Plain language summary
Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications
This review, carried out by authors of the Cochrane Oral Health Group, has been produced to assess the possible benefits of antibiotics taken orally at the time of the placement of a dental implant in order to prevent infection. If antibiotics are shown to be of benefit in preventing infection, this review also seeks to establish which type, dosage and duration of treatment is the most effective. The use of antibiotics to prevent infection in implant dentistry is controversial, and there is a need to answer these questions in order to improve the success rates of dental implants whilst minimising complications, harms or adverse effects.
Missing teeth can sometimes be replaced with dental implants to which a crown, bridge or denture can be attached. Bacteria introduced during the placement of implants can lead to infection, and sometimes implant failure. Infections around biomaterials (such as dental implants) are difficult to treat and almost all infected implants have to be removed, which is why it is so important to prevent infection if possible.
It has been suggested that taking antibiotics orally either before or after placement (or both) can minimise the chances of infection.
Generally the use of antibiotics in surgery in order to prevent infection is only recommended for people at risk, when surgery is extensive, or performed in infected sites, and when large foreign materials are implanted in the body. Recently, a short term course of antibiotics has been recommended when antibiotics have to be used, because sometimes antibiotics can cause side effects that range from diarrhoea to life-threatening allergic reactions. Another major concern associated with the widespread use of antibiotics is the increase in the appearance of antibiotic-resistant bacteria.
The evidence on which this review is based was up to date as of 17 June 2013. Six trials were included with a total of 1162 participants.
All six of these trials compared the use of antibiotics to prevent infection (failures and complications) with no treatment or treatment with a placebo (a fake medicine with no active ingredient). The antibiotic used in all the trials was amoxicillin; doses and timing of doses varied, although most used a single dose taken just before the implant was placed. One of the trials, with 100 participants, also looked at different doses of amoxicillin taken at different times.
There were no trials that looked at alternative antibiotics.
Participants were people over 18 years of age who were able to give consent to taking part in a medical trial. Potential participants were excluded for a variety of reasons that included: if they were at risk of heart disease, had artificial joints, had problems with their immune system, were affected by diabetes, had received radiotherapy in the head and neck area, had need of additional procedures at the time of implant placement, were allergic to penicillin, had chronic/acute infections near the planned implant site, were already receiving antibiotic treatment for any other reasons (or had taken them up to six months previously), had been treated with or were receiving intravenous amino-bisphosphonates, were pregnant or breast feeding, were receiving long-term nonsteroidal anti-inflammatory drug therapy, or had blood clotting problems. The follow-up period in all the trials was at least three months.
It appears that the oral administration of two grams of amoxicillin one hour before placement of dental implants is effective in reducing implant failures. More specifically, giving antibiotics to 25 people will avoid one person experiencing early implant losses. It is still unclear whether postoperative antibiotics are beneficial, or which antibiotics work best.
Quality of the evidence
The evidence from the six trials (1162 participants) that compared the use of antibiotics with placebo or no treatment was considered to be of moderate quality. However, the one trial (100 participants) that investigated antibiotics given for different lengths of time was found to be at high risk of bias.
Interventions dans le remplacement de dents manquantes : antibiotiques lors de la pose d'un implant dentaire pour prévenir toute complication
Question de la revue
La présente revue, réalisée par des auteurs du groupe Cochrane sur la santé bucco-dentaire, vise à évaluer les éventuels effets bénéfiques des antibiotiques pris par voie orale lors de la pose d'un implant dentaire afin de prévenir tout risque d'infection. Si les antibiotiques se révèlent utiles dans la prévention d'infections, cette revue cherche également à déterminer le type, la posologie et la durée de traitement les plus efficaces. L'administration d'antibiotiques pour prévenir tout risque d'infection dans l'implantologie dentaire est contestée. Il est donc urgent de trouver des réponses à ces questions afin d'améliorer les taux de réussite des implants dentaires tout en minimisant les complications, les dangers ou les effets indésirables.
