PROPHYLACTIC ANTIBIOTICS DURING THE IMPLANT PROSTHETIC PHASE MAY NOT SUBSTANTIALLY DECREASE THE INCIDENCE OF INFECTIOUS COMPLICATIONS

Abstract

Subjects or Study Selection

The systematic review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in the International Prospective Register of Systematic Reviews under the registration number CRD42021277959.

The literature search was conducted using multiple electronic databases (PubMed/MEDLINE, Web of Science, Google Scholar, and LILACS), with no language or date restrictions for studies published up to September 2021. Additionally, unpublished literature search was performed on the OpenGrey database and bibliographic references were examined for publications that did not appear in the initial search. Search strategies were executed using medical subjects headings (MeSH) terms, keywords, and various freely chosen terms while utilizing Boolean operators to combine the searches. Two researchers independently performed the selection of potentially eligible studies following a two-phase process (i.e. screening and eligibility phases), while a third researcher was consulted in case of a disagreement. Based on eligibility criteria, 3 studies were included for the qualitative and quantitative analysis. The systematic review resulted in the final inclusion of a retrospective clinical study, a consensus document, and a clinical protocol. All included articles were published between 2005 and 2008.

Key Study Factor

Comparing the use of prophylactic antibiotics versus no antibiotics in healthy patients during various procedures of implant prosthetics phase, such as implant exposure surgery, peri-implant plastic surgery, impression-taking, and prosthesis placement

Main Outcome Measure

The main outcome measure is the incidence of infectious complications, however, in the article's text, a clear definition of "infectious complications" is not established, nor is it explained how these are measured. In addition, the authors performed quality assessment analyses of the included studies based on their risk of publication bias.

Main Results

In one study, no significant difference was observed in infection rates between patients who received PA and those who did not in various implant procedures. Within a clinical protocol, second-stage implant surgery is categorized as a procedure with a low risk of bacterial contamination and surgical site infection in healthy patients, making the use of PA unnecessary. As per clinical consensus, when discussing peri-implant plastic surgery during the prosthetic implant phase, which can be referred to as mucogingival surgery, it is regarded as a high-risk procedure for infection. Consequently, the use of PA is recommended. Conversely, the authors of a clinical consensus also make reference to other potential interventions during the prosthetic implant phase, categorizing them as low-risk procedures and consequently, not advocating for the use of PA. The methodological quality of eligible studies was evaluated following Joanna Briggs Institute Critical Appraisal Tool. The concordance between the two researchers was 97.43% with a κ coefficient of 0.93 (SE, 0.08 [95% CI, 0.74–1]).

Conclusions

The prescription of PA in second-stage implant surgeries, impression-taking procedures, and/or implant prosthetic placements cannot be justified. In cases of certain second-stage implant procedures, as in peri-implant mucogingival interventions lasting more than 2 hours and in which soft tissue grafts or biomaterials are used extensively, the administration of PA may be suggested. Due to a lack of data, high-quality controlled studies are recommended to enhance the quality of primary research in this field.