The influence of prophylactic antibiotic administration on postoperative morbidity in dental implant surgery. A prospective double blind randomized controlled clinical trial

ObjectivesA prospective double-blind randomised controlled trial was conducted to test the effect of prophylactic antibiotics on post-operative morbidity and osseointegration of dental implants. Materials and MethodsFifty-five subjects scheduled for implant surgery were enrolled. The patients were randomly assigned to the antibiotic (test group) and placebo (control group). Twenty-seven patients (test group) received 3g amoxicillin one hour pre-operatively, and 28 patients (control group) received placebo capsules 1h pre-operatively. No post-operative antibiotics were prescribed. Pain diaries and interference with daily activities diaries were kept by the patients for 1week post-operatively. Signs of post-operative morbidity (swelling, bruising, suppuration and wound dehiscence) were recorded by the principal investigators at day 2 and day 7 following the operation. Osseointegration was assessed at 2nd stage surgery or 3-4months post-operatively. ResultsThe results of this study suggest that the use of prophylactic pre-operative antibiotics may result in higher dental implant survival rates (100% vs. 82%). Five implant failures, one in each of five patients, were reported in the placebo group and none in the antibiotic group (P=0.0515). No significant differences were found for most of the signs of post-operative morbidity 2 and 7days post-operatively. Only bruising at 2days following the operation appeared to be higher in the placebo group (P=0.0511). Post-operative pain (P=0.01) and interference with daily activities (P=0.01) appeared to be significantly lower for the antibiotic group after 7days. Those patients with implant failure reported higher pain (based on the VAS scores) after 2days (P=0.003) and after 7days (P=0.0005), higher pain (based on the amount of analgesics used) after 7days (P=0.001) and higher interference with daily activities (based on the VAS scores) after 2days (P=0.005). ConclusionsThe use of for dental implant surgery may be justified, as it appears to improve implant survival in the short term and also results in less post-operative pain and interference with daily activities. From the results of this study, it appears that prophylactic antibiotics may also be beneficial both in terms of implant survival, especially when the surgical procedure is prolonged due to its difficulty, high number of implants placed or operator's inexperience.