Avaliação clínica do uso de antibióticos em cirurgias para instalação de implantes dentários: um ensaio clínico randomizado, triplo cego e controlado

Abstract

Objective: conduct a randomized, triple-blind, controlled test to clinically assess 2 pharmacological treatments of antibiotic prophylaxis, in patients submitted to a two-stage dental implant procedure, in terms of pain, infection and implant failure. Materials and methods: A total of 61 patients received 115 dental implants. Data collection was conducted by a blind calibrated examiner during the following postoperative follow-up periods: T1 (7 days), T2 (14 days), T3 (30 days) and T4 (120 days). Randomization was performed using the random function of Microsoft Excel® (2013), which randomly divided patients according to the list generated by the program. The study subjects were divided into 3 groups: group 1 (G1) consisting of 21 patients who did not use an antibiotic prophylaxis, group 2 (G2), with 20 patients who used preoperative antibiotic prophylaxis (1 g of amoxicillin) applied orally 1 hour before the procedure and group 3 (G3), with 20 patients who used preoperative antibiotic prophylaxis (1g of amoxicillin) applied 1 hour before the procedure, maintaining the antibiotic, consisting of 500 mg of amoxicillin, for 5 days every 8 hours. Variable pain was analyzed using a visual analog scale (VAS) and the number of analgesics taken. Infection was considered by the presence of pus and fistula. The implant was reopened at time T4 to evaluate the success of primary osseointegration, considering the absence of mobility and pain while replacing the cover screw with a healing screw. Pain (VAS and number of analgesics) was analyzed using the Kruskal-Wallis and Dunn’s post hoc tests. Infection was analyzed with Fisher’s Exact test and failure described. A 5% significance level was established, with a 95% confidence interval. Results: Analysis of postoperative pain showed better results in the groups that used antibiotics (G2 and G3) at follow-up T1 (7 days), with patients experiencing less pain (Kruskal Wallis, p < 0.05). Intergroup assessment also demonstrated differences (Dunn’s post hoc, p < 0.05), being higher in G3, but there were no significant differences in the other periods. Infection was present in group 1 (2 cases) and G3 (2 cases), with no significant intergroup differences (Fisher’s Exact test, p > 0.05), with a loss (failure) of two implants: one in G1 and the other in G3. Conclusions: The preliminary results of the study revealed better pain results in patients who used prophylactic antibiotics, but was not superior in relation to infection or implant failure when compared to the group that did not use antibiotics. Thus, based on the results of the present study, considering a maximum of 4 implants per procedure, in healthy patients with no additional procedures, although antibiotics improved pain in the immediate postoperative, they did not decrease infection indices or implant failure.