Key messages
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Taking antibiotics one hour before dental implant placement probably reduces the risk of early implant failure under routine conditions. This benefit is mainly based on studies using a single dose of amoxicillin taken before surgery, most often 2 g one hour before implant placement. Based on the available evidence, about 19 people would need to receive antibiotics to prevent one person from having an early implant failure.
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We do not know whether taking antibiotics for longer periods, taking them before or after surgery, or using other antibiotics other than amoxicillin provides additional benefit. Evidence about unwanted effects is uncertain because they were rare and not always reported.
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Future studies are needed to better understand the effects of giving antibiotics around the time of dental implant surgery, especially when an implant is placed immediately after a tooth is removed. Studies should compare a single dose of antibiotics given before surgery with longer or repeated treatment. It would also be useful to compare commonly used antibiotics, such as amoxicillin and clindamycin.
What are dental implants, and why could taking antibiotics for them be useful?
Dental implants are used to replace missing teeth and support crowns, bridges, or dentures. During implant placement, bacteria can be introduced into the surgical site. If the site around an implant becomes infected, treatment is difficult and removal of the implant is often required.
Antibiotics are sometimes given before or after surgery to reduce the risk of infection. However, they can also cause unwanted effects, ranging from mild symptoms to severe allergic reactions. Also, their widespread use contributes to antibiotic resistance, where bacteria change and grow so that the antibiotics that used to effectively treat them no longer work. For these reasons, the routine use of antibiotics for dental implant placement remains controversial.
What did we want to find out?
We wanted to know whether taking antibiotics around the time of dental implant placement:
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reduces implant failures and artificial teeth failures;
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reduces postoperative infections;
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causes unwanted effects.
We wanted to know if the effects of antibiotics differed according to:
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antibiotics compared to placebo (dummy treatment) or no antibiotics;
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different doses or different durations of the same antibiotic;
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the same dosage of the same antibiotic given at different times;
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different antibiotics.
What did we do?
We searched for studies in which adults receiving dental implants without the addition of bone tissue (bone augmentation procedures) were assigned by chance to receive either antibiotics or no antibiotics, or to receive different antibiotic regimens. We compared and summarised the results of the studies and rated our confidence in the evidence based on factors such as study methods and sizes.
What did we find?
We found 15 studies including a total of 2874 people. The studies were conducted in Europe (Italy, Spain, Belgium, Ireland, and Sweden), the USA, Canada, Brazil, Iran, and Saudi Arabia, and were published between 2008 and 2024.
Antibiotics versus placebo or no antibiotics
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People who received antibiotics one hour before dental implant placement were probably less likely to experience early implant failure than those who received placebo or no antibiotics (10 studies, 1919 people). This means that about 80 out of 1000 people without antibiotics experienced implant failure, compared with about 27 out of 1000 people who received antibiotics.
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Antibiotics probably reduce artificial teeth failures (9 studies, 1864 people) and postoperative infections (10 studies, 1919 people).
Single dose versus multiple doses of antibiotics
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There may be little to no difference between taking a single dose of antibiotics and taking multiple doses in implant failures (5 studies, 760 people) or postoperative infections (5 studies, 760 people).
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The evidence for artificial teeth failures is very uncertain.
Antibiotics before surgery versus after surgery
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The evidence is very uncertain for implant failures, artificial teeth failures, and postoperative infections.
Different antibiotics
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There may be little to no difference in implant failures, artificial teeth failures, and postoperative infections between amoxicillin and clindamycin (1 study, 81 people).
Unwanted effects
Unwanted effects were rare and inconsistently reported. Most were mild (such as diarrhoea), but one severe allergic reaction requiring hospital admission was reported. Because few people experienced unwanted effects, we cannot reliably rule out rare but serious harms.
What are the limitations of the evidence?
Our confidence in the evidence ranged from moderate to very low because some studies had problems with their methods, and in many cases, the evidence was based on small numbers of events.
How up to date is this evidence?
This review is current to 19 November 2025.
