Peri-implant bone behavior after single drilling technique versus undersized drilling technique of immediately loaded implant in posterior maxilla: a one-year prospective study

TL;DR

This study compares two drilling techniques for dental implants in the posterior maxilla and finds both are equally effective over one year.

Contribution

The study introduces a comparison of undersized and single drilling techniques for implant placement in low-density bone.

Findings

Both drilling techniques achieved high implant stability and similar bone and soft tissue outcomes.

Single drilling reduced surgical time and avoided excessive heat and mechanical damage.

No complications occurred in either group over the 12-month follow-up period.

Abstract

Implant placement in the posterior maxilla is challenging, so modifications of the surgical techniques were introduced to overcome these challenges. The undersized drilling technique uses a final drill smaller than the diameter of the implant. The single drilling technique is a simplified method where the osteotomy is made using a single drill without sequential widening. This study was directed to evaluate the peri-implant bone behavior of the undersized drilling technique versus the single drilling technique of immediately loaded dental implants inserted in the posterior maxilla.

32 patients were selected for prosthetic replacement of a missing maxillary posterior single tooth by an immediately loaded dental implant and divided randomly into two equal groups. In Group I: 16 patients received 16 implants using the undersized drilling technique, while in Group II: 16 patients received 16 implants using the single drilling technique. Insertion torque, implant stability, modified sulcus bleeding index (mBI), peri-implant probing depth, bone density, and marginal bone height were evaluated for both groups. Statistical analysis was made for clinical and radiographic data.

32 implants were inserted in the posterior maxilla. During a 12-month follow-up, every dental implant was successful with no complications. Both techniques showed high insertion torque (≥ 35 Ncm) and primary stability (> 70 ISQ) with no significant difference between the two groups (P > 0.05). Also, there were no significant differences between the study groups regarding peri-implant soft tissue health, bone density, and marginal bone loss (P > 0.05).

Both techniques revealed comparable, promising clinical and radiographic outcomes over a 12-month post-loading follow-up period when the immediate loading protocol was used in the posterior maxilla, where bone density is poor, but preparing the implant bed using the single drilling technique offers several merits for both the patient and clinician. In addition to avoiding excessive heat generation, mechanical damage, and high frictional forces during drilling procedures, surgical operations, and surgical site exposure take less time.

Clinical-Trials.gov PRS (https://register.clinicaltrials.gov) had this study registered under the identifier number. NCT06770231 on 01/01/2025.

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