A recent study has indicated high antibiotic prescription rates in implant dentistry in Europe and called for standardised protocols to combat antibiotic resistance. (Image: Creative Cat Studio/Shutterstock)
LEIPZIG, Germany: There are conflicting opinions and evidence on antibiotic use before and after implant surgery and in peri-implantitis treatment. Given that inappropriate antibiotic prescription plays a major role in antibiotic resistance in dentistry, a recent study sought to investigate prescribing practices in relation to implant treatment and awareness of antibiotic resistance among dentists in Europe. It found that, although the participants showed good understanding of the topic, the antibiotic prescription rate in implant dentistry was high. To that end, the study pointed to a need for the development of and adherence to standardised European guidelines to improve antibiotic stewardship in dentistry.
Dr Björn Klinge. (Image: EVENTFOTOGRAFEN)
According to the World Health Organization, antimicrobial resistance is among the most significant threats to global public health and development. In 2019, bacterial antimicrobial resistance was estimated to be the direct cause of 1.27 million deaths worldwide and played a role in 4.95 million deaths.
“Antibiotic resistance is a growing and alarming concern related to the misuse and overuse of antibiotics in various clinical settings and situations,” co-author Dr Björn Klinge, professor emeritus in the Faculty of Odontology at Malmö University and at the Department of Dental Medicine of Karolinska Institutet in Stockholm in Sweden, told Dental Tribune International (DTI). After talking to his peers about their routines for antibiotic use in implant dentistry, he understood that antibiotic prescription in this context varies considerably. He also noted that access to and awareness of national guidelines and recommendations for using antibiotics in implant dentistry seems to vary between European countries. “After discussing this with our research team, we agreed to investigate antibiotic use and the availability of guidelines more systematically,” Dr Klinge explained.
Dr Giulia Brunello. (Image: Charité—Universitätsmedizin Berlin)
To better understand the prescribing patterns and attitudes of dentists towards antibiotic use, the researchers developed a questionnaire and sent it to 6,431 recipients who had been members of the European Association for Osseointegration at least once since 2018. The questionnaire contained 17 items, and 281 dentists from 33 European countries completed the survey. The questions gathered data on working environment, years of experience, number of implant placements and surgical treatments of peri-implantitis per year and the use of antibiotics for these, attitudes towards antibiotic prescription, adherence to national guidelines for antibiotic prescription and awareness of antibiotic resistance. Data was collected from April to May 2023.
Prof. Bodil Lund. (Image: Stefan Zimmerman)
According to senior author Dr Giulia Brunello, a postdoctoral research fellow in the Department of Oral Surgery at the University Hospital of Düsseldorf in Germany, the survey yielded several interesting outcomes. She told DTI that, although current evidence does not support using systemic antibiotics as an adjunct in non-surgical and surgical peri-implantitis therapy, more than half of the study participants indicated that they use systemic antibiotics to treat peri-implantitis. “This highlights a significant discrepancy between clinical practice and available knowledge,” she commented.
The study found that almost 80% of the respondents routinely prescribe antibiotics prophylactically and after implant placement, especially in medically compromised patients or in cases requiring bone grafting. As observed in other studies, amoxicillin, alone or in combination with clavulanic acid, was found to be the most commonly prescribed antibiotic among the participants. Commenting on these findings, Dr Brunello said: “Despite a significant awareness of antibiotic resistance among the respondents, their prescription rate for dental implant procedures remains high.”
Urgent need for national guidelines in Europe
Dr Katarzyna Gurzawska-Comis. (Image: ABAOMS)
Additionally, the findings pointed to a notable inconsistency in prescription practices among the respondents. The researchers suggested that this may be explained by the lack of or difficulty accessing national guidelines on antibiotic prescription in implant dentistry in some European countries.
In light of the findings, co-author Prof. Bodil Lund, head of the Department of Dental Medicine of Karolinska Institutet, said that the study indicates potential for enhancing antibiotic prescribing practices in Europe. She told DTI: “Although surgical placement of dental implants is a common therapy, there are several European countries that either lack national guidelines or those available are not known to the dental professionals. Both educational efforts and guidelines are needed to improve the use of antibiotics in implant dentistry.”
Future perspectives on antibiotic prescription in implant dentistry
Prof. Kathrin Becker. (Image: Susanne Kurz)
Discussing future perspectives on antibiotic prescribing practices in dentistry, lead author Prof. Kathrin Becker, director of the Department of Dentofacial Orthopedics and Orthodontics at Charité—Universitätsmedizin Berlin in Germany, and co-author Dr Katarzyna Gurzawska-Comis, an associate professor and lead of maxillofacial surgery and pathology at the Aarhus University in Denmark, and a consultant and senior lecturer in oral surgery at the University of Liverpool in the UK, told DTI that there is an urgent need for more judicious use of antibiotics in implant dentistry to curb global antimicrobial resistance. “Although we do not anticipate significant shifts in antibiotic prescribing in relation to dental implant placement, we envisage the progressive replacement of prolonged antibiotic therapies, aiming at minimising postoperative infections with the adoption of single-dose antibiotic prophylaxis in the near future,” they noted.
Since current scientific data lacks robust evidence to support the use of antibiotic prophylaxis in implant dentistry, the researchers recommend conducting additional randomised clinical trials to address this research gap. They also emphasised the importance of collaboration to establish standards regarding quality and uniformity in national guidelines across European countries towards consistent and evidence-based antibiotic prescribing practices in implant dentistry.
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