Antibiotics are very important and needed drugs. Since their discovery the benefits cannot be calculated for their role in halting and treating minor to severe bacterial infections.

However, for the last few years we have been dealing with overuse, misuse and abuse of antibiotics. Many bacteria are no longer susceptible to antibiotics, commonly used drugs are less effective and patients have more allergic reactions.

As healthcare providers we play an important role in judging the appropriate use of antibiotics. The important issue is to consider which procedures alter the risk-benefit ratio in favour of using antibiotic prophylaxis in healthy patients.

Risk factors are associated with an increased risk of infection, which may be systemic, or local factors.

The review analysed the beneficial use of prophylactic antibiotics for dental implant placement under ordinary conditions, along with the dose and time frame needed, the type of antibiotic and the possible side effects.

As a Cochrane produced review, the authors followed the correct methodology for systematic reviews and appropriately searched and selected randomised clinical trials to answer the proposed question.

Six articles were selected and analysed, three of which were assessed with a high risk of bias and three studies were assessed with a low risk (two of the clinical trials were done by the principal author of the systematic review).

The evidence from the meta-analysis shows statistically significant results for the use of preoperative antibiotics, specifically amoxicillin, however the clinical significance is debatable.

There are many variables and cofounders to be taken into consideration for early implant failure even in healthy patients.

The number needed to treat for one additional benefit outcome (NNTB) calculated in the review provides additional information about the effect size that providers may find useful in clinical decision making. Single digit values of number needed to treat (NNT) usually represent a useful difference when comparing one intervention to another. However in this case an NNT of 25 (range of 14-100) seems quite large for the decision to use preoperative antibiotic, which indicates that we need to treat 24 patients with antibiotic in order to prevent one implant failure.

The results showed no benefit in preventing post-operative infection and no side effects were reported.

The results seem convincing, however providers need to balance the risk and benefits in order to preoperatively prescribe 2-3 g of amoxicillin to patients prior to implant placement to prevent early implant failure.