Antibiotic Prophylaxis in Dental Implant Procedures: Evidence from a Systematic Review

Antibiotics are antimicrobial drugs active against bacterial strains, acting as bacteriostatic or bactericidal, thereby facilitating elimination by the host’s immune system [1]. However, the widespread and often inappropriate use of antibiotics has played a key role in the rise and propagation of antibiotic-resistant bacteria, posing a significant global health threat [2]. The global prevalence of antibiotic resistance should be a cause for concern as resistant microbes may play a role in exacerbating or hindering the treatment of chronic inflammatory diseases and infections. Prudent antibiotic use is therefore essential to mitigate this growing problem.

Placement of dental implants has become a standard clinical approach for replacing missing teeth, whether due to extraction or congenital absence. Its popularity stems from high reported success rates and long-term stability [3]. Antibiotics are commonly prescribed before implant surgery to lower the risk of early implant failure. However, current guidelines regarding this practice are inconsistent. Notably, discrepancies exist between recommendations from UK professional bodies such as the FGDP and the FDS, with some guidelines advising against routine antibiotic use for implant placement [4].

Conflicting evidence further complicates this issue. While some studies, such as that by Anitua (2009), suggest that antibiotic prophylaxis may not be necessary for single implant placement, others, such as Esposito (2013), have proposed it as essential [5, 6]. This lack of consensus underscores the need for a comprehensive evaluation of the existing evidence.

The association between the use of antibiotics and the emergence of resistance informs the question: Does the use of antibiotic prophylaxis in dental implant procedures effectively prevent post-operative complications in healthy patients, or does it contribute unnecessarily to the broader problem of antibiotic resistance?

The aim of this systematic review is to establish whether antibiotic prophylaxis contributes to a reduction in post-operative complications following dental implant placement by systematically searching and assessing the current available evidence to inform recommendations for targeted, individualized antibiotic use that could be incorporated into the management and prevention of implant failure.

Protocol Registration

PRISMA, Preferred Reporting Items for Systematic Reviews and Met-Analysis, principles were applied when designing and implementing the question and research strategy for the systematic review using the PRISMA 2020 statement. The study protocol was registered with PROSPERO (ID CRD42025633888) [7].

The principles of PICO, Population, Intervention, Comparison, and Outcomes, were applied:

Population (P): Healthy individuals undergoing dental implant treatment (possessing no comorbidities).
Intervention (I): Preoperative administration of antibiotic prophaylaxis.
Comparison (C): Absence of prophylactic antibiotics (placebo / no intervention).
Outcomes (O): Implant failure, implant success, and postoperative infection.

Source and search strategy for electronic databases

The search strategy included an electronic search of the database, PubMed (MEDLINE). The search strategy utilized a combination of keywords and Medical Subject Headings (MeSH terms), including: “dental implant,” “implants,” “prophylaxis,” “prophylactic antibiotics,” and “antibiotics.” Various combinations of these terms, using Boolean operators (AND, OR, NOT), were employed to maximize search sensitivity. The date the searches were performed was up to January 2025.

Study and data extraction

Eligibility criteria
The inclusion criteria applied to the studies identified from the search strategy were:
• Participants: Systemically stable adult patients undergoing dental implant treatment.
• Intervention: Pre-surgical administration of prophylactic antibiotics (any type, dosage, route, time of administration within 1 hour of surgery).
• Comparison: Control group receiving placebo or no intervention.
• Study Design: Randomized controlled trials (RCTs).
• Publication Characteristics: English language, available full text.
The exclusion criteria applied to the studies identified from the search strategy were:
• Patients with systemic conditions increasing infection risk or impairing osseointegration.
• Concomitant interventions confounding prophylaxis assessment.
• Studies primarily comparing different antibiotic types/ dosages/routes.
• Non-RCT study designs.
• Non-English language or unavailable full text.

Data extraction
Two independent reviewers screened titles and abstracts of retrieved records based on pre-defined inclusion and exclusion criteria. Full texts of potentially eligible studies were then extracted and independently reviewed by the same two reviewers. Discrepancies at both stages were resolved through discussion or consultation with a third reviewer. The process of selecting studies for the research was recorded using a PRISMA flow diagram, which visually outlines each step of the selection.

A standardized data extraction form was developed. Two independent reviewers extracted data from included studies (n = 4), with discrepancies resolved by discussion. The following data were extracted: Author, Year, Design, Sample Size, Mean Age (Years), Male Percentage, Female Percentage, Antibiotic Dose and Group, Control Group, Ratio of Failed to Success in Antibiotic Group, Ratio of Failed to Success in Control Group, and Post-op Infection Percentage. Data were recorded in a pre-designed spreadsheet structured to facilitate data analysis. Any discrepancies encountered during data extraction were documented and resolved through discussion.

