Use of antibiotics for prevention and treatment of sinus lift infections: an umbrella review of systematic reviews and meta-analyses

TL;DR

This review examines whether antibiotics help prevent infections during sinus lift procedures, finding limited evidence they are only useful in high-risk cases.

Contribution

The study synthesizes multiple reviews to clarify antibiotic effectiveness in sinus lift surgeries, highlighting the need for better research.

Findings

Infection rates after sinus lift ranged from 0.3% to 11.6%.

Antibiotics may reduce infection risk in high-risk scenarios like membrane perforation.

Routine antibiotic use in uncomplicated cases appears unnecessary.

Abstract

Antibiotic use in sinus floor elevation (SFE) procedures remains controversial due to heterogeneous protocols and inconsistent clinical outcomes.

To evaluate the effectiveness of systemic antibiotic regimens for the prevention and management of infections associated with SFE procedures, based on a synthesis of existing systematic reviews and meta-analyses.

The study protocol was registered in the PROSPERO (CRD420251061400). Seven systematic reviews and meta-analyses (2008–2024) were included. Methodological quality was appraised using AMSTAR-2, overlap among primary studies was evaluated with the GROOVE tool, and certainty of evidence was assessed through the GRADE approach. A descriptive synthesis was performed, as methodological heterogeneity and overlap precluded meta-analytic pooling.

Infection rates following SFE ranged from 0.3% to 11.6%, with implant survival consistently above 90% regardless of antibiotic regimen. Prophylactic antibiotics were commonly prescribed (Amoxicillin or Amoxicillin/Clavulanate, 7–10 days), although no standardized protocol was identified. Reviews rated as high or moderate quality provided limited yet consistent evidence suggesting that antibiotics may reduce infection risk in high-risk situations (e.g., membrane perforation, extensive lateral approach, or systemic comorbidities). The overall certainty of evidence was low to very low.

Current evidence suggests that antibiotic prophylaxis may be beneficial only in selected high-risk scenarios, whereas routine use appears unnecessary in uncomplicated SFE. Given the low certainty and heterogeneity of existing studies, recommendations should be interpreted cautiously, and future well-designed randomized trials are needed to define standardized antibiotic and non-antibiotic strategies for infection prevention.

The online version contains supplementary material available at 10.1186/s12903-025-07465-2.

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