• Marco Esposito, Maria Gabriella Grusovin, Minesh Talati, Paul Coulthard, Richard Oliver, and Helen V Worthington.
• Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH. espositomarco@hotmail.com
• Cochrane Db Syst Rev. 2008 Jan 1(3):CD004152.

BackgroundSome dental implant failures may be due to bacterial contamination at implant insertion. Infections around biomaterials are difficult to treat and almost all infected implants have to be removed. In general, antibiotic prophylaxis in surgery is only indicated for patients at risk of infectious endocarditis, for patients with reduced host-response, when surgery is performed in infected sites, in cases of extensive and prolonged surgical interventions and when large foreign materials are implanted. To minimize infections after dental implant placement various prophylactic systemic antibiotic regimens have been suggested. More recent protocols recommended short term prophylaxis, if antibiotics have to be used. With the administration of antibiotics adverse events may occur, ranging from diarrhoea to life-threatening allergic reactions. Another major concern associated with the widespread use of antibiotics is the selection of antibiotic-resistant bacteria. The use of prophylactic antibiotics in implant dentistry is controversial.ObjectivesTo assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the most effective.Search StrategyThe Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to 9th January 2008. Several dental journals were handsearched. There were no language restrictions.Selection CriteriaRandomised controlled clinical trials (RCTs) with a follow up of at least 3 months comparing the administration of various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.).Data Collection And AnalysisScreening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using risk ratios (RRs) for dichotomous outcomes with 95% confidence intervals (CIs). Heterogeneity was to be investigated including both clinical and methodological factors.Main ResultsTwo RCTs were identified: one comparing 2 g of preoperative amoxicillin versus placebo (316 patients) and the other comparing 2 g of preoperative amoxicillin plus 500 mg 4 times a day for 2 days versus no antibiotics (80 patients). The meta-analyses of the two trials showed a statistically significant higher number of patients experiencing implant failures in the group not receiving antibiotics: RR = 0.22 (95% CI 0.06 to 0.86). The number needed to treat (NNT) to prevent one patient having an implant failure is 25 (95% CI 13 to 100), based on a patient implant failure rate of 6% in patients not receiving antibiotics. The other outcomes were not statistically significant, and only two minor adverse events were recorded, one of which in the placebo group.Authors' ConclusionsThere is some evidence suggesting that 2 g of amoxicillin given orally 1 hour preoperatively significantly reduce failures of dental implants placed in ordinary conditions. It remains unclear whether postoperative antibiotics are beneficial, and which is the most effective antibiotic. It might be recommendable to suggest the use of one dose of prophylactic antibiotics prior to dental implant placement.

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