Dental Implants still follow concepts put forth by Branemark. Interesting thing about Branemark is that he was an Orthopaedic surgeon and the protocols that he instituted were based on the same principles of open joint surgeries and implants done in orthopaedics including the scrubbing, draping and isolation. While this is still important for oral environment, no matter how careful we are, contamination of the surgical site with saliva and the bacteria from saliva is inevitable.

Regarding the antibiotic prophylaxis prior to implant surgery or in the post procedure period, it is highly controversial. A few studies done in this regard concluded that post operative antibiotics would not be required. And that the standard surgical prophylaxis prior to surgery is all that is required. But interestingly some have questioned even the administration of pre procedure antibiotics. (more on this later).

For all practical purposes, I wish to state that while I have routinely seen antibiotics being administered after minor oral surgery by most dentists and even oral surgeons, I have not seen high level evidence supporting the same. Infact, most studies in this regard question the routine use of antibiotics after minor oral surgery. Any patient who is being planned for dental implant is being prepared for the procedure with oral prophylaxis and elimination of active periodontal disease before the procedure itself. In this regard, the oral cavity is presumably in pristine health. We do not use antibiotics even for placement of bone implants (post trauma) and haven't encountered any significant increase in infection rates. Post procedure antibiotics cannot and should not be considered a replacement for sound surgical technique and it cannot protect the patient against failure if the technique is erroneous.

Quoting from the article (1) attached :

"The use of prophylactic antibiotics prior to implant placement is controversial. A systematic review supports the use of 2 g amoxicillin as presurgical prophylaxis while a few other studies conclude that there is no added benefit. There is no evidence that implant failure is prevented by antibiotic usage"

The relevant references are also cited for your references. Though this is not exhaustive, the general recommendation will be that for a single site single implant placement, antibiotic prophylaxis would not be required considering that the entire surgical duration will be short and uncomplicated. For longer durations when the bone is expected to be exposed for longer durations or if combined with graft placements, prophylaxis may be considered but stress must be towards following all sterile precautions to prevent contamination of the surface of the implant for best osseointegration and for meticulous surgical technique with slow drilling combined with copious irrigation to prevent bone damage around the implant placed. These are far more important factors for implant success than antibiotics.

Irrational use of antibiotics should be avoided.

Regards,

Dr. Akilesh. R

India

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I do not do surgery myself but I agree with Dr Alikhasi.

Just chlorhexidine mouthwash before surgery.

But in the case of smokers, may be some premedication can be helpful.

for example metronidazol and amoxicillin

Dear Dr. Akilesh. R

Thank you for your informative and useful answer. But I want to know your own regimen used in your routine practice. Please let me know.

I can answer from a veterinary perspective - depends on the surgery. If there is evidence of infection (gingivitis), then we do prophylactic antibiotics (usually something like clindamyicin for the bugs specific to the oral cavity). because you will be breaking mucosa, there is a risk for bacteria entering the bloodstream, and these bacteria tend to like things like heart valves. if it is a 'clean' mouth and we are performing a routine procedure, it will be doctor-dependent. but afterwards, antibiotics and antiseptic mouthwash for all. everything is very case-dependent.

Reading the responses above - it appears that most of the antibiotic use is geared more towards improving outcome of the oral surgery. we use antibiotics for this, but also to prevent bacteremia. - maybe this is due to differences in the bacterial flora between the species?

I completely agree with explanation given by Akilesh

In my experience, chlorahexadine has been used pre-op as well as post-op. Antibiotics are typically given post-op to help prevent infection and rejection of the implant. Some Doctors use an iodine swab stick, as long as there are no allergies, prior to surgery. The iodine (Betadine) is used to remove bacteria from the surgical site. Typically smokers are not good candidates for dental implants, as the success rate drastically decreases. Some Doctors won't place implants for the patient until they have quit smoking.

Pre op can use a disinfecting rinse like 0.2% CHX for 7 day  and 2g amoxicillin for 2 day

post op can use a disinfecting rinse like 0.2% CHX for 10 day (time for suture)  and 2g amoxicillin for 2 day

The oral cavity cannot be totally disinfected during any oral surgery procedure. However, we aim to reduce the load of bacteria both anaerobic and aerobics present prior to surgery. We also depend on the patient's immune response in promoting healing. As the literature and research has not provided absolute answers to this pertinent question of infection control and implantology it is better to err on the side of caution.  Pre-operative Chlorhexidine mouth rinses plus antibiotic administration is what we all have accepted as wise.

Whiles drilling to insert implants into the alveolar bone, we inadvertently inoculate existing opportunistic bacteria into the implant site.  Would you depend on the patient's immune response alone?

I agree with explanation given by Akhlesh 

A very important question and excellent feedback from the members also. Well there is certainly an evidence that use of prophylactic antibiotics reduces implant failure upto and extent. However; other factors such as bone levels, patient''s medical condition and skills of the operators are of utmost importance.

2 g of amoxicillin given orally 1 h preoperatively significantly reduce failures of dental implants placed in ordinary conditions without any adverse effects. But then therapy may be altered depending on patient's acceptance to a certain group of drugs.

Please read through and give us further feedback. Good Luck !

http://www.ncbi.nlm.nih.gov/pubmed/20623035

http://www.ncbi.nlm.nih.gov/pubmed/20467647