Antibiotic prophylaxis for dental implants: what the new Cochrane evidence means for your chair

A single preoperative dose of amoxicillin probably reduces early implant failure for routine implant placement, but high‑quality evidence is lacking for implant surgery with bone augmentation — act with targeted prescribing and clear patient counselling.

Antibiotics before implant surgery are one of the commonest routine prescriptions in private clinics. The updated Cochrane workstream separates two questions: implants placed without concurrent bone augmentation, and implants placed together with bone grafts or sinus lifts. The completed review for implants without augmentation pooled randomised trials and concludes that a single preoperative dose of oral amoxicillin probably reduces early implant failure; the effect size translates to roughly 80 failures per 1,000 patients without antibiotics versus about 27 per 1,000 with a single pre‑op dose (number needed to treat ≈ 19). This is a modest but real absolute benefit you can explain to patients as preventing about one early failure for every 19 similar patients treated. (Cochrane review 2026).