Dans certains cas, il est possible de remplacer des dents manquantes par des implants dentaires auxquels une couronne, un bridge ou un appareil dentaire peut être fixé(e). Les bactéries qui se sont introduites lors de la pose d'implants peuvent provoquer des infections et, parfois, faire échouer l'intervention. Le traitement des infections qui se trouvent autour des biomatériaux (comme les implants dentaires) se révèle compliqué et la quasi-totalité des implants infectés doivent être retirés, c'est la raison pour laquelle il est primordial de prévenir, dans la mesure du possible, tout risque d'infection.
Il a été suggéré que la prise d'antibiotiques par voie orale avant et/ou après la pose peut minimiser les risques d'infection.
En général, la prise d'antibiotiques en chirurgie dentaire afin de prévenir tout risque d'infection est uniquement recommandée pour les personnes à risque, dans le cas d'une chirurgie lourde ou pratiquée sur des sites infectés et d'une implantation de matériaux étrangers de grande taille dans l'organisme. Depuis peu, un traitement antibiotique à court terme est préconisé lorsque la prise d'antibiotiques s'avère nécessaire, car ils peuvent parfois provoquer des effets secondaires comme des diarrhées, voire des réactions allergiques potentiellement mortelles. Une autre préoccupation majeure liée à l'utilisation généralisée d'antibiotiques est l'augmentation du nombre de bactéries résistantes aux antibiotiques.
Caractéristiques des études
Les preuves sur lesquelles se base cette revue étaient à jour en date du 17 juin 2013. Six essais ont été inclus avec un total de 1 162 participants.
Ces six essais comparaient l'administration d'antibiotiques pour prévenir tout risque d'infection (échecs et complications) à l'absence de traitement ou à un traitement par placebo (faux médicament ne contenant aucun ingrédient actif). L'antibiotique administré dans l'ensemble des essais était l'amoxicilline ; les doses et leurs posologies variaient, bien que la plupart des participants ne prenaient qu'une seule dose juste avant la pose d'un implant. L'un des essais, totalisant 100 participants, examinait également différentes doses d'amoxicilline prises à différents moments.
Aucun essai n'examinait des antibiotiques alternatifs.
Les participants étaient âgés de plus de 18 ans et capables de donner leur consentement à participer à un essai médical. Les participants potentiels étaient exclus pour diverses raisons, notamment : risques de maladie cardiaque, port de prothèses articulaires, troubles du système immunitaire, diabète, radiothérapie de la tête et du cou réalisée antérieurement, procédures supplémentaires requises au moment de la pose d'un implant, allergie à la pénicilline, infections chroniques/aiguës près du site prévu de l'implant, traitement antibiotique en cours pour toute autre affection (ou prise d'antibiotiques jusqu'à six mois auparavant), traitement antérieur ou en cours par aminobisphosphonates par voie intraveineuse, grossesse ou allaitement, traitement médicamenteux anti-inflammatoire non stéroïdien à long terme en cours ou problèmes de coagulation. La période de suivi dans tous les essais était d'au moins trois mois.
Il semblerait que l'administration orale de deux grammes d'amoxicilline une heure avant la pose d'implants dentaires permette de réduire les échecs d'implants. Plus particulièrement, l'administration d'antibiotiques à 25 personnes permettra à une personne d'éviter un échec prématuré de la pose d'un implant. Cependant, nous ignorons si les antibiotiques postopératoires ont des effets bénéfiques ou ceux qui sont les plus efficaces.
Qualité des preuves
Les preuves provenant de ces six essais (1 162 participants) comparant l'administration d'antibiotiques à un placebo ou à l'absence de traitement étaient considérées comme étant de qualité médiocre. Toutefois, les risques de biais de l'unique essai (100 participants) qui examinait l'administration d'antibiotiques pendant des durées différentes étaient élevés.
