Antibiotic Prophylaxis at Dental Implant Placement: Which is the Best Protocol? A Systematic Review and Network Meta-Analysis.

AIM: This systematic review of randomized controlled trials (RCTs) aims to answer to the following question: "In patients undergoing dental implant placement, which is the best antibiotic prophylaxis protocol to prevent early failures?". MATERIALS AND METHODS: The MEDLINE, SCOPUS, CENTRAL and Web of Knowledge electronic databases were searched in duplicate for RCTs up to July 2017. Additional relevant literature was identified through 1) hand-searching on both relevant journals and on reference lists, and 2) searching in databases for grey literature. A Network Meta-analysis (NMA) was conducted and the probability that each protocol is the "Best" was estimated. RESULTS: Nine RCTs were included, with a total of 1,693 participants. Due to the few events reported, it was not possible to conduct a NMA for adverse events, therefore it was conducted only for implant failures (IF). The protocol with the highest probability (32.5%) of being the "Best" one to prevent IF was the single dose of 3g of amoxicillin administered 1-h pre-operatively. Even if the single pre-operative dose of 2g of amoxicillin is the most used, it achieved only a probability of 0.2% to be the "Best" one. CONCLUSIONS: Basing on the available RCTs, the use of antibiotic prophylaxis is protective against early implant failures, but there is still insufficient evidence to confidently recommend a specific dosage. The use of post-operative courses does not seem however to be justified by the available literature. This article is protected by copyright. All rights reserved.