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

Abstract

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