Notes de traduction
Traduit par: French Cochrane Centre 4th September, 2013
Traduction financée par: Pour la France : Minist�re de la Sant�. Pour le Canada : Instituts de recherche en sant� du Canada, minist�re de la Sant� du Qu�bec, Fonds de recherche de Qu�bec-Sant� et Institut national d'excellence en sant� et en services sociaux.
Intervencije za zamjenu zuba koji nedostaju: antibiotici prilikom stavljanja zubnih usadaka (implantata) za sprječavanje komplikacija
Ovaj pregledni članak napravili su autori Cochrane uredničke skupine za oralno zdravlje (engl. Cohrane Oral Health Group), a izrađen je kako bi se procijenile moguće prednosti uzimanja antibiotika na usta u vrijeme ugradnje zubnog usadka (dentalnog implantata) u svrhu sprječavanja infekcije. U slučaju da se pokaže da su antibiotici korisni u sprječavanju infekcije, ovaj Cochrane pregledni članak imao je daljnji cilj utvrditi i koja je vrsta, doza i trajanje liječenja najučinkovitija. Uporaba antibiotika u svrhu sprječavanja infekcije u implantologiji je kontroverzna, međutim potrebno je odgovoriti na to pitanje da bi se poboljšao uspjeh zubnih usadaka te istodobno smanje komplikacije i štetni učinci.
Zub koji nedostaje ponekad pacijenti žele zamijeniti zubnim usadkom (implantatom) koji onda služi kao nosač za krunu, most ili protezu Bakterije prisutne tijekom postavljanja usadka mogu izazvati infekciju, a ponekad i gubitak usadka Infekcije oko biomaterijala (kao što su zubni usadci) teško je liječiti i gotovo svi zaraženi usadci moraju se onda ukloniti, što je razlog zašto je tako važno da se spriječi infekcija – ako je to moguće.
Predloženo je da uzimanje antibiotika na usta prije ili poslije postavljanja usadka (ili oboje) može smanjiti vjerojatnost infekcije.
Općenito se uporaba antibiotika u kirurgiji u svrhu sprječavanja infekcije preporučuje samo za osobe izložene većem riziku, kada je operacija opsežna, ili se obavlja u zaraženim mjestima te kad se u tijelo ugrađuju veliki strani materijali. Odnedavno se kratkoročna upotreba antibiotika preporučuje samo kada se zaista moraju koristiti, jer ponekad antibiotici mogu izazvati nuspojave koje se kreću od proljeva do po život opasne alergijske reakcije. Još jedan velik problem povezan sa širokom primjenom antibiotika je sve češća pojava bakterija otpornih na antibiotike.
Dokazi na kojima se temelji ovaj pregledni članak objavljeni su do 17. lipnja 2013. Uključeno je 6 istraživanja s ukupno 1162 ispitanika. Uključeno je 6 istraživanja s ukupno 1162 ispitanika.
Svih šest istraživanja su usporedila primjenu antibiotika u svrhu prevencije infekcije (neuspjesi i komplikacije) s izostankom liječenja ili s liječenjem placebom (lažni lijek bez djelatne tvari). Antibiotik koji se koristio u svim ispitivanjima bio je amoksicilin; doze i vrijeme doziranja su se razlikovali, iako je većina studija koristila jednu dozu neposredno prije postavljanja usadka. Jedno od istraživanja, sa 100 sudionika, također je istražilo različite doze amoksicilina u različitim vremenima.
Nije bilo istraživanja koje bi proučavala druge antibiotike.
