Implant Primary and Secondary Stability after Site Preparation with Electromagnetic Osteotomes or Osseodensification Burs: a Randomized Controlled Trial with Split-Mouth Design

Objectives: The purpose of this split-mouth randomized clinical trial is to compare implant primary and secondary stability over 90 days following site preparation with electromagnetic osteotomes or osseodensification burs.

Material and Methods: Nineteen patients received two identical implants in contralateral posterior maxillary sites. Test sites were prepared with electromagnetic osteotomes (EO), and control sites were prepared with osseodensification burs (ODB), reaching the same osteotomy diameter. Resonance frequency analysis (RFA) was recorded at implant placement and after 7, 14, 21, 28, 60 and 90 days. Surgical time, final insertion torque and eventual complications were recorded. Radiographic marginal bone levels were assessed at surgery (T0), prosthesis delivery (T1), and 1 year after loading (T2).

Results: Median final insertion torque did not differ significantly in the two techniques (EO: 58 [IQR 23] Ncm; ODB: 61 [IQR 21.5] Ncm; P = 0.15). Baseline implant stability quotient (ISQ) was significantly higher in ODB sites (75.19 [SD 4.95]) than in EO sites (70.66 [SD 6.03]) (P = 0.004). Mean ISQ values were significantly higher in the ODB group at all timepoints (P < 0.05). Marginal bone levels showed no significant differences between techniques at T1 or T2, and final insertion torque was the only variable significantly associated with initial bone remodeling (P = 0.016). All inserted implants were in function at T2.

Conclusions: Within the limitations of this randomized controlled trial conducted in posterior maxillary sites with low bone density, osseodensification burs resulted in significantly higher implant stability, as measured by ISQ values at placement and during early healing, compared with electromagnetic osteotomes, despite similar insertion torque values. Multivariate analysis revealed a significant association between insertion torque and early radiographic changes in marginal bone levels, independent of the preparation technique.

J Oral Maxillofac Res 2026;17(1):e2

doi: 10.5037/jomr.2026.17102

Accepted for publication: 29 March 2026

Keywords: bone density; dental implants; maxilla; osseointegration; resonance frequency analysis; treatment outcome.