**7. Future prospective and knowledge gap**

The prescription of antibiotics in medical practice needs to be addressed globally, particularly in the dental field, including dental implant procedures [29]. In fact, there is a decrease in surgical infection rate incidence even without the use of antibiotics, yet there is still an increase in antibiotic prescriptions [118]. There are a lot of factors influencing the prescription of antibiotics by healthcare practitioners including patients request, gap in knowledge and practitioner's education. Indeed, considering the serious situation regarding emerging and quickly disseminating antibiotic resistance there is no justification for prescription antibiotics without medical indication [29].

Within the literature, there is a lack of scientific evidence showing the additive effect of antibiotics, either prophylactic or therapeutic, in the treatment of dental implant. However, with the demands on restrictive antibiotic policy more studies are needed to assess the benefit of antibiotic prescription and the safety to refrain from its use. In order to restrict antibiotic use to fields where it has unquestioned medical value, it is important to investigate the need for antibiotics. Therefore, additional RCTs with larger sample sizes and longer follow-up period are needed to determine the role of antibiotic prophylaxis during implant insertion to prevent early implant failure in both uncomplicated/straight forward and complicated cases. Furthermore, different type of complicated cases such as immediate insertion into extraction site, bone augmentation procedures, full jaw surgery and implant surgery in the medically compromised patient, may pose a variable risk of postoperative infection and should therefore be studied separately. In the treatment of peri-implantitis, there is a critical need for doubleblinded placebo-controlled randomized clinical trials to demonstrate the efficacy of adjunctive use of systemically delivered antibiotics [80]. Furthermore, more studies are needed to evaluate antibiotic prescriptions from the societal and cost-effective perspectives, not just from the healthcare perspective.


**Figure 3.** Tips for the clinician regarding antibiotic prescription in implant dentistry.

Finally, there is a need for recommendations to limit and optimize the utilization of antibiotics in the dental implant field. This recommendation may result in a more sustainable antibiotic usage, preventing the risk of infection, which in turn can improve the results of a surgical intervention, reduce the risk of resistant bacterial strains developing, reduce the total use of antibiotics, and possibly reduce the cost of care [119]. Based on available evidence some summarized suggested advices to the clinician are presented in **Figure 3**.
