Every year in the United States at least 2 million people become infected with antibiotic-resistant bacteria and approximately 23,000 people die as a result.¹ Dentists prescribed 10% of the antibiotics used and 80% are unnecessary.²

Dentistry is also the top prescriber of clindamycin, the antibiotic most associated with C. difficile infections. Each year 500,000 Americans develop C. difficile infections and about 15,000 die from the illness. The American Dental Association (ADA) has many articles written on the stewardship of antibiotic use and specifically speaks to the use of antibiotic prophylaxis prior to dental procedures should be reserved for patients at high risk of post treatment complications. You may download the guidelines at: https://jada.ada.org/action/showPdf?pii=S0002-8177%2819%2930617-8

The ADA together with the American Heart Association (AHA) now recommend antibiotics only for surgical patient who have prosthetic heart valves, a history of infective endocarditis, a heart transplant or certain congenital heart conditions. Evidence from recent studies indicates just a small dose of antibiotics administered an hour before surgery may be sufficient to reduce the risk of infection-related implant failure with only minimal risk of side effects from the drug.

One of the many reasons for implant failure is the development of bacteremia around the implant and can be due to the contamination from the bacteria while inserting the implant. Various prophylactic systemic antibiotics have been suggested to minimize infections after dental implant placement. If a dental implant becomes infected, there are more chances for implant failure. Hence, to prevent the onset of infection at the site of implant placement prophylactic antibiotics are prescribed to elevate the antibiotic concentration in blood to reduce the chance of bacterial proliferation and dissemination.  

Results from over 15 studies show an incredibly wide variance as to what antibiotics clinicians use, dosage and timing. 1, 2, and 3g of amoxicillin one hour prior to treatment time, 500mg-750mg the day prior to surgery,  amoxicillin/clavulanic acid  one hour before surgery are found relatively commonly with better implant results varied to the ideal of 2g or 3g 1 hour prior to surgery. In an analysis of 8 studies postoperative antibiotics does not appear to be justified.

There was a range of a 5 - 7-day 500 mg - 750 mg amoxicillin protocol. Additionally, a protocol of choice was 875 amoxicillin and 125 mg of clavulanic acid from 7 - 8 days surrounding surgery. There are many studies proving and disproving the results from the use of antibiotics. The majority of the studies found that giving antibiotics preoperatively or postoperatively did not improve clinical outcomes. There is no consensus. As with many studies there is a high potential for bias. The hope would be to at least standardize prescription guidelines to help bridge the gaps on the subject.

The question could perhaps be: Is there potential that there will be no need for antibiotic protocol when the implant treatment of choice is minimally invasive implantology?

¹ Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013.

² Suda KJ, Calip GS, Zhou J, et al. Assessment of the Appropriateness of Antibiotic Prescriptions for Infection Prophylaxis Before Dental Procedures, 2011 to 2015. JAMA Netw Open. 2019;2(5):e193909. doi:10.1001/jamanetworkopen.2019.3909 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2734798