Clindamycin associated with elevated risk of dental implant failure and infection: Study

Dental implants are currently the most predictable therapeutic option for total or partial replacement of missing teeth, with high survival rates of around 95% according to different studies, both in pristine bone and in regenerated bone. Despite this, some implant failures occur. Chrcanovic et al. defined implant failure as those signs and symptoms that lead to the explantation of the implant, whereby "failure" is equivalent to implant loss. The failure rate has been estimated to be around 0.7–3.8%. These failures are classified as "early" or "late" depending on whether they take place before or after, respectively, the functional loading of the implants with a prosthetic restoration. This differentiation is important because different etiological factors are associated depending on the time of their occurrence. In this regard, early failures are caused by a failure of osseointegration due to local and/or systemic factors and account for approximately 5% of all failures, affecting more women and younger patients. In contrast, late failures are usually due to bacterial infections, parafunctional habits or mechanical factors related to the implant-supported prostheses and affect the 95% of implants that reach osseointegration

The prescription of preventive antibiotics in dental implant treatments reduces the incidence of early failures. This study has focused mainly on the influence of amoxicillin, which is contraindicated in penicillin-allergic patients.

The present systematic review aimed to determine whether penicillin-allergic patients have a higher risk of implant failure compared to non-allergic patients.

An electronic search was performed on Medline and Web of Science using the following MeSH terms: (penicillin allergy OR clindamycin OR erythromycin OR azithromycin OR metronidazole) AND (dental implant OR dental implant failure OR dental implant complications). The criteria employed were those described in the PRISMA® Declaration. Only five articles were included that analyzed the failure rates of implants placed in penicillin-allergic patients who were prescribed clindamycin compared to non-allergic patients who were prescribed amoxicillin.

Salomó-Coll et al. [16] (2018) described failure rates in patients non-allergic to penicillin of 8.03%, while in the group of patients with SRPA the failure rates were 24.68%, i.e., one in four implants failed (p = 0.032), with a relative risk (RR) of 3.84. Clindamycin was prescribed in 100% of these patients. In patients with SRPA, 21.05% of implants failed late, while 78.95% failed early. The reason for early failure was either a failure of the osseointegration process (80%) or uncontrolled infection (20%). At an individual patient level, failure rates were 5.17% in non-allergic patients and 18.86% in patients with SRPA (p = 0.046) (RR = 3.64).

French et al. [19] (2015) found twice the risk of implant failure in confirmed penicillin-allergic patients who were prescribed clindamycin versus those who were prescribed amoxicillin (hazard ratio (HR) = 2.16).

However, these results were not significant (p = 0.11) due to the low number of allergic patients included and the low failure rates experienced in the whole sample (0.70%). These authors suggest avoiding immediate implant placement in patients in whom penicillin cannot be administered and placing implants on a delayed basis.

Thus, the researchers concluded that Clindamycin has been associated with a significantly elevated risk of failure and an up to six times increased risk of infection. Immediate implants also have a 5.7 to 10 times higher risk of failure.

Reference:

Is Penicillin Allergy a Risk Factor for Early Dental Implant Failure? A Systematic Review by Angel-Orión Salgado-Peralvo et al. published in the Antibiotics.

https://www.mdpi.com/2079-6382/10/10/1227/htm