Study selection

An electronic search of the databases was conducted on up to January 2025. Four studies were identified for full paper searches. Four studies fulfilled the criteria, thus were eligible for inclusion in the systematic review. Figure 1 shows the Flow Chart adapted from the PRISMA Model.

Study characteristics

The characteristics of the four eligible studies are summarised in Table 1. All studies were randomised control trials. The studies were published between 2008 and 2022. The sample sizes ranged from 62, to 473. The mean ages of participants ranged from 47.85 to 57.4 years. All studies compared preoperative antibiotic prophylaxis with a placebo control. Table 1 gives details of the studies.

Table 1:Characteristics of Included Studies.

Risk of bias within and across the studies

The risk of bias assessment using the Cochrane Risk of Bias 2 tool suggested a generally low risk of bias across the included studies. There were some minor issues regarding blinding in some of the studies, as complete details of blinding techniques were not always reported.

Synthesis of results

A meta-analysis of the results was not plausible due to the small number of studies; therefore, a narrative synthesis was used.

Changes in Implant Failure, in relation to antibiotic prophylaxis across the studies

Palwasha (2022) reported a low failure rate in both the antibiotic (2.5%) and placebo (2.9%) groups. Gorka (2022) observed a higher failure rate in the clindamycin group (6.8%) compared to no failures in the placebo group. Eduardo (2009) reported similar failure rates in the antibiotic (3.8%) and placebo (3.7%) groups. Marco (2008) observed a lower failure rate in the antibiotic group (1.2%) compared to the placebo group (6%). The evidence on the impact of antibiotics in preventing implant failure is inconsistent. Some studies highlight a possible advantage, while others show no effect or even a tendency toward higher failure rates when antibiotics are used.

Changes in Post-operative Infection, in relation to antibiotic prophylaxis across the studies

All four studies reported on post-operative infection rates. The reported infection rates were generally low across both groups. Palwasha (2022) reported a 1.5% infection rate, Gorka (2022) reported 4.83%, Eduardo (2009) reported 3.8%, and Marco (2008) reported 1.26%. Due to variations in reporting and the small number of events, it is difficult to draw firm conclusions about the effect of antibiotic prophylaxis on post-operative infection.

The interventional studies applied similar principles to the definition of antibiotic prophylaxis. All of the studies observed mixed results for implant failure rates in participants receiving antibiotic prophylaxis when compared with participants who did not receive antibiotic prophylaxis. The evidence for the use of antibiotics to reduce post-operative infection was inconclusive.

The combined evidence suggests that antibiotic prophylaxis in healthy patients undergoing dental implant placement cannot be definitively recommended or discouraged [8-10].

Increasing the number of participants in the interventional studies would have reinforced the validity of the observations, as lower participant numbers amplify the risk of outliers influencing the results.

This systematic review found mixed and inconclusive evidence regarding the effectiveness of antibiotic prophylaxis in preventing implant failure and post-operative infections in healthy patients undergoing dental implant procedures. The small number of included studies, heterogeneity in study design and outcome reporting, and apprehensions about bias restrict the strength of the conclusions. Further well-constructed and sufficiently powered RCTs are needed to clarify the impact of prophylactic antibiotics in this clinical setting.

Conceptualization: Dr. Qazi Jawad Hayat, Dr Radaina,
Methodology:> Dr. Qazi Jawad Hayat, Dr. Radaina
Software: Dr. Naeem Ul Haq, Dr. Ziad Khan, Validation: Dr. Qazi Jawad Hayat, Naeem Ul Haq
Formal analysis: Dr. Radaina, Dr. Ziad Khan, Investigation: Dr. Ziad Khan, Resources: Dr. Naeem Ul Haq, Dr. Ziad Khan Data Curation: Dr. Qazi Jawad Hayat, Dr. Ziad Khan
Writing – Original Draft: Dr. Qazi Jawad Hayat, Writing – Review & Editing: Dr. Qazi Jawad Hayat, Dr Radaina
Visualization: Dr. Qazi Jawad Hayat, Dr. Naeem Ul haq, Supervision: Dr Ziad Khan
Project Administration: Dr. Qazi Jawad Hayat, Dr. Ziad Khan

The authors declare no competing interests. This research did not breach any ethical standards.

The author(s) received no specific funding for this work.

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