Should you pre-med with antibiotics before dental implant surgery?

Whether to use prophylactic antibiotics before dental implant or dental implants are placed is controversial and you will find many different opinions.

What does the research say about antibiotic use for dental implant placement?

Meta-analysis COIR 2015 Lund 2% less implants lost but no benefit for routine implant in healthy patient

Lit review says yes.  2-3 g amoxicillin one hour prior.  Keenan EBD 2015  and very similar here Keenan EBD 2015 says no difference if use after surgery

A really nice RCT Kashani 2019 showing 2.2% failure rate with the antibiotic and 7.5% early failure rate without.

Interesting study from JoPerio 2015 found that 500 mg azithromycin seems to possibly be better choice than amoxicillin.

What antibiotic should we use and at what dose for dental implants?

The main choices today, 2023, are amoxicillin, azithromycin, and cefuroxine. Different doctors will use different antibiotics at different doses and it is probably better for the population that not everyone is using the same thing to reduce the resistance to any one particular antibiotic. There are systemic reviews with recommendations like the first two below. Salgado-Peralvo JOI 2023

• Amoxicillin loading dose for a dental implant is 2 grams.
• Azithromycin loading dose for a dental implant is 500 mg.
• Cefuroxine loading dose is 1 gram. This is go to for bone grafting if patient has Pen allergy according to Misch. 1 gram loading dose pre-op for penicillin allergy. There is debate on the amount of cross antibiotic reactions that exist.

Misch protocol for antibiotic use and dental implants.

This is pretty old at this point. However, it is still a nice guideline.