Prophylactic Antibiotic Regimens in Oral
Implantology: Rationale and Protocol
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Randolph R. Resnik, DMD, MDS,* and Carl Misch, DDS, MDS†
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ostoperative wound infections
P may have a significant impact on
the success of dental implants and
bone grafting procedures. The occur-
rence of surgical wound infection re-
quires local inoculums to overcome host
defenses and allow an environment that
is conducive for bacterial growth. This
process is very complex with interac-
tions of host, local tissue, systemic and
microbial virulence factors. Various
measures attempt to minimize infection
by modifying the host and local tissue
factors. Such measures include control
of the operating room environment, pa-
tient selection, aseptic protocol, and the
surgical technique. The use of antimi-
crobials has also been shown to be sig-
nificant in reducing postoperative
wound infections.1– 4
The scope of implant treatment
encompasses an increasing older pop-
ulation with more complex cases, so
that a greater understanding of com-
promised wound healing and inade-
quate immune systems is of benefit.
The dental practitioner should have a
thorough understanding of the indica-
tions and protocol for the use of anti-
microbials in implant dentistry. The
morbidity of implant related compli-
cations may be reduced with the ideal
selection and sufficient dosage levels
of medications.
There is no current accepted phar-
macologic protocol for dental im-
plants, based on both the patient’s
health status and procedure type.
*Clinical Professor, Department of Periodontology and Implant
Dentistry, Temple Dental School, Philadelphia, PA.
**Professor and Director Oral Implantology, Department of
Periodontology and Implant Dentistry, Temple Dental School,
Philadelphia, PA.
ISSN 1056-6163/08/01702-142
Implant Dentistry
Volume 17 • Number 2
Copyright © 2008 by Lippincott Williams & Wilkins
DOI: 10.1097/ID.0b013e3181752b09
142 PROPHYLACTIC ANTIBIOTIC REGIMENS
The use of antimicrobials re-
duces the incidence of surgical
wound infection in oral implantol-
ogy. Antimicrobial prophylaxis is
indicated in all Class 2 (clean-
contaminated) surgical procedures,
which include sufficient blood levels
at the time of bacterial contamina-
tion of dental implant and bone graft
procedures. Timing and dosage are
critical to the efficacy of antibiotics.
Many practitioners prescribe medica-
tions empirically or generically with
respect to all implant procedures. The
understanding and use of the various
antibiotic regimens is beneficial for
both the success and maintenance of
dental implants. Antibiotic therapy in
implant dentistry may be classified as
either prophylactic (to prevent infec-
tion) or therapeutic (to treat infection).
This article provides the dentist with
an overview of the pharmacokinetics
and pharmacodynamics of various an-
timicrobials and a prophylactic protocol
based on varying patient and proce-
dure characteristics.
ANTIMICROBIALS
One of the most important compli-
cations that requires prevention after im-
plant surgery is infection. Infection can
lead to a multitude of problems ranging
from pain and swelling, bone loss, and
implant failure. Because of the morbid-
ity of infections, antimicrobial therapy is
an essential component of the surgical
protocol. Although adverse effects are
sometimes associated with antimicrobial
therapy, these are usually mild and
rarely life-threatening. The most com-
mon antimicrobials used in implant den-
IN ORAL IMPLANTOLOGY
Antibiotic selection is determined mainly
by the bacteria which is most likely to
cause an infection from the specific pro-
cedure. The authors have developed a
classification and protocol that allows
the dental practitioner to properly pre-
scribe medication based on procedural,
local host and systemic factors. (Implant
Dent 2008;17:142–150)
Key Words: dental implants, antibiotic
prophylaxis, surgical wound infection,
pharmacologic protocol, risk factors
tistry consist of antibiotics (local and
systemic) and antimicrobial rinses
(0.12% chlorhexidine gluconate).
PROPHYLACTIC ANTIBIOTICS
In general surgery and its subspe-
cialties, the principles of antibiotic
prophylaxis are well established.
These guidelines specifically relate the
procedure, the type of antibiotic, and
the dosage regimen.5,6 The use of pro-
phylactic antibiotics in dentistry has
been documented to prevent compli-
cations in patients who are at risk of
developing infectious endocarditis and
immunocompromised patients. 7 In
oral implantology, however, there ex-
ists no general consensus on the use
and indications for prophylactic anti-
biotics. Antibiotic selection, dosage
and duration of coverage for this pop-
ulation is variable and some authors
avoid its routine use.8 The numerous
disadvantages of the use of antibiotics
that have been documented include the
development of resistant bacteria, sec-
ondary infections, toxicity of antibiot-
ics, adverse reactions, and possible
poor surgical technique.9,10
A number of studies have docu-
mented the benefit of preoperative anti-
 biotics for dental implantology.3,11,12 The
most comprehensive and controlled
study to date related to antibiotics and
implants is from the Dental Implant
Clinical Research Group.3,11 Data from
2973 implants were evaluated and cor-
related with integration failure at different
time periods; initial healing, at surgi-
cal uncovering, before loading the
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prosthesis, and from prosthesis loading
to 36 months. A significant difference
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was found with the use of preoperative
antibiotics (4.6% failure) compared with
no antibiotics (10% failure), both in the
initial healing and surgical uncovery of
the implants.
The main goal of prophylactic an-
tibiotic use is to prevent infection from
the surgical wound site, thus decreasing
the chance of infectious complications
and insufficient integration. Although
there is no conclusive evidence on the
mechanism of how preoperative anti-
biotics work, most likely a greater
aseptic local environment is achieved.
