Dental implant site preparation with conventional rotary drill or piezosurgery: five-year after placement results from a within person randomised controlled trial

Purpose: To evaluate whether there are clinical benefits by preparing dental implant sites using piezosurgery instead of conventional rotary drills in healed bone crests and if initial crestal soft tissue thickness could have an impact on marginal bone loss. Methods: Twenty-five partially edentulous patients requiring two single implants in molar/premolar areas had each site randomly allocated to either piezosurgery or to conventional rotary drill preparation according to a split-mouth design. Definitive screw-retained metal-ceramic crowns were delivered after 6 months. All patients were followed to 5 years after placement. Outcome measures were: implant/crown failures, complications, peri-implant marginal bone level changes, resonance frequency analysis (RFA), and time required come complete site preparation, recorded, when possible, by blinded assessors. Results: No patients dropped-out and no implant failed. Five years after placement, there were no statistically significant differences for complications (only one complication in the piezo group: difference = 0.04; P = 1), for peri-implant bone loss (difference = -0.11 mm; 95% CI -0.24 to 0.01; P = 0.083), and for RFA changes (6 months) (difference = -0.35; 95% CI -1.95 to 1.25; P = 0.672 between groups. Significantly more time was needed to prepare implant sites with piezosurgery (difference = 236.8 sec; 95% CI -286.12 to -187.48; P <0.0001). Initial soft tissue thickness had no effect on peri-implant bone loss (estimate = 0.05; 95% CI -0.03; 0.12; P = 0.239). Conclusions: No clinically appreciable differences were noticed when placing implants using piezosurgery or conventional instrumentation with rotary drill, however, the preparation with rotary drills was on average 4 minutes faster. No effect of initial crestal soft tissue thickness was observed on peri-implant bone loss.