A Comparative Evaluation of Marginal Bone Loss Around Dental Implants Using Slow- and Medium-Speed Drilling Without Irrigation Versus High-Speed Drilling With Irrigation: An In Vivo Study.

Aim and objectives In this study, we aimed to compare the impacts of slow-speed (50 rpm) drilling without irrigation and medium-speed (300 rpm) drilling without irrigation with high-speed (800 rpm) drilling with irrigation on marginal bone loss around the dental implant. Material and methods This study was conducted and reported following the CONSORT (Consolidated Standards of Reporting Trials) guidelines. This randomized controlled trial utilized a within-subjects design, wherein each participant received three implants in the unilateral maxillary posterior region. A minimum of 24 patients (72 implants, three per patient) was proposed to ensure adequate statistical power and equal allocation across all intervention arms. Each implant site was prepared using a distinct drilling protocol: slow-speed (50 rpm, without irrigation), medium-speed (300 rpm, without irrigation), and high-speed (800 rpm, with irrigation). Randomization of implant sites was performed using the Research Randomizer website to reduce bias. The 50- and 300-rpm sites were designated as the case group, while the 800-rpm site served as the control. All procedures followed a standardized two-stage surgical protocol, with implants placed 1 mm subcrestally and flaps closed using 3-0 silk sutures. Drilling torque was maintained at 45 Ncm. Periapical radiographs were obtained immediately postoperatively and at six months using standardized settings (70 kV, 8 mA, 0.2 seconds, 30 cm of focus distance) with a customized XCP positioning system. Marginal bone levels were measured on mesial and distal aspects using ImageJ software. A single-blind design was implemented to ensure that the radiologist assessing bone loss was unaware of the group allocations. Results The study compared the marginal bone loss among two case groups and a control group based on drilling speeds: 50 rpm without irrigation (subgroup A), 300 rpm without irrigation (subgroup B), and 800 rpm with irrigation (group C), respectively. Mesial and distal bone loss was significantly lower in subgroup A (mesial: 0.383 ± 0.018 mm; distal: 0.403 ± 0.018 mm) compared to subgroup B (mesial: 0.434 ± 0.014 mm; distal: 0.440 ± 0.014 mm) and group C (mesial: 0.477 ± 0.013 mm; distal: 0.491 ± 0.013 mm). Statistical analysis revealed significant differences between groups (ANOVA: p < 0.001). Pairwise comparisons confirmed the order of marginal bone loss as group C > subgroup B > subgroup A. Conclusion The study demonstrated that slow-speed drilling without irrigation resulted in significantly lower marginal bone loss compared to medium-speed drilling without irrigation and high-speed drilling with irrigation. These findings suggest that slow-speed drilling may offer a clinically advantageous alternative for implant site preparation, promoting better osseointegration and reducing the risk of implant failure.