Antibiotics for implantation can be prescribed both before and after installation of implants, depending on the clinical picture. Their use can significantly reduce the risk of developing inflammatory processes and reduce the likelihood of complications after implantation, including rejection of installed structures.
Getting a new smile doesn’t end with implant surgery. In order for the rehabilitation period to be as successful as possible, without tissue inflammation, and for the implant to take root safely, doctors must prescribe medications, including antibacterial drugs.
How does surgery affect the body?
Dental implantation is a much more complex procedure than, for example, caries treatment. This is already an operation, and during it tissue injury is inevitable - gums, jaw bones, riddled with blood vessels. After all, to install an implant, you need to cut the gum and drill a hole into the bone. And since hundreds of millions of pathogenic microorganisms (bacteria, fungi, protozoan parasites) are constantly present in the oral cavity, there is a risk that they will penetrate deep into the tissues around the implant or spread throughout the body through the bloodstream. As a result, implant healing will slow down, or peri-implantitis may begin or rejection may occur.
Injury to oral tissues triggers reactions in the body aimed at their restoration. Therefore, after the end of anesthesia, a person often feels pain and notices that swelling has appeared on the cheek. The gums may bleed slightly in the area of the sutures in the first hours after installation of the implants. To relieve pain, swelling and, to some extent, inflammation, dentists prescribe painkillers and antihistamines to patients. But they cannot cope with the infection, and the body itself is also not always able to resist pathogens. To reduce the risk of infection, antibiotics may be prescribed during implant placement[1].
Antibiotics or antimicrobials, as the World Health Organization prefers to call them, include 3 groups of drugs. These are antibacterial - bacteriostatic inhibit the proliferation of bacteria, and bactericidal kill them. Next come antifungal or antimycotic drugs - they act on harmful fungi, such as Candida. The third group is antiprotozoal, which suppress the vital activity of protozoan parasites (amoebas, plasmodia). They do not kill viruses, because... act specifically against bacteria.
Possible consequences of violating prophylactic antibiotic therapy
After implantation, tissue swelling occurs and pain may be bothersome. Taking antihistamines and painkillers helps eliminate these consequences. But these groups of medications will not be able to cope with pathogenic microbes. Infectious inflammation does not develop immediately, so some patients believe that an antibiotic is not necessary. But if the prescribed regimen for taking the antibacterial drug is violated, peri-implantitis may occur - inflammation of the tissues surrounding the artificial root. In this case, the full engraftment and stability of the implant cannot be guaranteed, and in case of failure, the patient will have to take responsibility. But when taking antibiotics, the risk of developing an inflammatory process is significantly reduced.
Indications for the use of antimicrobial agents
Is it necessary to take antibiotics after dental implantation? Here everything depends on several factors - the extent of the intervention, the time of installation of prostheses on implants, the health of the patient himself, etc. Let’s take a closer look at the indications when it is necessary to take antibiotics after implantation (but let’s immediately make a reservation that you should take medications only as prescribed by the dentist):
- more than 2 implants are installed at the same time: for example, with complex techniques, from 3 to 14 implants can be placed on the dentition - and this means increased traumatism,
- One-stage implantation was performed: i.e. the implant was placed immediately after the removal of a tooth or root, around which there may be inflammation,
- immediate prosthetics are planned: in a situation where prostheses are placed immediately or 3-4 days after the surgical stage, it is necessary to completely eliminate the risk of infection and “help” the implants take root faster,
- osteoplasty[2] and/or sinus lifting was performed: when replanting the bone or raising the bottom of the maxillary sinus, it is also necessary to minimize the likelihood of inflammation,
- the patient has granulomas or cysts under the tooth roots: of course, they will be removed, but a small focus of infection may remain in the tissues,
- the patient has chronic diseases: for example, dental diseases - gingivitis, periodontitis, periodontal disease, stomatitis, osteoporosis, as well as diseases of the throat and nasopharynx,
- impossibility of carrying out high-quality oral hygiene: the maximum number of microbes is found in the mouth 12 hours after the previous cleaning. And if they are not removed, then the local immunity (already “working” so intensely after the operation) may simply not be able to cope with them - as a result, inflammation develops,
- weakening of general immunity or changes in hormonal levels: for example, if the patient is not in very good health, has recently suffered from an illness, or has diabetes mellitus in a compensated form. Women during menopause are also often prescribed a certain antibiotic after dental implantation.
There may be other (individual) indications for the use of antibiotics not only after, but also before dental implantation. This includes the already mentioned chronic diseases. The dentist can also prescribe antimicrobial agents a few days before the installation of implants - if tests in preparation for treatment showed a slightly increased content of leukocytes, or a large number of pathogens were detected in the smear. Patients who decide to transform their smile during the epidemic may be prescribed antibiotics and vitamins - which must be taken before dental implantation (1-2 days before). After the surgical stage, taking prescribed medications, as a rule, continues.
