Comparison of Five Osteotomy Protocols on Implant Stability and Postoperative Anxiety: A Randomized Controlled Trial

This randomized controlled clinical trial compared five implant osteotomy techniques-high-speed drilling (800 rpm), moderate-speed drilling (300 rpm), ultra-low-speed drilling (50 rpm), osseodensification, and bone condensation-with respect to insertion torque (IT), early implant stability quotient (ISQ) progression, and immediate postoperative VAS-anxiety during early osseointegration.

One hundred healthy adults each received a single identical macrodesign implant and were randomly allocated to five osteotomy protocols (n = 20/group). Insertion torque was recorded at placement. ISQ was measured at placement (T0), 1 week (T1), 1 month (T2), 2 months (T3), and 3 months (T4). Immediate postoperative patient-reported anxiety was assessed using a 10-cm visual analog scale (VAS). Sites exhibiting IT < 25 Ncm were prespecified for submerged healing and excluded from longitudinal stability analyses. The primary endpoint was the change in ISQ from T0 to T4, with multiplicity controlled using Bonferroni-adjusted pairwise comparisons.

A total of 100 implants were included in the final analyzed cohort. Four additional implants exhibited IT < 25 Ncm at placement and were therefore excluded from longitudinal ISQ analyses according to the predefined protocol. Across the analyzed implants, all groups achieved mean IT values exceeding 30 Ncm and baseline ISQ values > 80. Moderate-speed drilling (300 rpm) demonstrated the most consistent ISQ increase over time and achieved the highest stability at T4 (adjusted p < 0.05). High-speed drilling (800 rpm) produced the highest initial IT, particularly in high-density bone. Osseodensification showed transient mid-healing ISQ gains, whereas bone condensation exhibited a progressive decline in ISQ values. Immediate postoperative VAS-anxiety decreased significantly in all groups (p < 0.001); osseodensification was associated with higher residual anxiety, while bone condensation demonstrated the greatest reduction (adjusted p < 0.05).

Osteotomy technique influenced both mechanical stability trajectories and immediate postoperative patient-reported VAS-anxiety. Moderate-speed drilling at 300 rpm provided the most balanced stability profile within the 3-month follow-up. Osteotomy selection should be individualized according to bone density, mechanical requirements, and patient-related factors.

ClinicalTrials.gov identifier: NCT07234214.