A landmark study by Burke13 in 1961
defined the scientific basis for the
perioperative use of antibiotics to pre-
vent surgical wound infection. From
this work and others, several impor-
tant and well accepted principles have
been established regarding the prophy-
lactic use of antibiotics.1
Principle 1: Incidence of Infection
A classification of operative
wounds and risk of infection was de-
veloped by the American College of
Surgeons Committee on Control of
Surgical Infections.13,14 To evaluate
the risk for postoperative wound infection,
all surgical procedures were classified
according to 4 levels of contamination
and infection rates (Table 1).
Class 1 (clean surgical procedures)
are least likely to have a post operative
infection. Class 4 (dirty/infected surgi-
cal sites) are most at risk for infection.
Class 2 medical and dental surgical pro-
cedures have been shown to have an
infection rate of 10% to 15%. By defi-
nition, elective dental implant surgery
and bone grafting procedures fall within
the Class 2 (clean-contaminated) cate-
gory. However, with proper surgical
technique and prophylactic antibiotics,
the incidence of infection may be re-
duced to 1%.15,16
In a healthy patient, risk of infec-
tion after dental implant surgery is in-
fluenced by numerous factors includ-
ing the type, location and duration of
surgery, skill of the surgeon, methods
of intraoperative management, patient
factors, and aseptic technique.16,17 In
addition, patient related (systemic and
local) risk factors are also important
and correlated with increased suscep-
tibility to infection. Therefore, these
factors should also be considered
when developing a protocol for the use
and duration of antibiotic prophylaxis
(Table 2).
Various routes of virulent bacteria
transmission include (1) direct contact
with the patient’s blood or other body
fluids; (2) indirect contact with contam-
inated objects; (3) contact with infected
nasal, sinus or oral mucosa; and (4) in-
halation of airborne microorganisms.21
For ideal conditions to prevent infection,
a controlled, well-monitored aseptic sur-
gical setting is beneficial. The aseptic
component includes proper disinfection
and draping procedures of the patient,
hand scrubbing, sterile gowns worn by
all surgical members and sterility of
instrumentation.22
Another surgical factor related to
postoperative infections is the dura-
tion of the surgical procedure. This
factor may be the second most critical
risk factor (behind wound contamina-
tion) for causing postoperative infec-
tions.23 Surgical operations lasting less
than 1 hour have been shown to have
an infection rate of 1.3%, whereas
those lasting 3 hours increase the rate
to over 4.0%.24,25 The rate of infection
may double with every hour of the
procedure.9,10
The skill and the experience of the
surgeon during the placement of im-
plants have also been shown to be
significant in postoperative infec-
tions and implant failures. Less ex-
perienced dentists (⬍50 implants
placed) have a 7.3% increase in fail-
ure rates, compared with less than
2% for experienced surgeons.11 A
factor in the less experienced dentist
which may contribute to this higher
failure rate is the longer duration of
the implant surgery.
The insertion of any medical pros-
thetic implant or device increases the
chance of infection at the surgical
site. An implant placed into the hard
or soft tissue may act as a foreign
body and the host’s defenses may be
IMPLANT DENTISTRY / VOLUME 17, NUMBER 2 2008
Table 1. Surgical Wound
Classification With Associated
Infection Rates15,16
Class 1: Clean (⬍2%)
Elective, nontraumatic surgery,
no acute inflammation, respira-
tory, gastrointestinal, and biliary
tracts not entered
Class 2: Clean-Contaminated
(10%–15%)
Elective opening of the respira-
tory, gastrointestinal, and biliary
tracts entered
Elective dental implant and bone
graft procedures
Class 3: Contaminated (20%–30%)
Inflammation, gross spillage from
gastrointestinal and biliary
tracts along with fresh trau-
matic injuries
Class 4: Dirty/Infected (50%)
Established clinical infection, per-
foration of respiratory, gastroin-
testinal, and biliary tracts
Table 2. Factors Associated With
Increased Risk of Infection15,18 –21
Systemic factors
Diabetes
Long term corticosteroid use
Smoking
Immunocompromised systemic
disorders
Malnutrition obesity
Elderly population
ASA3 or ASA4
Local factors
Use/type of grafting material (au-
togenous, allograft, alloplast)
Periodontal disease
Tissue inflammation
Odontogenic infections
Ill-fitting provisional prosthesis
Incision line opening
Inadequate hygiene
Surgical factors
Poor aseptic technique
Skill/experience of the surgeon
Increased duration of surgery
Wound contamination during surgery
Foreign body (implant)
compromised. In addition, the sur-
face of an implant may facilitate
bacterial adherence and the presence
of an implant may also compromise
blood supply to the region and affect
the host’s defenses. This may result
in normal bacterial flora with low
virulence potential to cause infec-
tions at the implant-host interface,
which are difficult to remedy.26 –28
143
 Principle 2: Appropriate Antibiotic
The antibiotic chosen should be ef-
fective against the bacteria that are most
likely to cause the infection. In the ma-
jority of cases, infections after surgery
are from organisms that originate from
the site of surgery.13 For example, most
postoperative infections after transoral
surgery are caused by endogenous bac-
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teria including aerobic Gram-positive
cocci (streptococci), anaerobic Gram-
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positive cocci (peptococci), and anaero-
bic Gram-negative rods (bacteroides).1
Although oral infections are mixed in-
fections in which anaerobes out number
aerobes 2:1, it has been shown that
anaerobes need the aerobes to provide
an environment to proliferate.29 The
early phase of intraoral infections involve
aerobic streptococci which prepare the
environment for subsequent anaerobic
invasion.30,31 With that in mind, the
ideal antibiotic must be effective
against both of these pathogens.
Another factor in selecting an an-
tibiotic is to use a drug with the least
