Does the Drilling Technique for Implant Site Preparation Enhance Implant Success in Low-Density Bone? A Systematic Review

The objective of this systematic review was to investigate the possible association between the drilling technique and proper implant integration and survival in areas with low bone density. An electronic search using the MEDLINE/PubMed database was performed including studies published up to April 2018. Animal and clinical studies that evaluated the association between the drilling technique and proper implant integration and survival in low-density bone were included. Fifteen studies met the inclusion criteria, including 7 experimental and 8 clinical. Undersized, osteotome, Piezosurgery, and osseodensification drilling were the 4 techniques found in the literature to enhance osseointegration of implants in low-density bone. Owing to the methodological variation, meta-analysis was not performed. The 4 drilling protocols were effective in increasing primary stability, but the long-term outcome is comparable with that of the conventional surgical drilling protocol. There is weak evidence suggesting that any of the previously mentioned surgical techniques could enhance successful osseointegration and survival of the implants placed in low-density bone.