Antibiotic Prophylaxis Not Indicated for Postoperative Dental Implant Infection Prevention

Objectives: Routine prescription of prophylactic antibiotics in dental implant placements is controversial in overall healthy patients. In this systematic review and meta-analysis, we aimed to determine the efficacy of antibiotic prophylaxis for prevention of surgical site infections (SSIs).
Methods: Electronic database and manual searches were independently conducted to identify human randomized controlled trials (RCTs). Publications were selected on basis of eligibility criteria and then assessed for risk-of-bias using the Cochrane Handbook. Total, early (1-2 weeks postoperative), and late (3-4 months postoperative) SSIs were the primary outcomes studied; wound dehiscence, pain, and adverse events were the secondary outcomes studied. Random-effects meta-analysis was conducted for risk-ratios of dichotomous data. This review was conducted according to PRISMA guidelines.
Results: With duplicates removed, 1,022 abstracts were screened and 21 full-text articles assessed; eight RCTs of 1,511 total patients were included. Studies were appraised as low risk-of bias overall, albeit three studies were at high-risk and three were at unknown-risk. Individual trials reported no statistically significant differences in any outcomes assessed, with exception of one at a time-point for wound dehiscence and two for patient-reported pain. Meta-analysis did not detect statistically significant differences in total, early, and late SSIs (P_total-SSI=0.82, P_early-SSI=0.57, P_late-SSI=0.66), wound dehiscence (P_dehiscence=0.31), and adverse events (P_{adverseevents}=0.21), between antibiotic and no-antibiotic groups. Qualitative analysis identified a number of confounding variables in patient risks and surgical protocols, including the peri-operative administration of chlorhexidine digluconate rinses in all studies.
Conclusions: Meta-analysis results suggested that antibiotic prophylaxis is not effective for prevention of SSIs. It remains critical to determine the efficacy of antibiotic prophylaxis on SSIs in low-risk patients, independent of chlorhexidine therapy and other confounding variables. Our results, and in light of antibiotics-associated risks for individual and public health, demand reevaluation of routine prescription of prophylactic antibiotics for SSI prevention in dental implant placement.