Unlocking implant success: the impact of surgical techniques on primary stability in the posterior maxilla

The study conducted by Olmedo-Gaya et al. aimed to investigate the effects of various surgical techniques on the initial stability of implants placed in the posterior maxilla through a randomized controlled clinical trial. The study compared insertion torque (IT) and implant stability quotients (ISQ) among implants placed using under preparation, expanders, and standard surgical instrumentation. The study enrolled 108 patients, each receiving one implant in the posterior maxilla region. Patients were distributed into three groups: group 1 (n = 36) with the under preparation technique, group 2 (n = 36) using the expander technique, and group 3 (n = 36) with conventional drilling. IT was measured using a torque indicator, while ISQ was recorded through resonance frequency analysis immediately post-surgery. The ISQ values were analyzed in relation to the patient’s bone quality, categorized into types II, III, and IV. ISQ values varied significantly with bone quality, being highest in type II (76.65) and type III (73.60), and lowest in type IV (67.34) bone, with a significant difference (p < 0.0001). The conventional drilling technique yielded lower ISQ values (69.31) compared to under preparation (74.29) and expander techniques (73.99), with statistical significance (p = 0.008 and p = 0.005, respectively). Surgical technique significantly influences primary stability in low-quality bone. Conventional drilling results in lower ISQ values, suggesting that alternative techniques such as under preparation or expanders should be used in low-quality bone to achieve better primary stability. For implants in low-quality bone, replacing the conventional drilling technique with under preparation or expander techniques can enhance primary stability.