Esposito M, Coulthard P, Oliver R, Thomsen P, Worthington H V
Department of Biomaterials and Department of Prosthetic Dentistry/Dental Material Sciences, The Sahlgrenska Academy at Goteborg University, PO Box 412, Medicinaregatan 8B, Goteborg, Sweden.
Cochrane Database Syst Rev. 2003(3):CD004152. doi: 10.1002/14651858.CD004152.
Some 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 minimise 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 antibiotics in implant dentistry is controversial. It would be useful to know whether prophylactic antibiotics are effective in reducing failures of dental implants.
To assess the beneficial or harmful effects of the administration of prophylactic antibiotics for 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.
We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. We handsearched several dental journals. No language restrictions were applied. Personal contacts and manufacturers of dental implants were contacted to identify unpublished trials. Most recent search: March 2003.
Randomised controlled clinical trials (RCTs) with a follow up of at least 3 months comparing the administration of various prophylactic antibiotics regimens and no antibiotics/placebo to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity).
Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were to be conducted in duplicate and independently by two reviewers. Results were to be expressed as random effects models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval. Heterogeneity was to be investigated including both clinical and methodological factors.
No RCTs were identified.
REVIEWER'S CONCLUSIONS: There is not appropriate scientific evidence to recommend or discourage the use of prophylactic systemic antibiotics to prevent complications and failures of dental implants. Even though the present review did not assess the effectiveness of prophylactic antibiotics for patients at risk for endocarditis, it seems sensible to recommend the use of prophylactic antibiotics for patients at high and moderate risk for endocarditis, with immunodeficiencies, metabolic diseases, irradiated in the head and neck area and when an extensive or prolonged surgery is anticipated.
一些牙种植体失败可能是由于种植时的细菌污染。生物材料周围的感染难以治疗，几乎所有受感染的种植体都必须移除。一般来说，手术中的抗生素预防仅适用于有感染性心内膜炎风险的患者、宿主反应降低的患者、在感染部位进行手术时、进行广泛且长时间的手术干预时以及植入大量异体材料时。为了尽量减少牙种植体植入后的感染，已提出了各种预防性全身抗生素治疗方案。最近的方案建议，如果必须使用抗生素，则进行短期预防。使用抗生素可能会发生不良事件，从腹泻到危及生命的过敏反应不等。与抗生素广泛使用相关的另一个主要问题是抗生素耐药菌的产生。在种植牙科中使用抗生素存在争议。了解预防性抗生素在减少牙种植体失败方面是否有效将是有用的。
评估预防性使用抗生素与不使用抗生素/安慰剂相比，对牙种植体植入的有益或有害影响，如果抗生素有益，找出哪种类型、剂量和疗程最有效。
我们检索了Cochrane口腔健康组试验注册库、Cochrane对照试验中央注册库（CENTRAL）、MEDLINE和EMBASE。我们手工检索了几本牙科杂志。未设语言限制。联系了个人联系人及牙种植体制造商以识别未发表的试验。最近一次检索时间为2003年3月。
随机对照临床试验（RCT），随访至少3个月，比较各种预防性抗生素治疗方案与不使用抗生素/安慰剂对接受牙种植体植入的患者的效果。结局指标为假体失败、种植体失败、术后感染及不良事件（胃肠道、超敏反应）。
由两名 reviewers 独立进行重复筛选符合条件的研究、评估试验的方法学质量及数据提取。结果以随机效应模型表示，连续结局使用加权均数差，二分结局使用相对危险度，并给出95%置信区间。将调查包括临床和方法学因素在内的异质性。
未识别到RCT。
没有适当的科学证据推荐或不推荐使用预防性全身抗生素来预防牙种植体的并发症和失败。尽管本综述未评估预防性抗生素对有感染性心内膜炎风险患者的有效性，但对于有高、中度感染性心内膜炎风险、有免疫缺陷、代谢疾病、头颈部接受过放射治疗以及预计进行广泛或长时间手术的患者，推荐使用预防性抗生素似乎是合理的。
