Comparing the Effect of Osseodensification Technique Versus Conventional Technique on Primary Stability of Implant in Low Density Bone: A Systematic Review

Abstract

Primary implant stability plays a crucial role in successful osseointegration and long-term implant survival. Conventional drilling removes bone during osteotomy, which can reduce bone density and compromise initial stability, especially in low-density bone. Osseodensification (OD), a non-subtractive drilling technique, aims to compact bone, maintain the natural trabecular structure, and enhance mechanical engagement of implants.

This systematic review compares the effectiveness of OD with conventional drilling in achieving primary stability in low-density bone. A comprehensive literature search was conducted according to PRISMA guidelines using PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar up to January 2025. Included studies directly compared OD and conventional techniques, evaluating outcomes such as insertion torque, implant stability quotient (ISQ), removal torque, marginal bone levels, and bone density. A total of fourteen studies met the inclusion criteria.

Results across clinical, ex vivo, animal, and review studies consistently showed that OD improves insertion torque, ISQ, bone density, and mechanical engagement compared with conventional drilling. Clinical studies also noted reduced early marginal bone loss and better short-term peri-implant stability. Advantages were most evident in low-density bone, ridge-split cases, and immediate implant placements.

In conclusion, osseodensification is a minimally invasive approach that enhances primary stability and preserves peri-implant bone. While current evidence is promising, variability among study methods underscores the need for high-quality randomized clinical trials using standardized protocols to confirm its long-term clinical benefits.