Antibiotic prophylaxis in implant surgery

About the project

Aim

The overall aim of the research project is to investigate the benefit of antibiotic prophylaxis in connection with implant surgery and to study how antibiotic prophylaxis is used in connection with implant surgery.

Background

The occurrence of bacteria with resistance to antibiotics is increasing, while the development of new antibiotics is decreasing. There is a clear connection between high consumption of antibiotics and the spread of resistant bacteria. Since antibiotic prescribing in dentistry contributes to the development of antibiotic resistance, this should be restrictive. Antibiotics in dentistry can be prescribed for several indications and both with the intention of treating infection and to prevent complications in connection with interventions in the oral cavity. Studies of prescribing patterns in dentistry that have been carried out have shown a significant misuse and overuse of antibiotics. Antibiotic treatment for preventive purposes is carried out for several different indications, and for most of these there is a lack of evidence for the benefit of antibiotic prophylaxis. An example is antibiotic prophylaxis in connection with implant surgery. In Sweden, approximately 50,000 patients are operated annually with this method. With the intention of preventing postoperative infection that could lead to the implant not healing firmly in the jawbone, antibiotics are often routinely given for preventive purposes. There is no consensus and no general guidelines regarding the choice of antibiotic types, dosage duration. There are also no studies that have been able to convincingly show a clinically relevant benefit with antibiotic prophylaxis.

Project description

Study I

Effect of antibiotic prophylaxis in dental implant surgery—a multicenter placebo-controlled, double-blinded, randomized clinical trial

Aim

To investigate whether routine administration of antibiotic prophylaxis 1 hour before implant surgery can prevent early implant loss and postoperative infection.

Material and methods

The study will be conducted as a multicenter clinical study, randomized and double-blinded, and according to a standardized method (SPIRIT). The study will include 1,000 patients who are treated with dental implants. Patients included will be allocated to either active treatment (antibiotic prophylaxis) or placebo. At postoperative control 7-14 days after surgery (Follow-up 1), the degree of postoperative infection is assessed according to an established template. At postoperative follow-up 3-6 months after surgery (Follow-up 2), the stability of the Implant is assessed according to a standardized method (tightening with 20 Ncm).

Study II

Is routine antibiotic prophylaxis warranted in dental implant surgery to prevent early implant failure? A systematic review

Aim

To investigate whether routine administration of antibiotic prophylaxis 1 hour before implant surgery can prevent early implant loss and postoperative infection.

Material and methods

PICO

• Population: Essentially healthy patients undergoing implant surgery
• Intervention: Administration of prophylactic antibiotics in conjunction with implant surgery
• Control: Administration of placebo or no prophylactic antibiotics in conjunction with implant surgery
• Outcome: Early implant loss (implant mobility and/or infection, at a time when the implant is expected to be healed, requiring the implant to be removed).

Study III

The effect of antibiotic prophylaxis on marginal bone loss in implant surgery – a multicenter placebo-controlled, double-blind, randomized clinical trial Aim To investigate whether routine administration of antibiotic prophylaxis 1 hour before implant surgery can prevent marginal bone loss.

Material and methods

Study III is a follow-up of the patients from Study I. At follow-up 3 years after implant surgery, an X-ray examination of the implants is carried out using a standardized method. The marginal bone level adjacent to the implants is compared with the bone level in the X-ray examination performed at the time of prosthetic loading.

Study IV

The use of antibiotic prophylaxis in implant surgery – analyses of prescribing records

Aim

To study the indications for which antibiotic prophylaxis is prescribed in connection with implant surgery and to map which antibiotic types, doses and duration have been prescribed.

Material and methods

Patient records from Folktandvården Stockholm (200 records) and from the private dental care Smile (200 records) will be used. In patient record databases, patients who received treatment with implant surgery are identified (measure 421 – 433).

Current diary entries in the selected patient records are reviewed using a review template:

• Type of implant surgery performed (straight forward/GBR/bone augmentation/open or closed sinus lift).
• Antibiotic prescription (antibiotic types, doses and duration)
• Medical history (age, sex, state of health, medication, smoking habits)

Significance

If the research project could show that antibiotic prophylaxis has no clinically relevant benefit when it comes to preventing early implant loss or postoperative marginal bone loss, it could form the basis for both national and international guidelines that advise against antibiotic prophylaxis during implant surgery. This would lead to a reduced use of antibiotics in dentistry.