Volume 26, Issue S11 pp. 1-14
EAO Consensus Report

Complex systematic review - Perioperative antibiotics in conjunction with dental implant placement

Bodil Lund

Corresponding Author

Bodil Lund

Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden

Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden

Corresponding author:

Bodil Lund, DDS

Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, S-141 86 Stockholm, Sweden

Tel.: +46858583950

Fax: +46858583522

e-mail: [email protected]

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Margareta Hultin

Margareta Hultin

Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden

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Sofia Tranæus

Sofia Tranæus

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

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Aron Naimi-Akbar

Aron Naimi-Akbar

Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden

Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden

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Björn Klinge

Björn Klinge

Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden

Department of Periodontology, Faculty of Odontology, Malmo University, Malmo, Sweden

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First published: 16 June 2015
Citations: 59

Abstract

Objectives

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.

Material and 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.

Conclusion

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.

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