Lund Bodil, Hultin Margareta, Tranaeus Sofia, Naimi-Akbar Aron, Klinge Björn
Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden.
Clin Oral Implants Res. 2015 Sep;26 Suppl 11:1-14. doi: 10.1111/clr.12637. Epub 2015 Jun 16.
The aim of this study was to revisit the available scientific literature regarding perioperative antibiotics in conjunction with implant placement by combining the recommended methods for systematic reviews and complex systematic reviews.
A search of Medline (OVID), The Cochrane Library (Wiley), EMBASE, PubMed and Health technology assessment (HTA) organizations was performed, in addition to a complementary hand-search. Selected systematic reviews and primary studies were assessed using GRADE and AMSTAR, respectively. A meta-analysis was performed.
The literature search identified 846 papers of which 10 primary studies and seven systematic reviews were included. Quality assessment of the systematic reviews revealed two studies of moderate risk of bias and five with high risk of bias. The two systematic reviews of moderate risk of bias stated divergent numbers needed to treat (NNT) to prevent one patient from implant failure. Four of the primary studies comparing antibiotic prophylaxis with placebo were estimated to be of low, or moderate, risk of bias and subjected to meta-analysis. The NNT was 50 (pooled RR 0.39, 95% CI 0.18, 0.84; P = 0.02). None of these four studies individually show a statistical significant benefit of antibiotic prophylaxis. Furthermore, narrative analysis of the studies eligible for meta-analysis reveals clinical heterogeneity regarding intervention and smoking.
Antibiotic prophylaxis in conjunction with implant placement reduced the risk for implant loss by 2%. However, the sub-analysis of the primary studies suggests that there is no benefit of antibiotic prophylaxis in uncomplicated implant surgery in healthy patient.
本研究旨在结合系统评价和复杂系统评价的推荐方法，重新审视有关种植体植入围手术期使用抗生素的现有科学文献。
除了补充手工检索外，还对医学期刊数据库（OVID）、考克兰图书馆（Wiley）、荷兰医学文摘数据库、美国国立医学图书馆生物医学信息数据库和卫生技术评估（HTA）机构进行了检索。分别使用推荐分级的评估、制定和评价（GRADE）以及测量工具改编的系统评价（AMSTAR）对选定的系统评价和原始研究进行评估。进行了荟萃分析。
文献检索共识别出846篇论文，其中纳入了10项原始研究和7项系统评价。系统评价的质量评估显示，两项研究存在中度偏倚风险，五项存在高度偏倚风险。两项中度偏倚风险的系统评价给出了预防一例患者种植体失败所需的不同治疗人数（NNT）。四项比较抗生素预防与安慰剂的原始研究估计存在低或中度偏倚风险，并进行了荟萃分析。NNT为50（合并相对危险度0.39，95%置信区间0.18，0.84；P = 0.02）。这四项研究中没有一项单独显示抗生素预防具有统计学显著益处。此外，对符合荟萃分析条件的研究进行的叙述性分析揭示了干预措施和吸烟方面的临床异质性。
种植体植入时使用抗生素预防可使种植体丢失风险降低2%。然而，对原始研究的亚组分析表明，在健康患者的非复杂性种植手术中，抗生素预防没有益处。
