Prophylactic antibiotic regimens in dental implant failure A systematic review and meta-analysis
Prophylactic antibiotic regimens in dental implant failure A systematic review and meta-analysis
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DOI：
10.1016/j.adaj.2018.10.015
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发表时间：
2019-06-01
影响因子：
3.9
通讯作者：
Khouly, Ismael
中科院分区：
文献类型：
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作者：
Braun, Rosalie S.;Chambrone, Leandro;Khouly, Ismael
背景。在这篇系统综述和荟萃分析中，作者检查了抗生素预防（AP）和特定抗生素方案在总体健康的患者中预防种植体失败的疗效。所回顾的研究类型。作者独立进行了电子数据库和人工检索，以确定随机对照试验（rct）。作者根据入选标准选择文章，并使用Cochrane手册评估偏倚风险。种植失败是研究的主要结果；膜周炎或种植体炎、假体失效和不良事件是研究的次要结果。作者对二分数据的风险比进行了随机效应荟萃分析，并使用OpenMeta[Analyst]（布朗公共卫生学院证据综合中心）对给药计划进行定性评估。除去重复，作者筛选了1022篇摘要，审查了21篇全文文章，并纳入了8项随机对照试验，其中包括1,585名患者的2,869个植入物。meta分析结果显示，与不使用抗生素相比，所有联合用药方案（种植体，P = 0.005；患者，P = 0.002）以及术前（种植体，P = 0.01；患者，P = 0.007）、术前和术后（种植体，P = 0.04）和术后仅使用AP（种植体，P = 0.02）导致种植体失败的数量均有统计学意义上的显著降低。作者发现在比较抗生素治疗或次要结果的分析中没有统计学上的显著差异。作者确定了混杂变量。结论和实际意义。虽然荟萃分析结果表明，AP可以减少种植体失败，但目前还不能得出明确的结论。个别试验中报告的总体不显著差异、讨论的局限性、种植体感染结果和抗生素相关风险必须考虑在内。因此，种植体失败的结果可能不能保证在接受牙种植体的健康患者中不加选择地使用抗生素。研究者必须进行大规模随机对照试验，以确定AP和各种方案的疗效，独立于混杂变量。
Background. In this systematic review and meta-analysis, the authors examine the efficacy of antibiotic prophylaxis (AP) and specific antibiotic regimens for prevention of dental implant failure in patients who are healthy overall.Types of Studies Reviewed. The authors independently conducted electronic database and manual searches to identify randomized controlled trials (RCTs). The authors selected articles on the basis of eligibility criteria and assessed for risk of bias by using the Cochrane Handbook. Implant failure was the primary outcome studied; perimucositis or implantitis, prosthetic failure, and adverse events were secondary outcomes studied. The authors conducted random effects meta-analysis for risk ratios of dichotomous data and used OpenMeta[Analyst] (Center for Evidence Synthesis, Brown School of Public Health) for qualitative assessment of administration schedules.Results. With duplicates removed, the authors screened 1,022 abstracts, reviewed 21 full-text articles, and included 8 RCTs that included 2,869 implants in 1,585 patients. Meta-analysis results indicated that AP resulted in a statistically significantly lower number of implant failures for all regimens combined (implant, P = .005; patient, P = .002), as well as preoperative (implant, P = .01; patient, P = .007), pre- and postoperative (implant, P = .04), and postoperative AP only (implant, P = .02), compared with no antibiotics. The authors found no statistically significant differences in analysis of comparative antibiotic treatments or secondary outcomes. The authors identified confounding variables.Conclusions and Practical Implications. Although meta-analysis results suggested that AP may reduce implant failure, definitive conclusions cannot be achieved yet. The overall nonsignificant differences reported in individual trials, limitations discussed, implant infection outcomes, and antibiotic-associated risks must be considered. Thus, the results for implant failure outcomes may not warrant the indiscriminate use of antibiotics in patients who are healthy who are receiving dental implants. Investigators must conduct large-scale RCTs to determine the efficacy of AP and various regimens, independent of confounding variables.