Comprehensive assessment of dental implant procedures: a comparative study on different antibiotic prophylaxis regimens

Relevance. The administration of antibiotics in implantology is indicated to prevent suppurative inflammation conditions. Two regimens are commonly used: a single preoperative dose or prolonged postoperative antibiotic administration. Due to ethical constraints, certain parameters of antibiotic efficacy cannot be directly evaluated within clinical trials. These include the status of the implant-mandibular segment microbiome and the histological parameters of the tissue's inflammatory response at the implant site.

Materials and methods. This study employed a miniature pig model comprising 10 males. The cohort was equally divided into two groups of five animals each. Group 1 received a single preoperative dose of amoxicillin/clavulanic acid 2 ml per 20 kg body weight. Group 2 received the same initial dose prior to implantation, followed by a daily postoperative dose of amoxicillin/clavulanic acid at 1 ml per 20 kg body weight for five days. Each animal received six dental implants. An implant site microbiological test was performed pre-surgery, on Day 1, 3, 7 and 14 post-surgery. Core needle biopsies for histological examination of the tissues were performed on the same postoperative days.

Results. Microbiological testing revealed that Group 2 exhibited lower levels of Streptococcus spp. on Day 3 (p = 0.04) and Porphyromonas spp. on Day 7 (p = 0.04). Group 1 demonstrated reduced levels of Fusobacterium spp. on Day 1 (p = 0.02) and Porphyromonas spp. both pre-surgery (p = 0.04) and on Day 1 (p = 0.012). Comparative analysis of histological assays from the implant sites indicated identical tissue inflammatory responses, regardless of the antibiotic prophylaxis regimen.

Conclusion. Both the single-dose and the prolonged antibiotic prophylaxis regimens, using amoxicillin/clavulanic acid for dental implantation, demonstrated similar histological patterns of tissue inflammation at the implant site, along with comparable microbiota profiles within the implant site. The oral mucosa exhibited an increased population of Staphylococcus spp. and Streptococcus spp., which might contribute to the development of resistant strains, as well as Candida spp., potentially increasing the risk of candidiasis infection onset.

1. Chrcanovic BR, Kisch J, Albrektsson T, Wennerberg A. Factors influencing early dental implant failures. J. Dent. Res. 2016;95(9):995–1002 doi: 10.1177/0022034516646098

2. Lomakin MV, Soloshchanskiĭ II, Druzhinin AE. Antibiotic prophylaxis during surgical stomatological interventions. Russian Journal of Stomatiology. 2012;5(4):25-28. (In Russ.) Available from: https://www.mediasphera.ru/issues/rossijskaya-stomatologiya/2012/4/032072-6406201247

3. Troiano G, Lo Russo L, Canullo L, Ciavarella D, Lo Muzio L, Laino L. Early and late implant failure of submerged versus non-submerged implant healing: A systematic review, meta-analysis and trial sequential analysis. J Clin Periodontol. 2018;45(5):613-623. doi: 10.1111/jcpe.12890

4. Shinde SV, Chansoria S, Limaye M, Vijay M, Bansal S, Dhakne VM. Wound Healing in Dental Implant Surgery in Patients with or without Antibiotic Prophylaxis. J Contemp Dent Pract. 2018 ;19(9):1111-1116. doi:10.5005/jp-journals-10024-2390

5. Veitz-Keenan A, Keenan JR. Antibiotic use at dental implant placement. Evid Based Dent. 2015;16(2):50-1 doi: 10.1038/sj.ebd.6401096

6. Chuvilkin VI, Chuvilkina EI, Tsarev VN, Shirokov JuE. Preventive antibacterial treatment in oral bone augmentation procedures. Stomatologiya. 2013;92(3):84-87. (In Russ.) Available from: https://www.mediasphera.ru/issues/stomatologiya/2013/3/030039-17352013322

7. Tan LW, Ng YE, Giok KC, Veettil SK, Menon RK. Comparative Efficacy of Different Amoxicillin Dosing Regimens in Preventing Early Implant Failure-A Systematic Review with Network Meta-Analysis. Antibiotics (Basel). 2023 3;12(3):512. doi: 10.3390/antibiotics12030512

8. Esposito M, Grusovin MG, Worthington HV. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. Cochrane Database of Systematic Reviews. 2013;2013(7):CD004152. doi: 10.1002/14651858.CD004152.pub4

9. Yakovlev SV, Briko NI, Sidorenko SV, Protsenko DN, editors. SATC Program (Strategy for Anrimicrobial Therapy Control) for in-patient care medical care. Moscow. Pero; 2018; 156 pp. (In Russ.). doi: 10.17513/np.318

10. Leonova OV. The use of Esparoxy in the prevention of complications after surgical interventions in dentistry. Pharmateca. 2014;(6-3):32-36.(in Russ.). Available from: https://pharmateca.ru/ru/archive/article/13507

11. Kim AS, Abdelhay N, Levin L, Walters JD, Gibson MP. Antibiotic prophylaxis for implant placement: a systematic review of effects on reduction of implant failure. Br Dent J. 2020;228(12):943–951 . doi:10.1038/s41415-020-1649-9

12. Romandini M, De Tullio I, Congedi F, Kalemaj Z, Ambrosio M, Lafori A, et al. Antibiotic prophylaxis at dental implant placement: Which is the best protocol? A systematic review and network meta-analysis. J Clin Periodontol. 2019;46(3):382-395. doi:10.1111/jcpe.13080

13. Roca-Millan E, Estrugo-Devesa A, Merlos A, Jané-Salas E, Vinuesa T, López-López J. Systemic Antibiotic Prophylaxis to Reduce Early Implant Failure: A Systematic Review and Meta-Analysis. Antibiotics. 2021; 10(6):698. doi:10.3390/antibiotics10060698

14. Andrade NK, Ramacciato JC, Carvalho PSP, Groppo FC, Motta RHL. Evaluation of two amoxicillin protocols for antibiotic prophylaxis in implant placement surgeries. Rev. Gaúch Odontol. 2017;65:249–253 doi: 10.1590/1981-863720170002000103371

15. Resnik RR, Misch C. Prophylactic antibiotic regimens in oral implantology: rationale and protocol. Implant Dent. 2008;17(2):142-50. doi: 10.1097/ID.0b013e3181752b09. PMID: 18545045.

16. Kapanadze GJ. Using minipigs in biomedical experiments. Journal Biomed. 2006;1(2):40-51.(in Russ.). Available from: https://journal.scbmt.ru/jour/article/view/954

17. Kulakov AA, Ashuev GA, Kapanadze GJ. The use of mini-pigs in dental implantation practice. Journal Biomed. 2006;1(4):94-95.(in Russ.). Available from: https://journal.scbmt.ru/jour/article/view/935

18. Stricker-Krongrad A, Shoemake CR, Bouchard GF. The Miniature Swine as a Model in Experimental and Translational Medicine. Toxicol Pathol. 2016;44(4):612-23. doi:10.1177/0192623316641784