Mazzocchi Alberto, Passi Luca, Moretti Roberto
Private Practice, Bergamo, Italy.
J Oral Maxillofac Surg. 2007 Nov;65(11):2321-3. doi: 10.1016/j.joms.2007.06.620.
The routine use of antibiotics in oral implant treatment seems to be widespread. The principle of antibiotic prophylaxis before oral surgical procedures in patients at risk for endocarditis or in those who are severely immunocompromised is well established. Antibiotic therapy in conjunction with implant surgery in fit patients and its correlation with failure and success rates remains poorly documented, however. The debate regarding overprescription of antibiotics raises the need for a critical evaluation of proper antibiotic coverage in association with implant treatment. The purpose of this study was to retrospectively show and value the outcomes of dental implant treatment without antibiotic prophylaxis.
The study included 437 consecutively treated patients, in whom a total of 736 implants were placed. The population received no prophylactic antibiotics, but received anti-inflammatory therapy (nimesulide 100 mg twice daily or Arnica montana 5C 3 times a day) for 3 days postoperatively. Healing was evaluated at second-stage surgery (4 to 6 months postoperatively). Failure was defined as removal of the implant due to either signs of infection or nonosseointegration of the implant, according to the criteria for success described by Albrektsson and Coll in 1988.
The implant survival rate in the sample (96.2%) was no lower than the high success rates published in the literature using various antibiotic regimens.
Our findings support the results of several recent reviews of minor use of antibiotics in oral surgery. These findings suggest that the use of antibiotics for routine oral implants may not be as beneficial as once believed and that clinicians should look forward to the reduction of their unnecessary use. The use of antibiotic prophylaxis before oral surgical procedures remains a controversial issue, poorly documented in the literature.
在口腔种植治疗中常规使用抗生素的情况似乎很普遍。对于有感染性心内膜炎风险的患者或严重免疫功能低下者，在口腔外科手术前进行抗生素预防的原则已得到充分确立。然而，对于健康患者在种植手术中联合使用抗生素及其与失败率和成功率的相关性，相关记录仍然很少。关于抗生素过度处方的争论引发了对与种植治疗相关的适当抗生素覆盖范围进行批判性评估的需求。本研究的目的是回顾性地展示和评估不进行抗生素预防的牙种植治疗结果。
本研究纳入了437例连续接受治疗的患者，共植入736颗种植体。所有患者均未接受预防性抗生素治疗，但术后接受了3天的抗炎治疗（尼美舒利100毫克，每日两次；或山金车5C，每日三次）。在二期手术时（术后4至6个月）评估愈合情况。根据1988年阿尔布雷克特松和科尔描述的成功标准，失败定义为因感染迹象或种植体未骨整合而取出种植体。
样本中的种植体存活率（96.2%）不低于文献中使用各种抗生素方案公布的高成功率。
我们的研究结果支持了近期几篇关于口腔外科手术中少量使用抗生素的综述结果。这些结果表明，常规口腔种植使用抗生素可能并不像人们曾经认为的那样有益，临床医生应期待减少不必要的使用。口腔外科手术前使用抗生素预防仍然是一个有争议的问题，文献中相关记录较少。
