Histological and Histomorphometric Insights into Implant Bed Preparation: A Systematic Review

Objective: To assess the bone histological changes and histomorphometric parameters when using different implant site preparation methods. Methods: A systematic search was conducted in March 2025 across the PubMed, Scopus, and Web of Science (WoS) databases following the PRISMA guidelines. An initial search of the databases yielded 338 potentially relevant articles. Ultimately, a total of 29 articles were included in the qualitative synthesis in this review. The considerable heterogeneity among the included studies precluded a meta-analysis. Results: This systematic review showed that, among all the assessed implant site preparation methods, which were drilling, laser, piezoelectric surgery, osteotomy and osteodensification, the classical drilling method was more likely to cause adverse changes at the drill site, such as microcracks, uneven bone margins, osteocyte damage and thermal injury. In contrast, alternative methods resulted in fewer microcracks, minimal inflammation, a reduced risk of thermal tissue damage and denser, more regular bone formation. When using these methods, the %BIC parameter was higher than when using the drilling method. Conclusions: Using alternative techniques to prepare the implant bed creates favourable conditions for proper healing and osseointegration by eliminating defects resulting from the drilling method. However, it should be noted that satisfactory results can be achieved using the classical method if the correct parameters of the drill rotation, cooling and load are employed. Further studies based on a uniform methodology are necessary to determine the most efficient and safest parameters for each method.