amount of adverse side effects. These
effects may vary from mild nausea to
the extreme allergic reaction (anaphy-
laxis). In addition, the antibiotic should
be bactericidal. Bacteriostatic antibiotics
work by inhibiting growth and repro-
duction of bacteria, thus allowing the
host defenses to eliminate the resultant
bacteria. However, if the host’s defenses
are compromised in any way, the bacte-
ria and infection may flourish. Bacteri-
cidal antibiotics are advantageous over
bacteriostatic antibiotics in that (1) there
is less reliance on host resistance, (2) the
bacteria may be destroyed by the antibiotic
alone, (3) faster results occur com-
pared with bacteriostatic medications,
and (4) there is greater flexibility with
dosage intervals.15
Principle 3: Tissue Concentration
The minimum inhibitory concentra-
tion is the lowest antibiotic concentration
needed to destroy a specific bacteria. A
sufficient tissue concentration of antibi-
otic should be present at the time of
bacterial invasion. To accomplish this
goal, the antibiotic must be given in a
dose that will reach plasma levels that
are 3-to-4 times the minimum inhibitory
concentration of the expected bacteria.32
It has been shown that normal therapeu-
tic blood levels are ineffective to coun-
144 PROPHYLACTIC ANTIBIOTIC REGIMENS
teract bacterial invasion.33 Most often, to
achieve this tissue concentration, the an-
tibiotic must be given at twice the ther-
apeutic dose and at least 1 hour before
surgery.1 If antibiotic administration oc-
curs after bacterial contamination, no
preventive influence occurs and similar
clinical results are reported as compared
with taking no preoperative antibiotic.13
Principle 4: Antibiotic Exposure
In a healthy patient, a single dose
of antibiotics is usually sufficient for
most Class 1 and 2 surgical proce-
dures. Continuing antibiotics dosing
after surgery does not decrease the
incidence of immediate postoperative
surgical wound infections.5,34 –36 How-
ever, for patients or procedures with
increased risk factors (Table 2), a
longer dose of antibiotics is warranted.37
With the high degree of morbidity as-
sociated with dental implant infec-
tions, the benefits versus risk involved
for the extended use of antibiotics
should be evaluated.
ADVERSE REACTIONS
It is estimated that approximately
6% to 7% of patients taking antibiotics
will have some type of adverse event.38
Most of these complications of prophy-
lactic antibiotics are minimal, however a
small percentage can be life threatening.
The risks associated with antibiotics in-
clude gastro-intestinal tract complica-
tions, colonization of resistant or fungal
strains, cross reactions with other med-
ication, and allergic reactions. Allergic
reaction is the most serious complica-
tion occurring locally or systemically
and ranges from mild urticaria to ana-
phylaxis and death. Studies have shown
that 1% to 3% of the population receiv-
ing penicillin will exhibit urticaria type
of reactions and 0.04% to 0.011% will
present with true anaphylactic episodes.
Of this small percentage of anaphylactic
reactions, 10% will be fatal.39
A less serious, but increasing com-
plication in the general population after
antibiotic use is pseudomembranous co-
litis. This condition is caused by the
intestinal flora being altered and colo-
nized by Clostridium difficile. Clinda-
mycin has historically been associated
with pseudomembranous colitis, because
long term use in hospitalized patients
have resulted in death. However, most
IN ORAL IMPLANTOLOGY
antibiotics have been shown as caus-
ative agents for this complication.
The most recent concerns of antibi-
otic use are the development of resistant
bacterial strains and superinfection. It
has been shown that onset of resistant
bacteria overgrowth begins only after
the host’s susceptible bacteria are killed,
which usually takes at least 3 days of
antibiotic administration. Short-term (1
day) antibiotic use has been shown to
have little influence on the growth of
antibiotic-resistant bacteria.15
PROPHYLACTIC ANTIBIOTICS
Beta-Lactam Antibiotics
The most common drugs used for
prophylaxis in dentistry are the peni-
cillin and cephalosporins in the beta-
lactam category. These antibiotics are
bactericidal and have similar chemical
structures and similar mechanisms of
action. The death of the bacteria oc-
curs by inhibition of bacterial cell wall
synthesis via the interruption of the
cross-linking between peptidoglycan
molecules.40
Penicillin V. In the past, penicillin
V was one of the more popular antibi-
otics used in dentistry. It is well ab-
sorbed and will achieve peak serum lev-
els within 30 minutes of administration
with detectable levels of the drug for 4
hours.40 Penicillin V is very effective
against most Streptococcus species and
oral anaerobes.34 The main disadvantages
of penicillin is the need for frequent dos-
ing to maintain blood levels and the de-
velopment of resistant bacteria.
Amoxicillin. Amoxicillin is a
derivative of ampicillin, with the ad-
vantage over penicillin of superior ab-
sorption and a bioavailability of 70%
to 80% with very low toxicity. It has
excellent diffusion in infected tissues
and adequate tissue concentrations are
easily achieved. Amoxicillin is con-
sidered broad spectrum and is very
effective against Gram-negative cocci
and Gram-negative bacilli. This anti-
biotic has greater activity than Penicil-
lin V against streptococci and oral
anaerobes.40 As a result of these fea-
tures, it is often the drug of choice
when the patient is not allergic to this
drug category.
Augmentin (Amoxicillin/Clavu-
lanic Acid). Bacteria resistant to
Amoxicillin inactivate the drug with
 an enzyme beta-lactamase, which
breaks apart the beta-lactam ring. A
combination of 2 antibiotics was syn-
thesized to counteract the destructive
activity of beta-lactamase. Clavulanic
acid, also a beta-lactam antibiotic, was
added to amoxicillin to form Augmen-
tin. This combination antibiotic has a
great affinity for bacteria that produce
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penicillinases and inactivates the resis-
tant bacteria.34 This antibiotic is the
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drug of choice when penicillinase bac-