Read the full abstract
Some dental implant failures may be due to bacterial contamination at implant insertion. Infections around biomaterials are difficult to treat, and almost all infected implants have to be removed. In general, antibiotic prophylaxis in surgery is only indicated for patients at risk of infectious endocarditis; with reduced host-response; when surgery is performed in infected sites; in cases of extensive and prolonged surgical interventions; and when large foreign materials are implanted. A variety of prophylactic systemic antibiotic regimens have been suggested to minimise infections after dental implant placement. More recent protocols recommended short-term prophylaxis, if antibiotics have to be used. Adverse events may occur with the administration of antibiotics, and can 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. The use of prophylactic antibiotics in implant dentistry is controversial.
Objectives
To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement not subjected to concomitant bone augmentation procedures versus no antibiotic or placebo administration and, if antibiotics are beneficial, to determine which type, dosage, and duration is the most effective.
Search strategy
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the WHO ICTRP, and ClinicalTrials.gov from January 2013 to 19 November 2025.
Selection criteria
Randomised controlled clinical trials (RCTs) with a follow-up of at least three months, that compared the administration of various prophylactic antibiotic regimens versus no antibiotics to people undergoing dental implant placement. Outcome measures included prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc).
Data collection and analysis
Screening of eligible studies, assessment of the risk of bias of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as risk ratios (RRs) using a random-effects model for dichotomous outcomes with 95% confidence intervals (CIs). Heterogeneity, including both clinical and methodological factors, was to be investigated.
Main results
Six RCTs with 1162 participants were included: three trials compared 2 g of preoperative amoxicillin versus placebo (927 participants), one compared 3 g of preoperative amoxicillin versus placebo (55 participants), one compared 1 g of preoperative amoxicillin plus 500 mg four times a day for two days versus no antibiotics (80 participants), and one compared four groups: (1) 2 g of preoperative amoxicillin; (2) 2 g of preoperative amoxicillin plus 1 g twice a day for seven days; (3) 1 g of postoperative amoxicillin twice a day for seven days, and (4) no antibiotics (100 participants). The overall body of evidence was considered to be of moderate quality. The meta-analyses of the six trials showed a statistically significant higher number of participants experiencing implant failures in the group not receiving antibiotics (RR 0.33; 95% CI 0.16 to 0.67, P value 0.002, heterogeneity: Tau2 0.00; Chi2 2.87, df = 5 (P value 0.57); I2 0%). The number needed to treat for one additional beneficial outcome (NNTB) to prevent one person having an implant failure is 25 (95% CI 14 to 100), based on an implant failure rate of 6% in participants not receiving antibiotics. There was borderline statistical significance for prosthesis failures (RR 0.44; 95% CI 0.19 to 1.00), with no statistically significant differences for infections (RR 0.69; 95% CI 0.36 to 1.35), or adverse events (RR 1; 95% CI 0.06 to 15.85) (only two minor adverse events were recorded, one in the placebo group). No conclusive information can be derived from the only trial that compared three different durations of antibiotic prophylaxis since no event (implant/prosthesis failures, infections or adverse events) occurred in any of the 25 participants included in each study group. There were no trials that evaluated different antibiotics or different antibiotic dosages.
Authors' conclusions
Antibiotic prophylaxis at dental implant placement probably reduces early implant failures. This finding is mainly based on trials comparing a single preoperative oral dose of amoxicillin (usually 2 g one hour before surgery) with placebo or no antibiotics (number needed to treat for an additional beneficial outcome ≈ 19). Antibiotic prophylaxis probably also reduces prosthesis failures and postoperative infections. The evidence for adverse events is very uncertain because events were rare and inconsistently reported.
The available evidence is insufficient to determine the optimal regimen, including single- versus multiple-dose regimens, pre- versus postoperative administration, or whether antibiotics other than amoxicillin offer additional benefit.
One allergic reaction requiring hospitalisation was reported, highlighting that antibiotic prophylaxis should be used only when proven effective and clinically justified.
Funding
This Cochrane review was funded (in part) by Vita-Salute San Raffaele University, Milan.
Registration
Protocol (2003): doi.org/10.1002/14651858.CD004152.
Original review (2008): doi.org/1002/14651858.CD004152.pub2.
Review update (2010): doi.org/10.1002/14651858.CD004152.pub3.
Review update (2013): doi.org/10.1002/14651858.CD004152.pub4.