Sudionici istraživanja su bile osobe starije od 18 godina koje su bile u stanju dati pristanak za sudjelovanje u medicinskom ispitivanju. Potencijalni sudionici su bili isključeni zbog različitih razloga, među kojima su bili postajanje rizika od srčane bolesti, ako su pacijenti imali zglobne proteze, ako su imali problema sa svojim imunološkim sustavom, ako su bolovali od dijabetesa, primali radioterapiju u području glave i vrata, ako je postojala potreba za dodatnim postupcima u vrijeme postavljanja usadka, ako su bili alergični na penicilin, ako je postojala akutna/kronična infekcija u blizini planiranog mjesta usađivanja, ako su već primali antibiotike zbog nekih drugih razloga (ili su ih uzimali i do šest mjeseci ranije), ako su intravenozno primali amino-bifosfonate, ako su žene bile trudne ili dojile, ako su dugoročno primali terapiju nesteroidnim protuupalnim lijekovima, ili su imali problema sa zgrušavanjem krvi. Razdoblje praćenja u svim istraživanjima je trajalo najmanje 3 mjeseca.
Primijećeno je da je primjena 2 g amoksicilina na usta jedan sat prije postavljanja zubnoga usadka učinkovita u smanjenju neuspjeha postavljanja usadka. To bi značilo da ćemo davanjem antibiotika 25-orici ljudi izbjeći rani gubitak usadka u jedne osobe Još uvijek nije jasno je li davanje antibiotika poslije operacije korisno i koji su antibiotici najučinkovitiji.
Dokazi iz šest istraživanja (1162 sudionika) koji su usporedili upotrebu antibiotika s placebom ili nikakvom takvom terapijom, procijenjeni su kao umjereno kvalitetni. Međutim, jedno istraživanje (100 sudionika) koje je istraživalo antibiotike davane u različitim duljinama vremena imalo je visok rizik odstupanja zbog pristranosti.
Prevela: Ivana Propadalo
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Description of the condition
Dental implants are widely used for replacing missing teeth. Despite the high success rates published in the literature, implant failures do occur (Esposito 1998a). It is believed that a certain number of early dental implant losses are due to bacterial contamination at implant insertion (Esposito 1998b). It is known that infections around biomaterials, such as implants, are very difficult to treat and almost all infected implants have to be removed sooner or later (Esposito 1998b). The likelihood of an infection around dental implants is influenced by the surgical skill (traumatic and prolonged surgery is more likely to favour infections) and by the degree of asepsis (sterility). In general, antibiotic prophylaxis in surgery is only recommended in the following situations: for patients at risk of infectious endocarditis, patients with reduced host-response, when surgery is performed in infected sites, for extensive and prolonged surgical interventions, and when large foreign materials are implanted.
Description of the intervention
In order to minimise infections after dental implant placement various prophylactic systemic (whole body) antibiotic regimens have been suggested. Initially, antibiotics were recommended preoperatively and up to 10 days postoperatively, one of the most commonly followed protocols being the administration of 2 g of phenoxymethylpenicillin (penicillin-V), orally, about one hour preoperatively and then 2 g twice a day for 10 days (Adell 1985). More recent protocols recommended short-term prophylaxis (Flemmig 1990): 2 g of penicillin-V (or amoxicillin or amoxicillin/clavulanate) administered orally, one hour prior to surgery and 500 mg of penicillin-V four times a day for one day.
How the intervention might work
While it is important to minimise risk of implant failures, it is also sensible to minimise the use of antibiotics, since adverse events may occur. Complications most commonly associated with the use of antibiotics range from diarrhoea to life-threatening allergic reactions. Another major concern associated with the widespread use of antibiotics is the selection of antibiotic-resistant bacteria.
Why it is important to do this review
The use of antibiotics in implant dentistry is controversial and some controlled clinical trials yielded contradictory results (Dent 1997; Gynther 1998; Laskin 2000; Binahmed 2005). It would be useful to know whether prophylactic antibiotics are effective in reducing postoperative infections and failures of dental implants; and, if so, which is the most effective antibiotic, at what dose and for what duration.
To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic or placebo administration and, if antibiotics are beneficial, to determine which type, dosage and duration is the most effective.
