Comparative evaluation of implant stability using three osteotomy techniques- a randomised clinical trial

Abstract

The aim of this clinical trial was to compare the implant stability in terms of primary and secondary stability with three different osteotomy techniques, to establish a protocol that can consistently help achieve increased implant stability in the maxillary posterior region. A total of 30 patients (19 males, 11 females; mean age 46.3 ± 8.7 years) requiring single implant placement in the maxillary posterior region were divided into three groups. Endosseous implants (Straumann Bone Level Tapered, SLActive surface, 4 mm × 10 mm) were placed in Group I using conventional osteotomy, Group II with Summers’ osteotome technique, and Group III with the osseodensification technique. All implants were placed with an emerged (non-submerged) technique and immediately restored with provisional prostheses adjusted to eliminate centric and eccentric contacts (immediate restoration without functional loading). The stability was assessed at the time of implant placement, at three months and at six months using resonance frequency analysis (Osstell). One-way ANOVA and Tukey post-hoc test were used to compare the ISQ values between groups, and repeated measures ANOVA for intragroup comparisons. No statistically significant differences were observed in the ISQ values at the time of placement, three months, and six months after implant placement between Group I (Conventional osteotomy), Group II (Summers’ osteotome technique), and Group III (Osseodensification). However, numerical trends indicated slightly lower initial primary stability in Group II and slightly higher values in Group III throughout the observation period. All implants achieved 100% survival at six months. Within the limitations of this exploratory study, all three osteotomy techniques achieved adequate primary stability for immediate restoration in the maxillary posterior region. While no statistically significant differences were detected between techniques, numerical trends suggest that osseodensification may offer marginally better primary stability and Summers’ osteotome technique showed slightly lower initial values. These findings should be interpreted cautiously given the small sample size and relatively short follow-up period. Further large-scale, adequately powered studies are needed to definitively establish clinical superiority of any technique. CLINICAL TRIAL REGISTRY OF INDIA (CTRIICMR) REGISTRATION NO. CTRI/2021/09/036513. Registered retrospectively on 15/09/2021 (enrollment began September 2020). Available at https://www.ctri.nic.in.