The Role of Antibiotic Prophylaxis in the Prevention of Early Dental Implant Failure: A Systematic Review

Introduction: The routine use of antibiotic prophylaxis in dental implant surgery remains controversial. This systematic review and meta-analysis aimed to evaluate the effectiveness of preoperative antibiotics in preventing early implant failure and postoperative infection in healthy individuals. Materials and Methods: An electronic search of PubMed, Scopus, ScienceDirect, Web of Science, Google Scholar, and the Cochrane Library was conducted for studies published between 2000 and 2024. Randomized controlled trials and clinical studies comparing preoperative systemic antibiotic administration with placebo or no antibiotic use were included. The primary outcome was early implant failure; secondary outcomes included postoperative infection and complications. Two reviewers independently extracted data using a standardized form. Methodological quality was assessed with the Cochrane RoB 2.0 tool, and certainty of evidence was evaluated using GRADE. Meta-analysis was performed in Review Manager (RevMan) v5.4 using a fixed-effect Mantel-Haenszel model to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs); heterogeneity was assessed with I2 and Cochrane Q statistics. Results: Eight studies involving 2,026 evaluable patients met the inclusion criteria. The pooled patient-level implant-failure rate was 2.7% in the antibiotic group and 6.9% in the control group. The overall RR was 0.42 (95% CI: 0.27-0.66; p < 0.001), indicating a statistically significant 58% relative risk reduction; the 95% CI did not cross the null (RR = 1). Postoperative infection rates were lower with antibiotics in several trials, although definitions varied across studies (I2 = 0%; Cochrane Q p = 0.730). Conclusion: Preoperative antibiotics significantly reduced early implant failure in pooled analysis, yet absolute event rates remained low in healthy patients. Routine antibiotic prophylaxis should be individualized, balancing modest clinical benefit against antibiotic stewardship principles.