Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY, USA.
Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, 421 First Avenue - BCCR 2W, New York, NY, 10010, USA.
Clin Oral Investig. 2019 Apr;23(4):1525-1553. doi: 10.1007/s00784-018-2762-x. Epub 2019 Mar 1.
The purpose of the present systematic review and meta-analysis is to determine the efficacy of antibiotic prophylaxis and specific antibiotic regimens in dental implant placement for prevention of post-operative infection (POI) in overall healthy patients.
Electronic database and manual searches were independently conducted to identify randomized controlled trials (RCTs). Publications were selected on basis of eligibility criteria and then assessed for risk-of-bias using the Cochrane Handbook. The primary outcome was POI (total, early, and late). Wound dehiscence, pain, and adverse events were studied as secondary outcomes. Random-effects meta-analysis was conducted for risk ratios of dichotomous data. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.
With duplicates removed, 1022 abstracts were screened and 22 full-text articles assessed; 10 RCTs of 1934 total patients were included. Meta-analysis did not detect statistically significant differences in total (P = 0.82), early (1-2 week post-op) (P = 0.57), or late (3-4 months post-op) (P = 0.66) POIs, wound dehiscence (P = 0.31), and adverse events (P = 0.21), between antibiotic and no-antibiotic groups. Confounding variables identified.
The results of this systematic review suggest that antibiotic prophylaxis may not be indicated for prevention of POIs following dental implant placement in overall healthy patients. These findings and in light of antibiotic-associated risks for individual and public health demand revaluation of routine prescription of antibiotic prophylaxis in dental implant placement procedures.
It is up to the clinicians to evaluate the benefits (or lack thereof) of antibiotic prophylaxis for each patient given medical history and surgical complexity, until new evidence becomes available.
本系统评价和荟萃分析的目的是确定在整体健康患者中，预防种植牙术后感染（POI）的抗生素预防和特定抗生素方案的疗效。
电子数据库和手工搜索独立进行，以确定随机对照试验（RCT）。根据入选标准选择出版物，然后使用 Cochrane 手册评估偏倚风险。主要结局是 POI（总、早、晚）。研究了伤口裂开、疼痛和不良事件作为次要结局。对二分类数据的风险比进行了随机效应荟萃分析。本系统评价符合系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。
去除重复项后，筛选了 1022 篇摘要，并评估了 22 篇全文文章；纳入了 10 项 RCT 共 1934 名患者。荟萃分析未发现总 POI（术后 1-2 周）（P=0.57）或晚 POI（术后 3-4 个月）（P=0.66）、伤口裂开（P=0.31）和不良事件（P=0.21）方面抗生素组和非抗生素组之间有统计学意义的差异。确定了混杂变量。
本系统评价的结果表明，在整体健康患者中，预防种植牙术后感染可能不需要抗生素预防。鉴于抗生素与个体和公共健康相关的风险，需要重新评估在种植牙手术中常规应用抗生素预防的必要性。
在新证据出现之前，临床医生应根据患者的病史和手术复杂性，评估抗生素预防对每个患者的益处（或缺乏益处）。