Summary of main results
The meta-analysis of six randomised controlled trials (RCTs), three of which were assessed as being at high risk of bias and three at low risk of bias, suggests that short-term antibiotics, e.g. 2 g (Esposito 2008a; Anitua 2009; Esposito 2010a; Caiazzo 2011), or 3 g (Nolan 2013), of amoxicillin administered one hour prior to implant placement or 1 g of amoxicillin administered one hour prior to implant placement and 500 mg four times a day for two days postoperatively (Abu-Ta'a 2008), significantly decrease early implant failures (RR 0.33; 95% CI 0.16 to 0.67). This observation has important clinical implications, as the use of antibiotics in this way would prevent one person experiencing an early implant loss for every 25 people receiving antibiotics.
There were borderline statistical significance for prosthesis failures in favour of antibiotics (RR 0.44; 95% CI 0.19 to 1.00), and no statistically significant differences for any of the other outcomes: infections (RR 0.69; 95% CI 0.36 to 1.35) or adverse events (RR 1; 95% CI 0.06 to 15.85). In particular only two minor adverse events were reported, one in the antibiotic group (diarrhoea and somnolence) and one in the placebo group (itching for one day), which suggest that the antibiotic regimens used may not have a significant negative impact on the participants' well-being. In other words, the benefit of using short-term antibiotics may outweigh the risks in the short-term for individual patients. However we need to consider that the sample sizes of all trials together were far too small to be able to catch rare - but life-threatening - adverse events such as anaphylactic shock.
No conclusive information can be derived from the only trial that compared three different durations of antibiotic prophylaxis, since no event (implant or prosthesis failures, infections or adverse events) occurred in any of the 25 participants included in each study group (Caiazzo 2011).
Overall completeness and applicability of evidence
Results of this review appear to be easily applicable to populations of patients undergoing routine implant placement procedures both in university hospitals and private practices.
Quality of the evidence
Three trials were judged to be at low risk of bias (Esposito 2008a; Anitua 2009; Esposito 2010a), and the remaining three at high risk of bias (Abu-Ta'a 2008; Caiazzo 2011; Nolan 2013), however the results of all studies were homogenous, and this strengthens confidence in the results. The main issues were the lack of blinding of operators, participants and outcome assessors in two trials (Abu-Ta'a 2008; Caiazzo 2011), and the withdrawal of randomised participants not attending all follow-ups in another (Nolan 2013). Lack of blinding may induce surgeons to perform, more 'clean and careful' implantation procedures in people without antibiotic coverage to minimise risks of infection, and patients may report more or fewer adverse events depending on their personal beliefs on the role of antibiotic coverage. Proper blinding remains the only way to minimise these risks, and could have been easily and effectively done by use of a placebo. The withdrawal of participants who did not attend the immediate postoperative visits should not be done, since they attended the most relevant appointments, such as abutment connection, when the main outcome measures could have been recorded (implant/prosthesis success). All data should be recorded and reported, allowing readers to make their own judgements. Theoretically the trial authors could have retrieved this information from the participants' files, however participants were assigned a unique identification number at the beginning of the study and their names were not used, as requested by the ethical committee. Unfortunately, the list identifying participants was deleted recently, so their records could not be retrieved to see the outcome of their implants.
Potential biases in the review process
No particular biases in the review process could be identified.
Agreements and disagreements with other studies or reviews
An earlier systematic review on this topic concluded that there is little evidence for the use of antibiotic prophylaxis in general dentistry, and recommended monitoring of antibiotic use among dental practitioners (Schwartz 2007). One RCT was not included in this review because its follow-up was too short (eight weeks) (Tan 2013). In this trial 329 healthy adults in need of a single implant-supported crown were randomly assigned to four groups: 1) preoperatively 2 g of amoxicillin one hour before surgery (81 participants), 2) 2 g of amoxicillin immediately following surgery (82 participants), 3) preoperatively 2 g of amoxicillin one hour before surgery and 500 mg thrice daily on days two and three after surgery (86 participants), 4) preoperatively 2 g of placebo one hour before surgery (80 participants). Subjects were examined clinically by blinded examiners up to crown delivery at eight weeks after implant placement. Implants were not submerged. There was only a significant difference in flap closure at week 4, where 5% of the participants who did not receive antibiotic did not achieve complete wound closure when compared to 0% for the three other groups (P value 0.01). There was only one implant failure, which again occurred in one of the participants who did not received antibiotics. It is worth to observe that this trial reported an extremely low failure rate (0.3% at participant level), which is almost 13 times less than that reported in another trial (3.81% at participant level) that included participants with similar characteristics (Anitua 2009). The latter figures are more representative of what currently happens in 'everyday' conditions. Nevertheless, the findings of the non-included trial (Tan 2013) agree with the findings of the present review.
