Dental Implants and Antibiotics
Lowering Risk of Implant Failure
Dear Doctor,
I am about to have a dental implant to replace a missing tooth. Do I need to take antibiotics for the surgery?
Dear Wendy,
Thank you for bringing up this very important and often debated topic. Today, it is estimated that two in three Americans have one or more missing teeth, and with the increasing popularity of dental implants many may be considering this question right now.
What Are Dental Implants?
A dental implant is an artificial tooth root that is inserted into the jawbone and to which a crown, bridge, or denture is attached. Dental implants fuse with the bone in a process known as osseo-integration ("osseo" – bone; "integrate" – to make whole). Sometimes adjunctive procedures are necessary, such as bone or gum tissue grafting to enhance placement success, and in all of these scenarios antibiotics may play a role to ensure good healing.
Additionally, the mouth harbors multiple bacterial species capable of causing infection. Many minimally invasive dental procedures, including dental implant surgery, can allow bacteria to enter the bloodstream. In certain high-risk individuals, pre-medicating with antibiotics prior to surgery can prevent bacteria from reaching and infecting high-risk areas of the body. Most people do not fall into this category but if you do (based on your medical history) your doctor will let you know and discuss it with you. Let's assume, however, you are a low risk individual who is having a routine implant placed. Even though dental implants typically have a high rate of survival (over 90%), some may fail due to local bacterial contamination. Infections immediately following surgical implant placement are difficult to treat and almost all infected implants need to be removed.
High And Low Risk Individuals
Older adults with a weakened immune system or other serious health problems, smokers, diabetics and those who may be underweight or overweight are especially at risk for infection.
The American Dental Association (ADA) and the American Heart Association (AHA) recommend the use of prophylactic (preventive) antibiotics for patients at particular risk for infection. This includes individuals with prosthetic (false) cardiac (heart) valves, a history of infective endocarditis ("endo" inside lining; "card" – heart; "itis" – inflammation), a heart transplant, and certain congenital (present from birth) heart conditions.
Previously antibiotics were also recommended for people with prosthetic joints but recently the ADA together with the American Academy of Orthopedic Surgery (AAOS) concluded that prophylactic antibiotics are no longer routinely recommended for all prosthetic joints. However, some orthopedic surgeons recommend prophylactic antibiotics for patients with artificial joints for up to two years following replacement surgery.
Evidence-Based Research Findings
Generally it is still debated whether clinically healthy, low- and moderate-risk individuals should be prescribed antibiotics for dental implant surgery.
Generally it is still debated whether clinically healthy, low- and moderate-risk individuals should be prescribed antibiotics for dental implant surgery. The concerns include side effects that range from diarrhea to allergic reactions, and the rise in the appearance of antibiotic-resistant bacteria.
A recent Cochrane Central Register of Controlled Trials review, which performed a statistical analysis of multiple studies that included low-risk healthy individuals, found that taking oral antibiotics before dental implant surgery can be beneficial. It reported that 2 grams of amoxicillin given as a single dose an hour before surgery may reduce implant failure in ordinary conditions without any significant adverse outcomes.
The reviewers also inferred that giving antibiotics to 25 people would avoid one person experiencing early implant loss. They did not find any clear evidence about the benefit of taking antibiotics after surgery, or which antibiotics work best.
Individual Need And Your Dental Surgeon's Discretion
The benefit of antibiotics for dental implant surgery varies on a case-by-case basis and depends on individual needs. It is important to discuss your medical history with the oral surgeon, periodontist or other dental professional who is placing the implant. It should include any medical conditions, any medications you take, prescription and over-the-counter drugs, and supplements.
Your implant surgeon will not only weigh your case individually based on the aforementioned criteria, but also on his/her invaluable clinical experience and preferences. You will then be able to make an informed decision regarding whether antibiotics would be a good choice to enhance healing and success of your new dental implant.
