#Education 08. Dec 2025

Implant primary stability using different drilling protocols

A selected scientific recommendation by Dr. Marcin Maj: "Evaluation of implant primary stability using different drilling protocols: an in vitro study" by Batur Orak, Mehmet Akgül, Tuncer Akdoğan, Onur Evren Kahraman.

STUDY OBJECTIVES AND METHODS

The purpose of this study was to investigate the biomechanical impact of different drilling techniques on the primary stability of dental implants placed in D3-D4 type bone conditions. An in vitro experimental study was conducted using bovine costal bone specimens resembling D3-D4 bone quality. A total of 21 Straumann BLT implants (4.1 mm × 10 mm) were placed using three drilling protocols: undersized drilling (n = 7), standard drilling (n = 7), and countersinking (n = 7). Primary stability was assessed via insertion torque (IT), removal torque (RT), and resonance frequency analysis (RFA) using the Ostell Beacon device. Statistical analysis was performed using the Kruskal-Wallis test followed by Dunn-Bonferroni post hoc tests. Significance was set at p < 0.05.

RESULTS

  • The undersized and standard drilling groups showed significantly higher median insertion torque (20.0 Ncm and 18.0 Ncm, respectively) compared to the countersinking group (8.0 Ncm) (p < 0.05).
  • Similarly, removal torque values were significantly greater in the undersized and standard drilling groups (27.0 Ncm each) than in the countersinking group (9.0 Ncm) (p < 0.05).
  • Median ISQ values were highest in the undersized drilling group (77.0), followed by the standard drilling(75.0) and countersinking (69.0) groups.
  • The difference between the undersized drilling and countersinking groups was statistically significant (p < 0.05).  
     

CONCLUSIONS

In low-density bone models simulating D3-D4 bone, the use of a countersinking drill resulted in significantly reduced primary stability compared to standard and undersized drilling techniques. Undersized drilling proved more effective in enhancing implant stability when using tapered implants under low-density bone conditions.

Adapted from B Orak et al., BMC Oral Health. 2025 Aug 9;25(1):1306, for more info about this publication, click HERE.

This review is part of the Straumann "Scientific Highlights Newsletter 5/25".

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