teria are suspected and is very practi-
cal as a perioperative antibiotic for
sinus augmentation procedures.
Cephalosporins. First generation
cephalosporin antibiotics (eg, Cepha-
lexin) have an antibacterial spectrum
similar to Amoxicillin. However, they
have the advantage of not being sus-
ceptible to beta lactamase destruction
by Staphylococcus aureus. They are
frequently used in dentistry as an al-
ternative for the penicillin-allergic pa-
tient.34 Rates of cross-reactivity of first
generation cephalosporins with
penicillin-allergic patients have been
cited to be approximately 8% to 18%.
However, recent studies have shown
only patients who have had anaphylactic
type immediate hypersensitivity reac-
tions should not be administered a ceph-
alosporin. If the patient has a previous
history of a reaction that was of this
nature, (eg, mediated type II, III, IV or
idiopathic reactions), a first generation
cephalosporin may be administered.41
Newer second and third generation
cephalosporins exhibit a broader spec-
trum, less cross-reactivity, and even a
greater resistance to beta lactamase de-
struction. Cefuroxime axetil (Ceftin), a
second generation cephalosporin, may
be used as an alternative antibiotic for
sinus augmentation procedures. In addi-
tion, the parental form of a cephalospo-
rin, Cephazolin (Ancef), may be used
within the graft material.
Macrolides
The most common macrolide used
in dentistry is Erythromycin. It is active
against most streptococci, staphylo-
cocci, and some anaerobes and is an
alternative for patients allergic to peni-
cillin. Erythromycin has the advantage
of excellent absorption and not being
affected by the presence of food. It is
primarily used by the oral route and has
a relatively low toxicity.41 However, this
antibiotic has a high incidence of nausea
and is bacteriostatic. Therefore, this
drug is not an ideal first line choice for
infections in the oral cavity.
Clindamycin
Clindamycin is becoming more
popular in the treatment of dental infec-
tions, primarily because of its activity
against anaerobic bacteria. It also has
activity against aerobic bacteria, such as
streptococci and staphylococci, with su-
perior effects against Bacteroides. How-
ever, this drug is bacteriostatic in normal
concentrations and has a rather high tox-
icity.40 It also has a disadvantage related
to the occurrence of diarrhea in 20% to
30% of patients treated.35 This antibiotic
also has an accompanying incidence of
antibiotic-associated pseudomembra-
nous colitis, more often when taken over
a longer duration. Clindamycin (cleocin
phosphate) is also supplied in an aque-
ous 300 mg/2 mL solution, which
makes it suitable for incorporation into
graft materials for sinus augmentation
procedures.
Fluoroquinolones
Quinolones are a more recent
classification of bactericidal antibiot-
ics with a broad antibacterial spec-
trum. They may be used either orally
or parenterally. Ciprofloxacin is a first
generation quinolone and is the proto-
type drug for this antibiotic category.
Newer third and fourth generation
quinolones have also been developed
with great activity against resistant
bacteria and anaerobic bacteria (eg,
Levaquin). In implant dentistry, they
are mainly used during the prophylac-
tic and therapeutic treatment of sinus
augmentation procedures42 (Table 3).
CHLORHEXIDINE GLUCONATE
Another modality for antimicro-
bial prophylaxis for implant surgery is
the use of 0.12% chlorhexidine diglu-
conate (Peridex, Procter & Gamble,
Cincinnati, OH). Chlorhexidine glu-
conate is a potent antibacterial which
causes lysis by binding to bacterial
cell membranes. It has high substan-
tivity, which at high concentrations
exhibits bacteriocidal qualities, by
causing bacterial cytoplasm precipita-
tion and cell death.43,44 In the oral cav-
ity, chlorhexidine has been shown to
IMPLANT DENTISTRY / VOLUME 17, NUMBER 2 2008
Table 3. Prophylactic Antibiotic
Recommendations (in Order
of Preference)
Dental implant/bone graft procedures
Amoxicillin
Cephalexin (allergic to penicillin,
but no history of anaphylactic
allergy to penicillin)
Clindamycin (history of anaphylac-
tic allergy to penicillin)
Sinus augmentation procedures
Augmentin
Ceftin (allergic to penicillin, but no
history of anaphylaxis)
Levaquin (history of anaphylactic al-
lergy to penicillin, history of recent
antibiotic use or sinus pathology)
Local use of antibiotics
Ancef (1 g)
Clindamycin (300 mg/2 mL)—history
of anaphylactic allergy to penicillin
have a slow release from tissue sur-
faces for over a 12 hour period.45,46
PROPHYLACTIC PROTOCOL
There are many variables (local,
systemic, surgical) that need to be
considered with the prophylactic use
of antimicrobials. Therefore, a pro-
tocol has been developed by the au-
thors that allows the implant surgeon
to determine the most appropriate
antibiotic, dosage, and duration for
the prevention of postoperative com-
plications47 (Table 3). Five different
categories are proposed, based on the
previous factors presented and the vari-
ety of invasiveness and difficulty of
the procedure. This format has been
used by several hundred doctors
trained at the Misch International Im-
plant Institute over the last 4 years,
with few complications (Table 4).
Category 1
The first category encompasses all
simple extractions (without grafting)
and routine dental implant second
stage surgeries, in patients without
systemic or oral disease states. These
procedures have a low incidence of
bacterial contamination and infection
of the surgical site, and therefore, no
antibiotic is required. Chlorhexidine
0.12% is suggested as a preoperative
and postoperative agent to decrease
postoperative infection risk and pro-
mote soft tissue healing (Fig. 1).
145
 Table 4. Misch International Implant Institute Prophylactic Protocol
Type Patient Selection Procedures Antibiotic Antimicrobial
Type 1 ASA1/ASA2 Simple extractions of None Chlorhexidine (intra/extra
uninfected teeth oral): 1/2 oz. bid for 2
Single tooth implants wk
2nd stage surgery
Limited soft tissue
reflection surgery
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Type 2 ASA1/ASA2 Multiple simple extractions Amoxicillin: 1 g 1 Chlorhexidine (intra/extra

