Is Penicillin Allergy a Risk Factor for Early Dental Implant Failure? A Systematic Review

Abstract

The prescription of preventive antibiotics in dental implant treatments reduces the incidence of early failures. This study has focused mainly on the influence of amoxicillin, which is contraindicated in penicillin-allergic patients. The present systematic review aimed to determine whether penicillin-allergic patients have a higher risk of implant failure compared to non-allergic patients. An electronic search was performed on Medline and Web of Science using the following MeSH terms: (penicillin allergy OR clindamycin OR erythromycin OR azithromycin OR metronidazole) AND (dental implant OR dental implant failure OR dental implant complications). The criteria employed were those described in the PRISMA® Declaration. Only five articles were included that analyzed the failure rates of implants placed in penicillin-allergic patients who were prescribed clindamycin compared to non-allergic patients who were prescribed amoxicillin. With the limitations of this study, it is not possible to state that penicillin allergy per se constitutes a risk factor for early dental implant failure as most of the studies included self-reported allergic patients. Clindamycin has been associated with a significantly elevated risk of failure and an up to six times increased risk of infection. Immediate implants also have a 5.7 to 10 times higher risk of failure.

The effect of preoperative clindamycin in reducing early oral implant failure: a randomised placebo-controlled clinical trial

“…Clindamycin is frequently prescribed for penicillinallergic patients as an alternative to oral surgery; however, researchers have recently reported on the lack of highquality clinical evidence for its use in oral implant surgery [28,36,[48][49][50]. Clindamycin is a broad-spectrum antibiotic with activity against aerobic, anaerobic, and β-lactamaseproducing pathogens.…”

“…Clindamycin has appeared as one of the choices for oral implant surgery according to multiple surveys performed in the last few years among oral care professionals [26,[30][31][32][33][34][35][36]. In a survey performed in Spain, 58% of the respondents selected clindamycin as the alternative in cases of an allergy to amoxicillin [36].…”

Is Antibiotic Prophylaxis Necessary before Dental Implant Procedures in Patients with Orthopaedic Prostheses? A Systematic Review

“…Currently, there are only recommendations based on evidence regarding the placement of unitary implants in ordinary conditions [ 23 ] and bone regeneration with the placement of implants in one or two phases [ 21 ]. In both procedures, the recommended guideline is 2 or 3 g of amoxicillin, one hour before the intervention [ 21 , 23 ] and, in allergic patients, 500 mg of azithromycin one hour before surgery [ 24 ], which would be equivalent to what is recommended to prevent OPIs.…”

“…Furthermore, there is only clear scientific proof on the recommended PA dose in the clinical situation mentioned above [ 23 ] and in bone augmentation with the implant placement done in one or two phases [ 21 ], that is, 2–3 g of amoxicillin an hour before the intervention [ 21 , 23 ], while in allergic patients, 500 mg of azithromycin, 1 h before surgery, has recently been suggested. [ 24 ]. Regarding the remaining clinical situations, the type of antibiotic prescribed and its posology is up to the professional, who in many cases tends to over-prescribe them.…”

Preventive Antibiotic Therapy in the Placement of Immediate Implants: A Systematic Review

“…These authors explained these findings with an increased risk of infection in allergic patients [ 28 , 43 ], however, no specific diagnostic test was performed before inclusion in the studies, i.e., patients self-reported to be allergic. In clinical practice, 10–20% of patients report an allergy or reaction to penicillins, however, these are rarely hypersensitivity or immunoglobulin E-mediated reactions [ 44 , 45 , 46 ]. Furthermore, studies have shown that 80–99% of these patients may no longer be considered allergic after testing [ 47 , 48 , 49 ].…”