Global prevalence and guideline adherence of antibiotic prescribing in dental implant surgery: A systematic review and meta-analysis

Objectives This systematic review and meta-analysis synthesised global prevalence, regimens, guideline adherence, and factors associated with antibiotic prescribing in dental implant surgery. Methods MEDLINE, Scopus, and Web of Science were systematically searched from January 2010 to October 2025. Dentist surveys, patient-record studies, and register-based studies were included. Prevalence was pooled using random-effects meta-analysis with Freeman-Tukey transformation; regimen and appropriateness were narratively synthesised. Risk of bias and evidence certainty were assessed using JBI and GRADE tools. Results Thirty-nine studies (7266 dentists; 137,207 patients) were included. Pooled prevalence of routine antibiotic prescribing was 61.3% (95% CI: 53.4–68.8%; I²=96.8%) with extreme heterogeneity (24.9–88.8%). Combined pre- and post-operative regimens predominated (52.6%), typically involving 5–7-day post-operative courses. Amoxicillin was the most frequent choice (50.9%). Prescribing increased with procedural complexity, reaching 97.3% for compromised cases. Guideline-concordant prescribing was low (1–28%), with a declining temporal trend. Overall evidence certainty was very low. Conclusions Antibiotic prescribing for implant surgery varied widely but was often high, frequently exceeding evidence-based indications. Post-operative regimens predominated despite no demonstrated benefit over a single pre-operative dose. Reducing unnecessary antibiotic use in implant surgery may require procedure-specific international guidelines and targeted stewardship, though more robust evidence is needed to determine effective strategies.