Implant Stability Outcomes Following Immediate Implant Placement Using Osseodensification Versus Conventional Drilling

Immediate implant placement into fresh extraction sockets has become a well-established treatment approach because it reduces treatment time, decreases the number of surgical procedures, and helps preserve hard and soft tissue architecture. Nevertheless, obtaining adequate primary implant stability in fresh mandibular molar extraction sockets remains a major clinical challenge because of socket morphology, limited interradicular bone, and variations in bone density.

Osseodensification is a non-subtractive osteotomy preparation technique that uses specially designed burs rotating in a densifying mode to preserve and compact bone around the implant osteotomy. Unlike conventional drilling, which removes bone during osteotomy preparation, osseodensification compacts autogenous bone along the osteotomy walls, potentially increasing bone density, bone-to-implant contact, and primary implant stability while promoting favorable healing.

Although promising results have been reported for osseodensification, clinical evidence directly comparing this technique with conventional drilling during immediate implant placement in mandibular molar extraction sockets remains limited. This randomized clinical trial was designed to evaluate whether osseodensification provides superior clinical, radiographic, and implant stability outcomes compared with conventional drilling.

Eligible participants requiring extraction of a mandibular molar followed by immediate implant placement were randomly allocated to one of two treatment groups:

Osseodensification group: implant osteotomy prepared using the osseodensification drilling protocol.

Conventional drilling group: implant osteotomy prepared using the manufacturer's conventional drilling sequence.

All participants underwent atraumatic tooth extraction, immediate implant placement using the same implant system, grafting of the peri-implant gap when indicated according to the study protocol, customized healing abutment placement, and standardized prosthetic rehabilitation after the healing period. Postoperative care and follow-up schedules were standardized for both groups.

Clinical evaluations included assessment of the modified plaque index, modified bleeding index, and peri-implant probing depth. Implant stability was assessed using resonance frequency analysis and expressed as the Implant Stability Quotient (ISQ). Radiographic assessments included measurements of marginal bone loss using standardized periapical radiographs and peri-implant bone density using cone-beam computed tomography (CBCT). Participants were followed according to the study schedule to evaluate implant stability, peri-implant tissue health, and radiographic bone changes during healing and after functional restoration.

The primary objective of the trial was to compare primary and secondary implant stability between osseodensification and conventional drilling. Secondary objectives included comparison of peri-implant clinical parameters, marginal bone loss, and peri-implant bone density between the two treatment groups.

Inclusion criteria

Adults aged 20 years - 50 years. Patients requiring extraction of a mandibular first or second molar with immediate implant placement.

Presence of sufficient interradicular and apical bone to achieve primary implant stability following immediate implant placement.

Adequate bone dimensions to accommodate the planned dental implant without the need for extensive bone augmentation.

Good oral hygiene and willingness to comply with the study protocol and follow-up visits.

Ability to understand the study procedures and provide written informed consent.

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Exclusion criteria

Uncontrolled systemic diseases or medical conditions contraindicating oral surgery or implant placement.

Pregnancy or lactation. Current smokers or tobacco users. Untreated active periodontal disease or poor oral hygiene. Acute infection or extensive pathology at the implant site that would preclude immediate implant placement.

History of radiotherapy to the head and neck region or treatment with intravenous bisphosphonates or other medications known to adversely affect bone healing.

Bruxism or parafunctional habits likely to compromise implant success. Inability or unwillingness to attend scheduled follow-up visits or comply with study requirements.

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