Global prevalence and guideline adherence of antibiotic prescribing in dental implant surgery: A systematic review and meta-analysis.

Objectives: This systematic review and meta-analysis synthesised global prevalence, regimens, guideline adherence, and factors associated with antibiotic prescribing in dental implant surgery. Methods: MEDLINE, Scopus, and Web of Science were systematically searched from January 2010 to October 2025. Dentist surveys, patient-record studies, and register-based studies were included. Prevalence was pooled using random-effects meta-analysis with Freeman-Tukey transformation; regimen and appropriateness were narratively synthesised. Risk of bias and evidence certainty were assessed using JBI and GRADE tools. Results: Thirty-nine studies (7266 dentists; 137,207 patients) were included. Pooled prevalence of routine antibiotic prescribing was 61.3% (95% CI: 53.4-68.8%; I²=96.8%) with extreme heterogeneity (24.9-88.8%). Combined pre- and post-operative regimens predominated (52.6%), typically involving 5-7-day post-operative courses. Amoxicillin was the most frequent choice (50.9%). Prescribing increased with procedural complexity, reaching 97.3% for compromised cases. Guideline-concordant prescribing was low (1-28%), with a declining temporal trend. Overall evidence certainty was very low. Conclusions: Antibiotic prescribing for implant surgery varied widely but was often high, frequently exceeding evidence-based indications. Post-operative regimens predominated despite no demonstrated benefit over a single pre-operative dose. Reducing unnecessary antibiotic use in implant surgery may require procedure-specific international guidelines and targeted stewardship, though more robust evidence is needed to determine effective strategies.