The use of antibiotics in any form and dosage prior to or after dental implant placement to prevent implant failure and post-operative infection was the purpose of the systematic review and meta-analysis.

The therapy question search was not restricted to randomised clinical trials, as the authors included other research designs to answer the proposed clinical question. The pooled final data included all the studies first and then they performed a separate analysis excluding the high risk of bias studies to see if that was altering the results. However, after that the results did not change statistically and favoured the use of antibiotic prophylaxis for prevention of implant failure, but the results were not statistically significant for prevention of post-operative infection.

They even calculated the number needed to treat (NNT) in order to prevent one implant failure which resulted in a NNT of 50, a double digit number fairly high for prevention of early implant failures, a complication that can be associated with several risk factors even in healthy patients. As the authors reported, the results should be interpreted with caution due to several cofounders in the studies.

The units of analysis in this review were the implants, not the patients. Patients can receive more than one implant and the failure could be independent of the use or not of antibiotics.

A similar topic was published at the Cochrane Library using patients as the unit of analysis and arrived at similar conclusions, statistically favouring the use of antibiotic prophylaxis prior to dental implant placement. The results for prevention of infection were also not statistically significant.1 Despite the results of the review the data should be interpreted with caution. Practitioners should use their judgment and not jump to conclusions and prescribe antibiotics to prevent implant failures in healthy patients.2

Smoking and other risk factors should be taken into consideration. It is unclear how uncontrolled systemic conditions such as diabetes and osteoporosis may impact on the implant success, due to the variability of the studies as concluded in the review.3

It would be interesting to see the impact of antibiotic prophylaxis with regard to implant failure and post-operative infection in medically complex patients where the risk is increased.