Traumatic extractions h before surgery oral): 1/2 oz. bid for 2
Multiple implants/limited 500 mg 6 h later wk
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reflection
Socket grafting
Immediate implants/no
pathology
Type 3 ASA1/ASA2 Membrane bone grafting Amoxicillin: 1 g 1 h Chlorhexidine (intra/extra
(allograft/zenograft/ before surgery, oral): 1/2 oz. bid for 2
alloplast) then 500 mg tid wk
Multiple implants/extensive for 3 d
reflection
Multiple immediate implants
Type 4 Any of the following: Full arch implants/ Amoxicillin: 1 g 1 h Chlorhexidine (intra/extra
⬎ASA2 extensive reflection before surgery, oral): 1/2 oz. bid for 2
Long duration Sinus lift (SA2) then 500 mg tid wk
surgery Autogenous bone for 5 d
Less experienced grafts
surgeon
Immuno-
compromised
Active periodontal
disease
Type 4 Sinus SA3/SA4 sinus SA3/SA4 sinus patients Augmentin (875 Chlorhexidine (intra/extra
patients mg/125 mg): 2 oral): 1/2 oz. bid for 2
tabs starting 1 d wk
before, then 1
tab bid for 5 d
Medication equivalent doses.
Amoxicillin: (1 g) ⫽ cephalexin (1 g) ⫽ clindamycin (600 mg).
Augmentin (875 mg/125 mg) ⫽ ceftin (500 mg) ⫽ levofloxacin (500 mg).
ASA indicates American Society of Anesthesiologists.

