August 28, 2011
Many times in implantology we perform procedures based on anecdotal evidence or on dogma. One subject that often come up is whether or not to use antibiotics prophylactically either before or after surgery. This evidence based review seems to indicate that the administration of a single dose of amoxicilling prior to surgery may be of benefit.
Evidence-Based Dentistry (2008) 9, 109–110. doi:10.1038/sj.ebd.6400612
Do preoperative antibiotics prevent dental implant complications?
Does giving antibiotics at the time of dental implant placement prevent complications?
Address for correspondence: Luisa M Fernandez Mauleffinch, Cochrane Oral Health Group, MANDEC, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK. E-mail: firstname.lastname@example.org
Private practitioner, affiliated with Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Esposito M, Grusovin MG, Talati M, Coulthard P, Oliver R, Worthington HV. Intervention for replacing missing teeth: antibiotics at dental implant placement to prevent complications. Cochrane Database Syst Rev 2008, issue 3
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The Cochrane Oral Health Group’s Trials Registry, the Cochrane Central Register of Controlled Trials, Medline and Embase were consulted to find relevant work. Searches were made by hand of numerous journals pertinent to oral implantology. There were no language restrictions.
Randomised controlled clinical trials (RCT) with a followup of at least 3 months were chosen. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.).
Data extraction and synthesis
Two reviewers independently assessed the quality and extracted relevant data from included studies. The estimated effect of the intervention was expressed as a risk ratio together with its 95% confidence interval (CI). Numbers-needed-to-treat (NNT) were calculated from numbers of patients affected by implant failures. Meta-analysis was done only if there were studies with similar comparisons that reported the same outcome measure. Significance of any discrepancies between studies was assessed by means of the Cochran’s test for heterogeneity and the I2 statistic.
Only two RCT met the inclusion criteria. Meta-analysis of these two trials showed a statistically significantly higher number of patients experiencing implant failures in the group not receiving antibiotics (relative risk, 0.22; 95% CI, 0.06–0.86). The NNT to prevent one patient having an implant failure is 25 (95%CI, 13–100), based on a patient implant failure rate of 6% in people not receiving antibiotics. The following outcomes were not statistically significantly linked with implant failure: prosthesis failure, postoperative infection and adverse events (eg, gastrointestinal effects, hypersensitivity).
There is some evidence suggesting that 2 g of amoxicillin given orally 1 h preoperatively significantly reduces failures of dental implants placed in ordinary conditions. It remains unclear whether postoperative antibiotics are beneficial, and which is the most effective antibiotic. One dose of prophylactic antibiotics prior to dental implant placement might be recommended.
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Much has been published about implants with a length 10mm or over enjoying greater success than their shorter counterparts. However, Misch et al have published in an evidence based manner to cast some doubt on this. here is the abstract:
Carl E. Misch, Jennifer Steigenga, Eliane Barboza, Francine Misch-Dietsh, Louis J. Cianciola & Christopher Kazor
Implants <10 mm long in the posterior regions of partially edentulous patients have a higher failure rate in many clinical reports. The purpose of this case series study was to evaluate implant survival when a biomechanical approach was used to decrease stress to the bone-implant interface.
A retrospective evaluation of 273 consecutive posterior partially edentulous patients treated with 745 implants, 7 or 9 mm long, supporting 338 restorations over a 1- to 5-year period was reviewed from four private offices. Implant survival data were collected relative to stage I to stage II healing, stage II to prosthesis delivery, and prosthesis delivery to as long as 6 years follow-up.
A biomechanical approach to decrease stress to the posterior implants included splinting implants together with no cantilever load, restoring the patient with a mutually protected or canine guidance occlusion, and selecting an implant designed to increase bone-implant contact surface area.
Results: Of the 745 implants inserted, there were six surgical failures from stage I to stage II healing. All five failures were with a one-stage surgical approach (240 implants). There were two failures from stage II healing to prosthesis delivery. No implants failed after the 338 final implant prostheses were delivered. A 98.9% survival rate was obtained from stage I surgery to prosthetic follow-up.
Short-length implants may predictably be used to support fixed restorations in the posterior partial edentulism. Methods to decrease biomechanical stress to the bone-implant interface appear appropriate for this treatment.
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