There are a few controlled trials that provided contradictory results. The first study on this subject evaluated implant success at abutment connection (four to six months after implant placement) (Dent 1997). This trial compared various dosages and antibiotics given preoperatively and postoperatively, generally compared with no antibiotics or antibiotics given in an insufficient dosage to an unknown number of participants (2641 implants). Significantly fewer failures occurred in the antibiotic group (1.5% versus 4%). The study was updated by a second publication that presented data with a follow-up of three years after loading (Laskin 2000). This reported 387 participants (1743 implants) in the antibiotic group and 315 participants (1247 implants) in the control group. The results suggested fewer failures when antibiotics were used (4.6% versus 10%). This multicentre trial was initially described as a randomised controlled trial (RCT), but, in reality, dentists were free to choose when to give antibiotics, which antibiotics to give, and which dosage to use. In addition, there was no blinded assessment and participants were not considered as the statistical unit of the analysis, so the possible clustering of failures was not taken into account.
In a retrospective controlled clinical study (Gynther 1998), 147 participants (790 implants) who received 1 g of phenoxymethylpenicillin one hour preoperatively and 1 g every eight hours postoperatively for 10 days were compared with 132 participants (664 implants) who did not receive any antibiotics. Both groups were treated at the same centre, but at different time points (antibiotic group between 1980 and 1985; no antibiotic group between 1991 and 1995). No differences in survival rates of implants were reported. Another prospective multicentre controlled clinical study administered a single preoperative dose of penicillin G or V (1,000,000 units) or 600 mg of clindamycin to all patients, then one group had no postoperative antibiotics, the other receiving 300 mg penicillin V orally four times a day, or in case of penicillin allergy, 150 mg clindamycin orally three times a day for seven days (Binahmed 2005). A single dose was given to 125 participants (445 implants), while long-term prophylactic antibiotics were given to 90 participants (302 implants). Biological complications only were evaluated at one and two weeks post surgery and just before abutment connection. There were no differences regarding biological complications, which included three wound dehiscences in each group, with one developing an infection in the long-term antibiotic group. The authors concluded that long-term prophylactic antibiotic use was of no advantage or benefit over a single dose, however implant success, which should have been the primary outcome measure, was not evaluated. Unfortunately, all these studies were highly biased in their methodology, so the validity of their conclusions should be questioned.
Additional information can be obtained from three double-blinded RCTs that evaluated the efficacy of prophylactic antibiotics used for bone augmentation procedures prior to implant placement (Lindeboom 2003; Lindeboom 2005; Lindeboom 2006). One pilot placebo-controlled RCT (Lindeboom 2003) compared a preoperative single dose of 2 g penicillin phenethicillin with a placebo in 20 participants undergoing intraoral buccal onlay grafting with resorbable barriers to allow implant placement. Two participants developed an infection at both the receptor and donor sites; two participants developed a wound infection at the receptor site; and one participant developed an infection at the donor site only. All of these participants (50%) were in the placebo group. No infections were observed in the antibiotic group. It could be concluded that there was a statistically significant increased risk of having an infectious complication after bone augmentation with resorbable barriers without antibiotic prophylaxis. One RCT compared 2 g penicillin phenethicillin versus 600 mg of clindamycin as a single dose in participants treated with block-shaped bone graft harvested from the mandibular ramus and covered by resorbable barriers (the implants were not placed in the study) (Lindeboom 2006). Each group had 75 participants and the presence of infection was assessed weekly for eight weeks. No statistically significant differences were observed for postoperative infections (four infections at the augmented sites of the penicillin phenethicillin versus two in the clindamycin group, and three infections at the donor site of each group). The findings of this trial suggest that both penicillins and clindamycin are effective in reducing infection at augmented sites. No side effects related to the single-administration of antibiotics were reported. In another, similar, RCT the same research group evaluated whether it was more effective to use a single dose of 600 mg clindamycin one hour prior to onlay bone grafting procedures followed by either placebo or 300 mg clindamycin every six hours for one day (Lindeboom 2005). Each group had 62 participants. No statistically significant differences were observed for postoperative infections (two infections at the augmented sites of the single dose group versus three infections in the one-day group, and four infections at the donor sites of the single dose group versus two infections in the one-day group). Again, no side effects related to the administration of antibiotics were reported.
