British Journal of Oral and Maxillofacial Surgery 52 (2014) 149–153 Available online at www.sciencedirect.com Clinical analysis of the stability of dental implants after preparation of the site by conventional drilling or piezosurgery Ulisses Tavares da Silva Neto a , Julio Cesar Joly b , Sergio Alexandre Gehrke c,* a Postgraduate Program in Implantology of APCD, Jundiaí and Osasco, Brazil b São Leopoldo Mandic University, Campinas, Brazil c Catholic University of Uruguay, Montevideo, Uruguay Accepted 28 October 2013 Available online 20 November 2013 Abstract We used resonance frequency analysis to evaluate the implant stability quotient (ISQ) of dental implants that were installed in sites prepared by either conventional drilling or piezoelectric tips. We studied 30 patients with bilateral edentulous areas in the maxillary premolar region who were randomised to have the implant inserted with conventional drilling, or with piezoelectric surgery. The stability of each implant was measured by resonance frequency analysis immediately after placement to assess the immediate stability (time 1) and again at 90 days (time 2) and 150 days (time 3). In the conventional group the mean (SD) ISQ for time 1 was 69.1 (6.1) (95% CI 52.4–77.3); for time 2, 70.7 (5.7) (95% CI 60.4–82.8); and for time 3, 71.7 (4.5) (95% CI 64.2–79.2). In the piezosurgery group the corresponding values were: 77.5 (4.6) (95% CI 71.1–84.3) for time 1, 77.0 (4.2) (95% CI, 69.7–85.2) for time 2, and 79.1 (3.1) (95% CI 74.5–87.3) for time 3. The results showed significant increases in the ISQ values for the piezosurgery group at each time point (p = 0.04). The stability of implants placed using the piezoelectric method was greater than that of implants placed using the conventional technique. © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Implant stability; Resonance frequency analysis; Piezosurgery; Conventional drilling; Implant osteotomies Introduction Improvements in the bioengineering, geometry, and surfaces of implants, together with the advent of minimally invasive surgical techniques with increased tissue preservation, have changed the method of placement of dental implants, and allowed clinicians to obtain better results. Stability is a prerequisite for the long-term clinical success of implants, and it depends on the quantity and quality of local bone, the design of the implant, and the surgical technique * Corresponding author at: Rua Dr. Bozano, 571, 97015-001 Santa Maria (RS), Brazil. Tel.: +55 55 3222 7253; fax: +55 55 3222 7253. E-mail addresses: bioface@bioface.com.br (U.T. da Silva Neto), bio-tecnos@bio-tecnos.com (J.C. Joly), Sergio.gehrke@hotmail.com (S.A. Gehrke). used (subinstrumentation or overinstrumentation). 1 The changes during tissue healing, such as resorption of bone and integration of the bone–implant interface, can govern the degree of secondary stability of the implant. Obviously the healing process will be affected by the morphology of the bone including the trabecular pattern, the density, and the degree of maturation. 2 Rotary drills are efficient but they have several disadvan- tages, including the generation of debris and chips (which can spread and produce foreign-body reactions), the cre- ation of substantial haematomata at the drilling site, the production of heat, difficulties in attaining geometrical accu- racy, and wobbling. 3–5 Osteotomies designed to prepare the bony bed for placement of an implant generate heat, mainly from the high pressure manual movements and the speed of the rotary instrumentation that is required to achieve more 0266-4356/$ – see front matter © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjoms.2013.10.008