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

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.