Background: The use of antibiotic prophylaxis in dental implant surgery is controversial, with conflicting guidelines and variations in clinical practice. This systematic review aimed to evaluate the effectiveness of antibiotic prophylaxis in preventing implant failure and post-operative infection in healthy patients. Methods: A systematic search of the PubMed database was conducted to identify relevant randomized controlled trials (RCTs). Four RCTs met the inclusion criteria and were included in the review. Data on implant failure, post-operative infection, and study characteristics were extracted. Results: The four included RCTs, published between 2008 and 2022, encompassed 966 participants. The findings regarding the effect of antibiotic prophylaxis on implant failure were mixed. Two studies reported lower failure rates in the antibiotic group, one found similar rates, and one reported a higher failure rate in the antibiotic group. The findings regarding post-operative infections were also inconclusive, with generally low infection rates reported across both groups. Conclusion: The evidence regarding the benefit of antibiotic prophylaxis in preventing implant failure and post-operative infection in healthy patients is mixed and inconclusive. Further well-designed and adequately powered RCTs are needed to clarify the role of antibiotic prophylaxis in this setting. In the meantime, clinicians should carefully consider the individual patient's risk factors, the potential benefits and harms of antibiotic prophylaxis, and the available evidence when making decisions about antibiotic use in dental implant surgery.

The authors have declared no competing interest.

This study did not receive any funding

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