Background <p>Antibiotic prophylaxis in dental implant surgery remains a contentious topic, with varying guidelines and clinical practices worldwide.</p> Aim <p>Report how Swedish dentists use antibiotic prophylaxis during dental implant surgery, based in a review of patient records.</p> Method <p>This retrospective, cross-sectional study evaluated the antibiotic prophylaxis habits of Swedish dentists, focusing on the relationship between surgical complexity and antibiotic use.</p> Results <p>Data from 450 patient records with registered implant surgeries at two major dental care providers, one public and one private, were analysed. Thirty-seven clinics provided the data, and 109 dentists performed the surgeries. Findings revealed that 72.2% of implant surgeries were straightforward procedures, with no administration of antibiotic prophylaxis in 70.5% of these. Conversely, 90% of bone augmentation cases involved antibiotic use, particularly in complex protocols utilizing synthetic materials and membranes. Overall, 54.4% of patients in the study population received no antibiotic prophylaxis at all. Surgical complexity was a significant predictor for antibiotic administration, while patient-specific factors, such as age, chronic diseases, and tobacco use, had limited influence.</p> Conclusion <p>Restrained antibiotic use in implant surgery in Sweden reflects alignment with current stewardship goals, particularly in straight forward procedures. However, continued administration in some uncomplicated cases and frequent use in complex surgeries highlight the need for clearer, evidence-based guidelines and standardized antibiotic protocols.</p>