal.pone.0099682
- Schwartz, A. B., & Larson, E. L. (2007). Antibiotic prophylaxis and postoperative complications after tooth extraction and implant placement: A review of the literature. Journal of Dentistry, 35, 881–888. https://doi.org/10.1016/j.jdent.2007.08.003
- Sharaf, B., Jandali-Rifai, M., Susarla, S. M., & Dodson, T. B. (2011). Do perioperative antibiotics decrease implant failure? Journal of Oral and Maxillofacial Surgery, 69, 2345–2350. https://doi.org/10.1016/j.joms.2011.02.095
- Tan, W. C., Ong, M., Han, J., Mattheos, N., Pjetursson, B. E., Tsai, A. Y., … Lang, N. P. (2014). Effect of systemic antibiotics on clinical and patient-reported outcomes of implant therapy - a multicenter randomized controlled clinical trial. Clinical Oral Implants Research, 25, 185–193. https://doi.org/10.1111/clr.12098
- Tandan, M., Vellinga, A., Bruyndonckx, R., Little, P., Verheij, T., Butler, C. C., … Coenen, S. (2017). Adverse effects of amoxicillin for acute lower respiratory tract infection in primary care: Secondary and subgroup analysis of a randomised clinical trial. Antibiotics (Basel), 6, E36. https://doi.org/10.3390/antibiotics6040036
- Tu, Y. K., & Faggion, C. M. Jr (2012). A primer on network meta-analysis for dental research. ISRN Dentistry, 2012, 276520.
- Tu, Y. K., Needleman, I., Chambrone, L., Lu, H. K., & Faggion, C. M. Jr (2012). A bayesian network meta-analysis on comparisons of enamel matrix derivatives, guided tissue regeneration and their combination therapies. Journal of Clinical Periodontology, 39, 303–314. https://doi.org/10.1111/j.1600-051X.2011.01844.x
- Tu, Y. K., Woolston, A., & Faggion, C. M. Jr (2010). Do bone grafts or barrier membranes provide additional treatment effects for infrabony lesions treated with enamel matrix derivatives? A network meta-analysis of randomized-controlled trials. Journal of Clinical Periodontology, 37, 59–79. https://doi.org/10.1111/j.1600-051X.2009.01499.x
- White, I. R. (2015). Network meta-analysis. Stata Journal, 15, 951–985. https://doi.org/10.1177/1536867X1501500403
- World Health Organization (2014). WHO Library Cataloguing-in-Publication Data. Antimicrobial resistance: global report on surveillance. Retrieved from http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf (accessed 14 July 2017).
Citing Literature