We wish to thank Anne Littlewood (Cochrane Oral Health Group) for her assistance with literature searching; Luisa Fernandez Mauleffinch and Phil Riley (Cochrane Oral Health Group) for their help with the preparation of this review; Paul Coulthard, Vassiliki Loli, Richard Oliver, Minesh Talati and Peter Thomsen for their contributions in previous versions of the present review; Mahmoud Abu-Ta'a, Gorka Orive and Ioannis Polyzois for providing us with information about their trials. We would also like to thank the following referees: Ian M Brook, Alfonso Caiazzo, Matteo Chiapasco, Sue Furness, Anne-Marie Glenny, Lee Hooper, Jerome Lindeboom, David R Moles, Ian Needleman, Michele Nieri, Gorka Orive, and Ioannis Polyzois.
Appendix 1. MEDLINE (OVID) search strategy
1. exp Dental Implants/
2. exp Dental Implantation/ or dental implantation
3. exp Dental Prosthesis, Implant-Supported/
4. ((osseointegrated adj implant$) and (dental or oral))
5. dental implant$
6. (implant$ adj5 dent$)
7. (((overdenture$ or crown$ or bridge$ or prosthesis or restoration$) adj5 (Dental or oral)) and implant$)
8. "implant supported dental prosthesis"
9. ("blade implant$" and (dental or oral))
10. ((endosseous adj5 implant$) and (dental or oral))
11. ((dental or oral) adj5 implant$)
The above subject search was linked to the Cochrane Highly Sensitive Search Strategy (CHSSS) for identifying randomised trials in MEDLINE: sensitivity maximising version (2008 revision) as referenced in Chapter 188.8.131.52 and detailed in box 6.4.c of theCochrane Handbook for Systematic Reviews of Interventions version 5.1.0 (updated March 2011).
1. randomized controlled trial.pt.
2. controlled clinical trial.pt.
5. drug therapy.fs.
10. exp animals/ not humans.sh.