Category 2
The second category includes pro-
cedures which have a moderate risk of
bacterial invasion and infection and in-
cludes traumatic extractions, socket
grafting and immediate implant inser-
tion after an extraction. The graft mate-
rial, implant, or extended procedures in-
dicates a preoperative loading dose of
antibiotics and a single postoperative
dose. In addition, chlorhexidine (0.12%)
rinse is recommended twice a day until
suture removal for all category 2 proce-
dures listed. For these procedures, if the
patient’s systemic status is greater than
an ASA2, a different regimen (category
4) is to be used (Fig. 2).
Category 3
In category 3 procedures, a mod-
erate to high probability of bacterial
invasion is expected. This is due to the
greater amount of tissue reflection and
longer duration of surgery which are
more complex and extensive proce-
dures. These procedures include mem-
brane bone grafts, multiple implants
with extensive soft tissue reflection
and multiple immediate implant inser-
tions after extractions. A preoperative
loading dose of antibiotic, followed by
3 postoperative doses per day for 3
days is recommended. Chlorhexidine
(0.12%) is also recommended twice a
day until the sutures are removed
(Fig. 3).
Category 4
Category 4 procedures are the
same as category 2 or 3, however
these procedures are performed on
medically compromised patients, have
more extensive tissue reflection than
usual, and/or are longer in duration
than typical. Additionally, sinus floor
lift during implant insertion and autog-
enous block bone graft procedures are
included in this category. With these
conditions, higher risk of bacterial
contamination and infection is ex-
pected. A preoperative loading dose of
antibiotics, followed by 3 daily doses
for 5 days of postoperative antibiotics
is warranted. Chlorhexidine (0.12%) is
also recommended twice a day until
the sutures are removed (Fig. 4).
Category 5
Category 5 (Sinus) procedures
encompass all sinus augmentation
procedures. The unique bacterial envi-

