AICRG, Part III: The Influence of Antibiotic Use on the Survival of a New Implant Design
Purpose: The American College of Surgeons guidelines suggest that complex oral surgery may benefit from prophylactic antibiotic coverage. The use of preoperative antibiotics, postoperative antibiotics, or both during implant placement is a widely accepted practice in the United States, whereas dentists in other countries rarely use antibiotics. Purpose: The purpose of this study was to determine if antibiotic coverage at the time of implant placement improves the survival of the Ankylos implant. Methods: As part of a comprehensive, multicentered, multidisciplinary, prospective, independent, international clinical study, designed and coordinated in the United States by the Ankylos Implant Clinical Research Group (AICRG), the use of preoperative (several regimens) and postoperative antibiotics (yes/no) were carefully documented to assess their influence on improving survival. A total of 1500 Ankylos implants were placed and followed for a period of 3 to 5 years. The decision to use antibiotics and the regimen to be employed was made by the treating surgeon. Failure was defined as removal of the implant for any reason. All data were entered into a computerized database for analysis. Results: The use of preoperative antibiotics produced no significant improvement (P = .21, Fisher's exact test) in survival compared with those placed without antibiotic coverage. There was no significant difference between the regimens defined as AHA-1990, AHA-1997, and Peterson's recommendations. Conclusions: The results of this study suggest that there was little or no advantage to providing antibiotic coverage when placing this implant. These findings also suggest that the use of antibiotics for implant placement may not be as beneficial as once believed. If validated by other studies, the elimination of this practice for routine implant placement would represent a small but significant step forward in the reduction of unnecessary antibiotic use.Abstract

(A) Comparison of survival of implants provided with preoperative antibiotics coverage at the time of placement and those that did not receive coverage. There was no significant difference found using Fisher's exact test (P = .21). (B) Comparison of survival of implants provided with preoperative antibiotic coverage that was either adequate or inadequate according to the American Heart Association in 1990. There was no significant difference in survival using Fisher's exact test (P = .18)

(A) Comparison of implant survival of those implants provided preoperative antibiotic coverage at the time of placement using either an adequate or inadequate regimen based on the American Heart Association recommendations in 1997. No significant difference was found (P = .25) (B) Comparison of survival of implants provided adequate or inadequate preoperative antibiotic coverage based on Peterson's recommendations. There was no significant difference (P = .69)

Comparison of implant survival of those implants provided postoperative antibiotic coverage following implant placement surgery with those not receiving coverage. There was no significant difference found (P = .792) between the 2 groups
Contributor Notes
Harold F. Morris, DDS, MS, is codirector of the Dental Clinical Research Center (DCRC) and project codirector of the Ankylos Implant Clinical Research Group (AICRG), Department of Veterans Affairs Medical Center (VAMC), Ann Arbor, Mich. Correspondence should be addressed to Dr Morris at the DCRC (154), VA Medical Center, 2215 Fuller Road, Ann Arbor, MI 48105.
Shigeru Ochi, PhD, is codirector of the DCRC and project codirector of the AICRG, VAMC, Ann Arbor, Mich.
Richard Plezia, DDS, MS, is chief of the Dental Service, Oral and Maxillofacial Surgery, VAMC, Detroit, Mich.
Harry Gilbert, DDS, is chief of the Dental Service, Oral and Maxillofacial Surgery, VAMC, Houston, Tex.
C. Daniel Dent, DDS, is clinical professor, Medical College of Virginia School of Dentistry and staff dentist, VAMC, Richmond, Va.
James Pikulski, DDS, is staff dentist at the VAMC, Ann Arbor, Mich.
Paul M. Lambert, DDS, is chief of the Dental Service 160, VAMC, Dayton, Ohio.