Use of Antibiotics for Implant Placement: Evidence-Based Protocol?

Dr. A. asks:

As an experienced periodontist, I am always looking for evidenced-based guidance for any surgical technique.

Is anyone aware of any evidence-based protocol for the use of antibiotics routinely for placement of dental implants? In speaking to many other surgical practitioners, there seems to be no standard protocol that is adhered to. It has been suggested to use amoxicillin, tetracycline, clindamycin, and others too many to list. The dosing schedule also varies from pre-surgical to post-surgical start. So where are the studies to validate these antibiotic protocols? What are thoughts?

6 thoughts on “Use of Antibiotics for Implant Placement: Evidence-Based Protocol?

  1. good question!
    Do you medicate your patients for perio surgeries, especially osseous grafts? Saliva and bacteria are going to get in the surgical field-
    The mouth is full of bacteria that could potentially cause implant rejection ; so it seems logical we should do so.

  2. A pubmed search on this topic reveals some interesting studies on this topic. The bottom line for me:

    1. No need for antibiotics at all for healthy patients who receive standard procedures without grafting. Minimal grafting with autogenous bone from the drill might be added to that category.
    There is evidence that bone collected from a filter is sometimes contaminated.
    2. Single shot preoperative antibiotics in all other cases.

    Things have changed ! Just compare the articles of the author Dent CD in 1997 and in 2004.

  3. In Altemeier’s classification, oral surgical procedures are often graded as class II (clean-contaminated surgery), with a rate of local infection of 5 to 15% without antibiotics and <7% with antibiotics. In oral surgery prophylaxis, the target microbiota differs depending on whether the intention is to prevent local complications (cellulitis, abscess) or distant infections (endocardial infections, bone prostheses, joint replacements) in patients at risk who require prophylaxis because of their underlying condition.

    In order to prevent local infections, target microbiota is usually polymicrobial because many species tend to be isolated in pairs (Bacteroides sp. and Fusobacterium; Peptostreptococcus sp. Prevotella sp. and Eubacterium sp.), with a marked aerobic/anaerobic component, and to a much lesser extent microaerophilous component, since these infections originate from the possible surgical contamination/infection from the normal microbiota of the mouth and saliva, and from dental pathogens in a periodontal disease.

    Systemic infections that should be prevented in patients with underlying disease are caused by bacteremia, especially following invasive procedures. Specific prophylaxis against local infection . By remembering the resistance phenotypes (including ß-lactamase production on the part of the habitual anaerobic microbiota and of certain dental pathogens),and the pharmacodynamic coverage required, it might be advisable to use high doses of amoxicillin together with a ß-lactamase inhibitor, such as clavulanic acid.

    In certain circumstances, there is a problem in distinguishing between the term “prophylaxis” and the term “pre-emptive treatment” regarding infection arising from surgery. It has been demonstrated that complications following third molar surgical extraction included infection, and not just inflammation, since significant differences were found in the frequency of infectious complic! ations between groups receiving amoxicillin/clavulanic acid 20! 00/125mg as treatment (5 days), pre-operative prophylaxis (single dose) and placebo (2.7%, 5.3% and 16% respectively). The rate of infectious complications was higher in the case of osteotomy or longer surgery, and in these cases treatment was clearly more effective than prophylaxis or placebo.

    This may also be applicable to implant placement drilling procedures which are considered a kind of osteotomy per se, and may start to present problems in the case of any involvement by streptococci, Pepto-streptococci and anaerobic gram-negative dental pathogenic bacteria.

  4. There are mixed views on this and I don’t know of any published studies except description of sx protocol in articles. I premedicate and use ABX prophylaxis because I think its prudent to prevent something from happening. While I am not paranoid, I do think that in the event there would be litigation, failure to do so could be argued in court. But I do not do it for that. If you look at the medical field, every surgery is premedicated, mostly with IV ABX. JMHO. Bill

  5. The dental implant supplement to the Journal of Oral and Maxillofacial Surgery in 1997 (The influence of preoperative antibiotics on success of endosseous implants up to and including stage II surgery: a study of 2,641 implants. Dent C, Olson J, Farish S, Bellome J, Casino A, Morris H, Ochi S Journal of Oral and Maxillofacial Surgery
    December 1997 (Vol. 55, Issue 12 (Supplement), Pages 19-24)) showed that the use of preoperative antibiotics significantly improved the surival rate of dental implants. In the same journal (The influence of 0.12% chlorhexidine digluconate rinses on the incidence of infectious complications and implant success. Lambert P, Morris H, Ochi S Journal of Oral and Maxillofacial Surgery December 1997 (Vol. 55, Issue 12 (Supplement), Pages 25-30)) also showed that pre-operative rinses with chlorhexidine improved implant survival rates. Because of this, I currently use either an oral or IV dose of pre-operative penicillin-based anitbiotics and chlorhexidine before dental implant placement.

  6. It’s interesting to read why preoperative antibiotics are prescribed. I wished my dentist had educated me on why, so I actually would have taken them before. I am now using them because of the infection after I’ve received the implants.
    Dentists need to talk to their patients more and explain to them why they are doing the things they are doing, I think they’d have a higher success rate of people actually following their instructions.
    I just thought he was being overly cautious.

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