146 PROPHYLACTIC ANTIBIOTIC REGIMENS IN ORAL IMPLANTOLOGY


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Fig. 1. A single tooth implant with minimal
tissue reflection and inserted into existing
bone volume is a type I procedure for antibi-
otic prophylaxis.
Fig. 2. Multiple implants with limited tissue
reflection is a type II category for antibiotic
prophylaxis.
Fig. 3. Multiple implants with extensive tissue
reflection is an example of a type III category
for antibiotic prophylaxis.
ronment and delayed blood levels of
antibiotics in sinus mucosa (especially
in the presence of inflammation), in-
dicate a loading dose of antibiotics
initiated 1 day before surgery. With
this protocol, adequate blood levels of
antibiotics will be present within the
sinus tissues before surgery. The anti-
biotic is also continued for 5 days
postoperatively. A beta-lactamase anti-
biotic (Augmentin) is preferred, because
of the high incidence of beta-lactamase
producing pathogens associated with
maxillary sinus infections. Chlorhexi-
dine (0.12%) is also recommended
twice a day until the sutures are
removal (Fig. 5).
Fig. 4. Autogenous block bone harvest and
placement is an example of a type IV category
for antibiotic coverage before and after the
procedure.
Fig. 5. A sinus graft using the lateral wall ap-
proach is a unique host site for a bone graft
and is in a separate category (type IV sinus)
for antibiotic coverage before, during and af-
ter the procedure.
CONCLUSION
Antibiotic prophylaxis has been
shown to be effective in reducing post-
operative complications after dental
implant and bone grafting procedures.
Various recommendations on antibi-
otic use have generalized all implant
and bone grafting procedures under
one standardized protocol. The pro-
posed pharmacologic protocol in this
article involves 5 different categories,
which take into account various local,
systemic, surgical, and procedural
factors.
Disclosure
The authors claim to have no finan-
cial interest, directly or indirectly, in any
entity that is commercially related to the
products mentioned in this article.
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E-mail: rrresnik@comcast.net

Abstract Translations
GERMAN / DEUTSCH
AUTOR(EN): Bach Le, DDS, MD, Jeffrey Burstein, DDS,
MD. Korrespondenz an: Bach Le, DDS, MD, Gesichts- und
Kieferchirurgie (Oral & Maxillofacial Surgery), USC zahn-
medizinische Fakultät/medizinisches Zentrum des Stadtbezirks
LA (USC School of Dentistry/LA County Medical Center), OPD
1P51, 2010 Zonal Avenue, Los Angeles, CA 90089. Telefon:
(323) 226-5013, Fax: 323-226-5241, eMail: burstein@usc.edu
bzw. leb97201@yahoo.com
´Asthetischer Transplantationsansatz für kleinere Defekte in
Hart- und Weichgewebe zum Aufbau einer Implantierungsoption
tsprechendes Knochengewebe zur Stabilisierung des Implantats
vorhanden sein kann, kann eine von der Norm abweichende
Kochenanatomie dennoch zu einem unnatürlichen Erschei-
nungsbild der abschließenden Überkronung führen. Eine
Partikel-Onlay-Spanung zur Unterstützung des das Implantat
umgebenden Gewebes in Verbindung mit Spannungsfreiem
Verschluss bei Verwendung von Techniken zur Regeneration
der Stielpapille kann wenig ästhetisch erscheinende Zahnfleis-
chkonturen zu gut geeigneten Implantierungsstellen umformen.
SCHLÜSSELWÖRTER: Zahnimplantate, Onlay-Spanung,
Papillenregeneration

ZUSAMMENFASSUNG: Defekte in der Leistenkontur im SPANISH / ESPAÑOL

Bereich um Implantate herum werden durch diesen zu Grunde AUTOR(ES): Bach Le, DDS, MD, Jeffrey Burstein, DDS, MD.
liegende Knochendefekte hervorgerufen. Obwohl eventuell en- Correspondencia a: Bach Le, DDS, MD, Oral & Maxillofacial