Carrying out the operation
Each patient who will undergo surgery is individual. For some it is carried out in one stage, but sometimes there is a need for several. Therefore, before surgery, a complete examination of the patient takes place. This is necessary to identify contraindications. In some cases, the doctor performs osteoplasty so that the implant is securely fixed. To ensure that the postoperative period passes without complications, a course of antibiotics is prescribed. This prevents inflammatory processes and restores bone tissue.
Medicinal substances and requirements for them
Antibiotics for implantation, as already noted, can belong to three types - antibacterial, antifungal and antiprotozoal agents. Some substances have a combined effect - for example, they simultaneously affect both parasites and certain bacteria. Also, one drug can combine several substances (usually antibacterial), which act in combination on different groups of pathogens. But any antibiotics must meet the following requirements:
- effective impact,
- minimal risk of allergic reactions,
- modern production from purified raw materials,
- minimum number of contraindications,
- minimal side effects,
- convenient form of administration: as a rule, drugs are presented in the form of suspensions or tablets, film-coated or dispersible. The latter disintegrate into tiny particles upon contact with liquid - water or saliva.
Side effect
The use of antibiotics can cause side effects, especially if the regimen prescribed by the doctor has not been followed. Drugs in this group can cause the following negative consequences:
- Allergic reaction , manifested by skin rash, itching and other symptoms.
- Dysbacteriosis caused by the effect of antibiotics on beneficial bacteria living in the intestines, as a result of which its normal microflora is disrupted.
- Mycoses , provoked by strong proliferation of fungi caused by the destruction of natural bacterial microflora.
- Disturbances in the functioning of body systems and organs.
- Acquisition of resistance by pathogenic microorganisms to the action of antibiotics.
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If any side effect occurs, the patient must stop using the drug and report the body’s reaction to the doctor. If treatment without antibiotics cannot be continued, another appropriate medication will be prescribed.
Frequently prescribed drugs
It is immediately worth noting that the list of antibiotics presented below are drugs that are prescribed only by dentists after dental implantation. Self-administration of such medications “at will” is prohibited! After all, a dentist is a professional who sees the complete clinical situation in front of him and knows what to prescribe for a specific patient (if at all necessary) and not do harm.
Antibacterial drugs
Antibacterial agents from the group of penicillins and fluoroquinolones have a wide spectrum of action on bacteria “living” in the oral cavity. Penicillins are, for example, Amoxicillin, Flemoxin with the active ingredient amoxicillin (belongs to the 3rd generation penicillins). Amoxicillin can also be “enhanced” by the action of clavulanic acid - “Flemoklav”, “Amoxiclav”. Penicillins have a wide range of effects on staphylococci and streptococci.
Often in dentistry, Ciprolet and similar drugs with the active ingredient ciprofloxacin (belongs to the 2nd generation fluoroquinolones) are prescribed. It is active against many strains of staphylococcus, Pseudomonas aeruginosa, as well as some protozoan microorganisms.
Antiprotozoal antibiotics
During implantation, antiprotozoal drugs with an antibacterial effect can be prescribed - metronidazole and tinidazole (the drugs have the same names). They affect protozoan parasites and some types of anaerobic bacteria. When taken in combination with antibacterial agents that suppress aerobic bacteria, they enhance each other’s effects (synergy effect).
Combined products
A popular combination drug with a wide spectrum of action is Tsifran ST. One tablet contains 2 active ingredients at once - the antibacterial ciprofloxacin and the antiprotozoal tinidazole. The components are bioavailable, quickly penetrate the body tissues and have a complex effect on pathogens, reducing the risk of complications after implantation.
Antifungal drugs
Antimycotic agents are active against microscopic fungi. For example, Fluconazole suppresses Candida fungi. Or, more simply put, it treats candidiasis (thrush), which often appears in the oral cavity in patients with weakened immune systems or during long-term use of strong medications.
Dosage and regimen
Is it necessary to take antibiotics after installing an implant in the dosage prescribed by the implantologist? Yes, definitely, because... it is necessary for the required amount of medicine to penetrate into the tissues. If you drink, for example, not the conventional 500 mg, but 250 mg of the drug, the effect will be weaker - and the recovery, accordingly, will be longer. If, on the contrary, you increase the dosage yourself, then there is a risk of side effects.
The dentist-implantologist calculates the dose and frequency of administration of the drug in accordance with many factors - body weight, age of the patient, the presence of chronic diseases. And also over time, after which the maximum concentration of the drug in the blood will be reached, and when it begins to be eliminated from the body. Most often, antibiotics are prescribed 3 times a day, but according to indications, double or single doses are possible.
