Clinical Evaluation of Implant Stability in Poor Quality Maxillary Bone: Reverse Drilling vs Osteotome Techniques: A Randomized Controlled Clinical Trial.

Abstract

Aim: The current study was conducted to evaluate the potential of a dental implant placed with a new reverse drilling technique (test group) as an alternative treatment option to a dental implant placed with an osteotome technique (control group) according to primary implant stability.

Materials and methods: With fourteen patients in each group, twenty-eight implants were positioned in the posterior maxilla and split equally between two groups: Group A (new reverse drilling technique) and group B (osteotome technique). Periotest M (PTV) was used to measure implant stability, cone-beam computed tomography (CBCT) was used to measure crestal bone loss (mm) and bone density Hounsfield units (HU), and the visual analog scale (VAS) was used to measure pain and swelling. The patients were monitored for 5 months. For statistical analysis, SPSS (version 20) was utilized, and statistical significance was established at p < 0.05.

Results: Regarding the primary outcome of the study, the primary stability of the control group (osteotome technique) showed higher primary stability than the test group (reverse drilling technique). The Mann-Whitney U test revealed that this difference was not statistically significant (p = 0.4820) with a mean value of 0.23 and ±0.33 standard deviation. Crestal bone loss was 0.13 ± 0.06 mm greater measured mesially in the osteotome group and 0.04 ± 0.07 mm greater measured distally in the osteotome group. In each case, the differences were not statistically significant according to independent samples t-tests (mesial: p = 0.05974; distal: p = 0.55541).

Conclusion: The two implant placement protocols showed comparable implant stability (PTV) and implant success; the reverse drilling technique is potentially a viable option for the treatment of patients with poor bone quality.

Clinical significance: The reverse drilling technique can be used as an alternative to the osteotome technique when placing implants in the posterior maxilla for its comparatively reduced invasiveness and higher patient acceptance in terms of pain and swelling. How to cite this article: Awad MM, El Nawawy M, El Refaie I, et al. Clinical Evaluation of Implant Stability in Poor Quality Maxillary Bone: Reverse Drilling vs Osteotome Techniques: A Randomized Controlled Clinical Trial. J Contemp Dent Pract 2025;26(1):10-17.