148 PROPHYLACTIC ANTIBIOTIC REGIMENS IN ORAL IMPLANTOLOGY

 Surgery, USC School of Dentistry/LA County Medical Center,
OPD 1P51, 2010 Zonal Avenue, Los Angeles, CA 90089. Telé-
RUSSIAN
fono: (323) 226-5013, Fax: 323-226-5241, Correo electrónico:
О: Kelly Misch, доко соолог, Hom-
burstein@usc.edu o leb97201@yahoo.com Lay Wang, доко соолог, гс
Injerto estético en defectos de tejido duro y blando de угско соолог.
дс дл
pequeño volumen para el desarrollo de lugares de im- кос
од : Hom-Lay Wang., DDS., MSD, Dept. of
plante Periodontics and Oral Medicine, University of Michigan,
School of Dentistry, 1101 N. University, Ann Arbor, MI
ABSTRACTO: Los defectos del contorno de la cresta alred-
48109-1078. лфо: 734-763-3383., Фкс: 734-936-
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edor de los implantes dentales son causados por defectos

0374,
дс лкоо
о: homlay@umich.edu
óseos subyacentes. A pesar de que podrı́a existir un hueso
Осло
 , с с   уг ско
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adecuado para obtener la estabilidad del implante, una anato-

л

: 
олог

л

mı́a irregular del hueso puede resultar en una apariencia
innatural de la corona final. El injerto incrustado de partı́culas  !". Осло  угско л-
para apoyar el tejido blando periimplante con un cierre sin  лс с л 
tensión mientras se utilizan técnicas de regeneración de la соологско кк, ооу о о
papila pedicular puede convertir los contornos gingivales  од боб с к слу. л ого
poco estéticos en lugares favorables. обо — ок удос л угск
PALABRAS CLAVES: Implantes dentales, injertos incrusta-
dos, regeneración de la papila
PORTUGUESE / PORTUGUÊS
AUTOR(ES): Bach Le Cirurgião-Dentista, Médico, Jeffrey
Burstein Cirurgião-Dentista, Médico. Correspondência para:
Bach Le, DDS, MD, Oral & Maxillofacial Surgery, USC
School of Dentistry/LA County Medical Center, OPD 1P51,
2010 Zonal Avenue, Los Angeles, CA 90089. Telefone: (323)
226-5013, Fax: 323-226-5241, e-Mail: burstein@usc.edu ou
leb97201@yahoo.com
Enxerto Estético para Defeitos de Tecido Duro e Mole de
Pequeno Volume para Desenvolvimento de Local de Im-
plante
RESUMO: Os defeitos do contorno do rebordo em torno de
implantes dentários são causados por defeitos ósseos subja-
centes. Embora o osso adequado possa existir para obter a
estabilidade do implante, a anatomia óssea irregular pode
resultar numa aparência não-natural da coroa final. O enxerto
particulado onlay para apoiar o tecido mole do periimplante,
junto com o fechamento isento de tensão, enquanto se uti-
lizam técnicas de regeneração da papila do pedı́culo, pode
converter contornos gengivais não-estéticos em locais fa-
voráveis.
PALAVRAS-CHAVE: Implantes dentários, enxerto onlay,
regeneração da papila
JAPANESE /
IMPLANT DENTISTRY / VOLUME 17, NUMBER 2 2008
осло, с с ло л, о
 одуо,  к обсуд олог, од
боб   л дл дос
удололого ул.
КЛ!% СЛО
: уб л;
осло  л; уд л-
.
TURKISH / TÜRKÇE
YAZARLAR: Di Hekimi Kelly Misch, Di Hekimi Hom-
Lay Wang. Yazıma için: Hom-Lay Wang., DDS., MSD,
Dept. of Periodontics and Oral Medicine, University of Mich-
igan, School of Dentistry, 1101 N. University, Ann Arbor, MI
48109-1078 ABD. Telefon: 734-763-3383, Faks: 734-936-
0374, eposta: homlay@umich.edu
mplant Cerrahisi Komplikasyonları: Etiyoloji ve Tedavi
ÖZET: mplant cerrahisi komplikasyonları di
hekimliinde sık görülen olaylar olup, bu olguların tedavis-
inde bilgi büyük önem taır. Bu incelemenin amacı, tedavi
planına, anatomiye ve prosedüre balı cerrahi komplikasyon-
ların zorluklarının vurgulanması ve bunların yanı sıra tedav-
ide olumlu bir sonuç almak için etiyoloji, yönetim ve tedavi
seçeneklerinin tartıılmasıdır.
ANAHTAR KELMELER: Dental implantlar; implant
komplikasyonları; implant baarısızlıkları.
149
 ORAL IMPLANTOLOGY
IN
PROPHYLACTIC ANTIBIOTIC REGIMENS
CHINESE /

KOREAN /

150
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