11. 9 not 10
Appendix 2. The Cochrane Oral Health Group's Trials Register search strategy
An updated search was undertaken using the Cochrane Register of Studies and the search strategy below in January 2013:
#1 ("dental implant*" or "oral implant*" or "implant support*" or "endosseous implant*" or "blade implant*") AND (INREGISTER)
#2 ((implant* and (oral or dental))) AND (INREGISTER)
#3 ("subperiosteal implant*") AND (INREGISTER)
#4 ((implant* AND overdenture*)) AND (INREGISTER)
#5 (((overdenture* OR crown* OR bridge* OR prosthesis OR prostheses OR restoration*) AND ("dental implant*" OR "Oral implant" OR (zygoma* AND implant*)))) AND (INREGISTER)
#6 (#1 or #2 or #3 or #4 or #5) AND (INREGISTER)
A previous search of the Register was undertaken in January 2012 using the Procite software and the search strategy below:
(dental-implants OR "dental implant*" OR "oral implant*" OR dental-implantation OR dental-prosthesis-implant-supported OR "implant supported" OR "implant supported prosthesis" OR dental-implantation-endosseous-endodontic OR "endosseous implant*" OR blade-implantation OR "blade implant*" OR (implant* AND (oral OR dental)) or dental-implantation-subperiosteal OR "subperiosteal implant" OR (implant* AND overdenture*) OR ((overdenture* OR crown* OR bridge* OR prosthesis OR prostheses OR restoration*) AND ("dental implant*" OR "Oral implant" OR (zygoma* AND implant*))))
Appendix 3. The Cochrane Central Register of Controlled Clinical Trials (CENTRAL) search strategy
#1 DENTAL IMPLANTS explode all trees (MeSH)
#2 DENTAL IMPLANTATION explode all trees (MeSH)
#3 DENTAL PROSTHESIS IMPLANT-SUPPORTED single term (MeSH)
#4 ((osseointegrat* near implant*) and (dental* or oral*))
#5 (dental next implant*)
#6 (implant* near dent*)
#8 ((overdenture* near dental*) and implant*)
#9 ((overdenture* near oral*) and implant*)
#10 ((crown* near dental*) and implant*)
#11 ((crown* near oral*) and implant*)
#12 ((bridge* near dental*) and implant*)
#13 ((bridge* near oral*) and implant*)
#14 ((prosthesis near dental*) and implant*)
#15 ((prosthesis near oral*) and implant*)
#16 ((prostheses near dental*) and implant*)
#17 ((prostheses near oral*) and implant*)
#18 ((restoration* near dental*) and implant*)
#19 ((restoration* near oral*) and implant*)
#20 (implant next supported next dental next prosthesis)
#21 (blade next implant*)
#22 ((endosseous near implant*) and dental)
#23 ((endosseous near implant*) and oral*)
#24 ((dental* near implant*) or (oral* near implant*))
#25 (#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or
#14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24)
Appendix 4. EMBASE (OVID) search strategy
1. tooth implantation/
2. ((implant-supported or implant$) adj support$).mp.
3. ((osseointegrated adj implant$) and (dental or oral)).mp.
4. ((dental implant$ or dental-implant or implant$) adj (dent$ or oral or tooth)).mp.
5. (((overdenture$ or crown$ or bridge$ or prosthesis or prostheses or restoration$) adj5 (dental or oral)) and implant$).mp.
6. "implant supported dental prosthesis".mp.
7. ("blade implant$" and (dental or oral or tooth or teeth)).mp.
8. ((endosseous adj5 implant$) and (dental or oral or tooth or teeth)).mp.
9. ((dental or oral or tooth or teeth) and implant$).mp.
The above search was run with the Cochrane Oral Health Group's search strategy for isolating RCTs in EMBASE:
3. (crossover$ or cross over$ or cross-over$).ti,ab.
5. (doubl$ adj blind$).ti,ab.
6. (singl$ adj blind$).ti,ab.
10. CROSSOVER PROCEDURE.sh.
11. DOUBLE-BLIND PROCEDURE.sh.
12. RANDOMIZED CONTROLLED TRIAL.sh.
13. SINGLE BLIND PROCEDURE.sh.
15. ANIMAL/ or NONHUMAN/ or ANIMAL EXPERIMENT/
17. 16 and 15
18. 15 not 17
19. 14 not 18
Contributions of authors
Conceiving, designing and co-ordinating the review: Marco Esposito (ME).
Developing search strategy and undertaking searches: ME.
Screening search results and retrieved papers against inclusion criteria: ME, Maria Gabriella Grusovin (GG).
Writing to authors for additional information: ME.
Appraising quality: GG, ME, Helen Worthington (HW).
Data extraction: ME, GG, HW.
Analysis and interpretation of the data: ME, HW.
Writing the review: ME.
Declarations of interest
Marco Esposito is the first author of two of the included studies, however, he was not involved in the quality assessment of these trials.
Maria Bariella Grusovin: no interests to declare.
Helen Worthington: no interests to declare.