The purpose of this study was to compare the efficacy of two antibiotic regimens in reducing early dental implant failure. A preoperative single-dose regimen and a 3-day antibiotic course were compared. Eighty subjects needing dental implant placement were randomly allocated to one of the two antibiotic prophylaxis regimen groups. In the first group, dental implants were placed after the administration of a single preoperative dose of antibiotic (1 g of amoxicillin); no postoperative antibiotics were given. In the second group, dental implants were inserted in patients who received the same preoperative dose of antibiotic as the first group, but the antibiotic was then continued postoperatively for 3 days. Patients returned for postoperative evaluation at 3 days, 7 days, and 12 weeks. The surgical sites were assessed for pain, swelling, wound dehiscence, and pus formation. No statistically significant difference was observed between the two groups, probably because of the limited number of patients. Although minor complications were seen in a few patients, all implants were successfully osseointegrated. Until a study with a larger population rules definitively on the role of antibiotics in implant surgery, a single dose of antibiotic before implant placement may be sufficient.
No one can deny the importance of antibiotics in our life, whether used to cure an infection or as a prophylactic against one. Nowadays, it is widely agreed by health professionals that the overall use of antibiotics should be reduced. This is to conserve antibiotics for use in life-threatening infections and to reduce the development of bacterial resistance to the antibiotics that are available. The use of prophylactic antibiotics before oral surgical procedures in patients at risk of endocarditis or in those who are severely immunocompromised is well established.
Dental implant placement has a high success rate, ranging from 95% to 99%, but there is a group of cases in which implants fail. Infection is thought to play an important role in that failure, as implant placement surgery is of the clean–contaminated type. Many different techniques have been used to avoid implant infection during surgical placement, such as the use of chlorhexidine mouth rinse before the intervention, double aspiration to avoid salivary contamination of the surgical wound, reducing the amount of saliva secreted using atropine, and the use of various prophylactic antibiotic regimens.
The benefits of antibiotic prophylaxis in relatively normal patients undergoing routine surgical procedures, such as the placement of endosseous dental implants, remains a controversial issue. Whereas some studies have found little or no evidence of the benefits of prophylactic antibiotics, and that there are major adverse risks associated with the use of antibiotics, other studies have found the opposite.
Although many studies have been done to evaluate the role of antibiotics in oral implantology, no standard regimen or protocol for the proper use of antibiotics during implant placement is available. Various antibiotic regimens have been suggested: preoperative single or multiple doses, postoperative single or multiple doses for several days, or a preoperative followed by a postoperative dose. When antibiotic prophylaxis is indicated, an appropriate spectrum antibiotic should be taken preoperatively as a single dose, the antibiotic must be present at a certain concentration in the blood stream prior to the incision, and it should be discontinued postoperatively.
The null hypothesis of the present study was that a preoperative single-dose antibiotic would be as effective as a 3-day antibiotic course. The purpose of this study was to compare the efficacy of two antibiotic regimens in reducing early dental implant failure. A preoperative single dose and a 3-day antibiotic course were compared.
Materials and methods
Eighty patients (50 females and 30 males) needing dental implant placement as part of their treatment plan, were selected to participate in this study; these patients visited the dental clinic during the period September 2010 to December 2012. This study followed the principles of the Declaration of Helsinki with regard to the medical protocol and ethics, and was approved by the institutional ethics review board. Details of the treatment were discussed with the patients and all signed an informed consent agreement. All the patients were medically free and ranged in age from 20 to 45 years (mean age 31.1 years).
Patients were excluded from the study if they had a medical condition that mandated prophylactic antibiotic treatment before the surgical intervention, had taken antibiotics in the last month, were pregnant, needed bone grafting or extensive surgery, were younger than 18 years, or had any systemic disease that may affect healing or predispose to infection.
The patients were divided into two groups by simple randomization procedure: a computer-generated list of random numbers was used with a randomization ratio of 1:1 using Random Allocation Software (version 1.0, May 2004). One nurse blinded to the protocol enrolled all participants and assigned them to one of the two groups. In the first group, a single dose of 1 g oral amoxicillin was given 1 h preoperatively, with no antibiotics given postoperatively; 47 implants were placed in this group. In the second group, 1 g oral amoxicillin was given 1 h preoperatively and this was followed by postoperative oral doses of 500 mg amoxicillin every 8 h for 3 days; 43 implants were inserted in this group. All the implants used in this study were a titanium root-form implant (Vitane, Strasbourg, France). All implants were placed by the author and in accordance with the manufacturer’s recommended protocol. All the implants were inserted through a short crestal incision under local anaesthesia. A two-stage technique was used in which the implants were left to heal submerged in the bone for 3 months.
Both groups were asked to rinse with 0.12% chlorhexidine mouth wash for 1 min before the procedure. Postoperatively, the patients were advised to use the same mouth wash for 5 days and analgesics (paracetamol 500 mg four times daily) as needed. At the end of implant insertion, postoperative radiographs were taken and the patients were asked to return for postoperative evaluation at 3 days, 7 days, and 12 weeks. At the follow-up appointments, the surgical sites were assessed for wound dehiscence and any signs of wound or implant infection. Postoperative wound infection was defined as the presence of swelling, pain, erythema, tenderness, or pus formation at the site of surgery. For the diagnosis of apical peri-implantitis, apical radiolucency needed to be present around the implant, in addition to the previously mentioned signs and symptoms.
At the 12-week visit, another radiograph was taken to evaluate healing and to exclude any signs of a peri-implant infection. The second surgery for exposure of the implants was then performed and healing caps attached and torqued to 25 N cm. Any implant with good stability at 25 N cm with the absence of any clinical or radiographic sign of infection was considered successfully osseointegrated, and the patient was referred to the prosthodontics department to arrange the final prosthesis.
Data were analyzed by Chi-square test and Fisher’s test using SPSS version 14.0 software (SPSS Inc., Chicago, IL, USA). Statistical significance was considered for P < 0.05.