Department of Orofacial Medicine, Faculty of Odontology, Malmö University, Malmö, SE-20506, Sweden.
Faculty of Odontology, Health Technology Assessment-Odontology (HTA-O), Malmö University, Malmö, Sweden.
BMC Oral Health. 2024 Jul 25;24(1):842. doi: 10.1186/s12903-024-04611-0.
The question of whether antibiotic prophylaxis should be administered routinely for dental implant surgery is unresolved. Despite the lack of conclusive supportive evidence, antibiotics are often administered to reduce the risk of infection, which could lead to early implant failure. Increasing antibiotic resistance is a major concern and it is therefore important to reduce the overall use of antibiotics, including in dentistry. The aim of the present systematic review and meta-analysis was to evaluate the efficacy of preoperative antibiotics in preventing early implant failure, in overall healthy patients undergoing dental implant surgery.
An electronic search was undertaken of PubMed (Medline), Web of Science and the Cochrane Library up to October 1, 2023, to identify randomized clinical trials (RCTs). All RCTs comparing antibiotic prophylaxis with no antibiotics/placebo in overall healthy patients receiving dental implants were included. The primary outcome was patients with early implant failure. Risk of bias was assessed, data were extracted, a meta-analysis was done, and GRADE certainty-of-evidence ratings were determined. The risk ratio (RR), the risk difference (RD) and 95% confidence intervals (CI) were estimated.
After removal of duplicates, 1086 abstracts were screened, and 17 articles were reviewed in full text. Seven RCTs with moderate or low risk of bias and with a total of 1859 patients and 3014 implants were included in the meta-analysis. With reference to early implant failure at patient level, the meta-analysis failed to disclose any statistically significant difference (RR: 0.66, 95% CI: 0.30-1.47) between antibiotic prophylaxis and a placebo. The risk difference was -0.007 (95% CI: -0.035-0.020) leading to a number needed to treat (NNT) of 143.
Antibiotic prophylaxis for dental implant surgery does not seem to have any substantial effect on early implant failure ( ). The results do not support routine antibiotic prophylaxis for dental implant surgery.
是否应常规给予抗生素预防用于牙科种植手术仍存在争议。尽管缺乏确凿的支持证据，但抗生素常被用于降低感染风险，因为感染可能导致种植体早期失败。抗生素耐药性的不断增加是一个主要关注点，因此减少抗生素的总体使用（包括在牙科领域）非常重要。本系统评价和荟萃分析的目的是评估术前抗生素预防总体健康患者行牙科种植手术中早期种植体失败的疗效。
对 PubMed（医学文献在线数据库）、Web of Science 和 Cochrane 图书馆进行电子检索，检索截至 2023 年 10 月 1 日，以确定随机临床试验（RCT）。纳入所有比较抗生素预防与总体健康接受种植体患者中无抗生素/安慰剂的 RCT。主要结局为早期种植体失败的患者。评估偏倚风险、提取数据、进行荟萃分析，并确定证据确定性的 GRADE 评级。风险比（RR）、风险差异（RD）和 95%置信区间（CI）进行了估计。
去除重复项后，筛选了 1086 篇摘要，17 篇文章进行了全文审查。荟萃分析纳入了 7 项偏倚风险为中度或低度的 RCT，共纳入 1859 名患者和 3014 枚种植体。对于患者水平的早期种植体失败，荟萃分析未发现抗生素预防与安慰剂之间存在统计学显著差异（RR：0.66，95%CI：0.30-1.47）。风险差异为-0.007（95%CI：-0.035-0.020），导致需要治疗的人数（NNT）为 143。
牙科种植手术中抗生素预防似乎对早期种植体失败没有任何实质性影响（ ）。结果不支持牙科种植手术常规使用抗生素预防。