Moreover, it is important to follow not only the dosage, but also the rules of administration. Some drugs need to be taken before meals, others - during, but most - only 20-60 minutes after eating (so the drug is completely absorbed). Therefore, carefully read the instructions for each medicine. As a rule, antibiotics are washed down with clean water at room temperature - at the rate of 0.5-1 cups per 1 tablet.
How to use
All antibiotics have a number of contraindications for use, which, if ignored, can lead to serious consequences and health problems. The instructions for the drug are required reading . If it is written in a foreign language and there is no translation, such medicines cannot be purchased. Their sale is prohibited by law , and the risk of purchasing a low-quality drug increases many times over.
When prescribing a remedy, the doctor must first carefully examine the patient’s medical history. Otherwise, the development of various negative reactions of the body is possible.
If the medication contains a component that is an allergen for the patient, even death is possible.
You need to take the medicine with food (unless the instructions indicate a different dosage regimen). Thus, the active substance is absorbed into the blood from the gastrointestinal tract gradually. The prescribed drug should be taken based on the instructions of the implantologist, however, there are a number of general recommendations for most antibacterial drugs:
- Do not exceed the dose prescribed by the doctor , even if the drug is absorbed normally. An overdose may cause side effects.
- The appointment period should not exceed the time recommended by the implantologist . As a rule, the course of antibiotic therapy lasts 7 days. Longer use can cause various side effects, for example, intestinal upset or resistance of microorganisms to antibiotics of this group.
Side effects and what to do about them
Taking antibiotics can lead to side effects, which is absolutely undesirable after implantation, because the body has fewer free resources for their full engraftment. Let’s take a closer look at the list of common “side effects” (but let’s immediately note that they occur in a minimal number of patients):
- dry mouth, decreased appetite,
- nausea, abdominal pain,
- diarrhea or constipation,
- skin rashes,
- headaches, sleep disturbances,
- increased heart rate, decreased blood pressure,
- tinnitus, visual disturbances,
- impaired attention, anxiety.
If side effects cause discomfort, you should stop taking the medicine and contact your dentist to adjust your treatment. It is likely that the doctor will additionally prescribe the use of lacto- or bifidobacteria, prebiotics. If pronounced side effects occur - shortness of breath, difficulty breathing, swelling, severe nausea, hallucinations, loss of consciousness, anaphylactic shock, you should immediately seek medical help.
“After the implants were implanted, the doctor gave me a list of medications and told me what and how to drink. And he also said to be sure to take Suprastin. Firstly, it relieves swelling, and also prevents allergies to antibiotics from appearing (which makes the skin on my hands itchy). I was prescribed Tsifran to take for a week. It helped well, I have something to compare with. One day a tooth was removed and another medicine was prescribed. So there wasn’t much use for him.”
Mikhail, review from gidpozubam.ru
Reasons for appointment
At the time of surgery, the microflora of the oral cavity is disrupted. The dentist is obliged to foresee the development of complications. In order to prevent problems with rehabilitation, the doctor prescribes antibiotic therapy. Antibiotics are prescribed in the following cases:
- poor oral hygiene, lack of care for implants;
- surgery in the presence of diseases or performing it in one stage;
- diseases of ENT organs;
- osteoplasty.
The selection of drugs is carried out solely on the basis of previously performed diagnostics.
Cost of antibiotics for implantation
The price of antibiotics after implantation depends on the drug, accompanying medications (to restore the gastrointestinal microflora) and how much to take. The minimum cost of packaging an antimicrobial agent, which is designed for 5 days, is 150 rubles. A full-fledged “post-implantation first aid kit” can cost 1000-2000 rubles, because it also includes other drugs - painkillers, antihistamines, vitamin complexes.
[1] Ushakov R.V., Tsarev V.N. Antimicrobial therapy in dentistry. Principles and Algorithms, 2021.
[2] Alfaro F.E. Bone grafting in dental implantology. Description of methods and their clinical application, 2010.
Author: Bespalov R. D. (Thank you for your help in writing the article and the information provided)
Implantation is very stressful for the body
During implantation, in most cases, an incision is made in the gum, after which sutures are placed on it. On the first day, in order for the mucous membranes to recover, you need to care for the wound as carefully as possible. Any little thing can provoke inflammation and suppuration. The success of the post-implantation period is influenced by:
- the general health of the patient;
- professional skills of an implantologist;
- the type of implant used and the method of its implantation;
- patient compliance with medical recommendations.
Once the titanium pin is installed, postoperative therapy is prescribed. It is designed to speed up regenerative processes and prevent the development of infection. Antibiotics can be its basis.
