Prophylactic antibiotic regimens in dental implant failure: A systematic review and meta-analysis.
Amoxicillin
antibiotic prophylaxis
complications
dental implants
implant failure
Journal
Journal of the American Dental Association (1939)
ISSN: 1943-4723
Titre abrégé: J Am Dent Assoc
Pays: England
ID NLM: 7503060
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
04
04
2018
revised:
17
10
2018
accepted:
22
10
2018
pubmed:
24
4
2019
medline:
19
12
2019
entrez:
24
4
2019
Statut:
ppublish
Résumé
In this systematic review and meta-analysis, the authors examine the efficacy of antibiotic prophylaxis (AP) and specific antibiotic regimens for prevention of dental implant failure in patients who are healthy overall. The authors independently conducted electronic database and manual searches to identify randomized controlled trials (RCTs). The authors selected articles on the basis of eligibility criteria and assessed for risk of bias by using the Cochrane Handbook. Implant failure was the primary outcome studied; perimucositis or implantitis, prosthetic failure, and adverse events were secondary outcomes studied. The authors conducted random effects meta-analysis for risk ratios of dichotomous data and used OpenMeta[Analyst] (Center for Evidence Synthesis, Brown School of Public Health) for qualitative assessment of administration schedules. With duplicates removed, the authors screened 1,022 abstracts, reviewed 21 full-text articles, and included 8 RCTs that included 2,869 implants in 1,585 patients. Meta-analysis results indicated that AP resulted in a statistically significantly lower number of implant failures for all regimens combined (implant, P = .005; patient, P = .002), as well as preoperative (implant, P = .01; patient, P = .007), pre- and postoperative (implant, P = .04), and postoperative AP only (implant, P = .02), compared with no antibiotics. The authors found no statistically significant differences in analysis of comparative antibiotic treatments or secondary outcomes. The authors identified confounding variables. Although meta-analysis results suggested that AP may reduce implant failure, definitive conclusions cannot be achieved yet. The overall nonsignificant differences reported in individual trials, limitations discussed, implant infection outcomes, and antibiotic-associated risks must be considered. Thus, the results for implant failure outcomes may not warrant the indiscriminate use of antibiotics in patients who are healthy who are receiving dental implants. Investigators must conduct large-scale RCTs to determine the efficacy of AP and various regimens, independent of confounding variables.
Sections du résumé
BACKGROUND
In this systematic review and meta-analysis, the authors examine the efficacy of antibiotic prophylaxis (AP) and specific antibiotic regimens for prevention of dental implant failure in patients who are healthy overall.
TYPES OF STUDIES REVIEWED
The authors independently conducted electronic database and manual searches to identify randomized controlled trials (RCTs). The authors selected articles on the basis of eligibility criteria and assessed for risk of bias by using the Cochrane Handbook. Implant failure was the primary outcome studied; perimucositis or implantitis, prosthetic failure, and adverse events were secondary outcomes studied. The authors conducted random effects meta-analysis for risk ratios of dichotomous data and used OpenMeta[Analyst] (Center for Evidence Synthesis, Brown School of Public Health) for qualitative assessment of administration schedules.
RESULTS
With duplicates removed, the authors screened 1,022 abstracts, reviewed 21 full-text articles, and included 8 RCTs that included 2,869 implants in 1,585 patients. Meta-analysis results indicated that AP resulted in a statistically significantly lower number of implant failures for all regimens combined (implant, P = .005; patient, P = .002), as well as preoperative (implant, P = .01; patient, P = .007), pre- and postoperative (implant, P = .04), and postoperative AP only (implant, P = .02), compared with no antibiotics. The authors found no statistically significant differences in analysis of comparative antibiotic treatments or secondary outcomes. The authors identified confounding variables.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Although meta-analysis results suggested that AP may reduce implant failure, definitive conclusions cannot be achieved yet. The overall nonsignificant differences reported in individual trials, limitations discussed, implant infection outcomes, and antibiotic-associated risks must be considered. Thus, the results for implant failure outcomes may not warrant the indiscriminate use of antibiotics in patients who are healthy who are receiving dental implants. Investigators must conduct large-scale RCTs to determine the efficacy of AP and various regimens, independent of confounding variables.
Identifiants
pubmed: 31010572
pii: S0002-8177(18)30725-6
doi: 10.1016/j.adaj.2018.10.015
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Dental Implants
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e61-e91Informations de copyright
Copyright © 2019 American Dental Association. Published by Elsevier Inc. All rights reserved.