The aim of this study was to analyse and compare the biomechanical performance of a novel drilling technique known as osseodensification, which focuses on bone preservation and compaction rather than removal, against the conventional osteotomy technique in implant placement. Online databases were searched to identify relevant articles published in English during the last 10 years (up until September 11, 2025), reporting in vivo clinical trials involving a healthy adult population undergoing single or multiple implant placement, and comparing osseodensification and standard osteotomy drills, in a partially or fully edentulous segment of alveolar bone. Biomechanical measures analysed were the insertion torque and implant stability quotient (ISQ). Risk of bias and study quality were evaluated using the RoB 2 tool, Newcastle-Ottawa Scale, and GRADE system. The results were synthesized. Overall, a total of 555 patients (59.2% female, in studies reporting the sex distribution), received a total of 685 implants (343 using osseodensification). The overall mean insertion torque in the osseodensification group was 45.75 ± 6.55 N·cm, while in the standard osteotomy group it was 38.00 ± 7.01 N·cm (P < 0.001). The estimated average mean difference in ISQ (random-effects model) was 3.24 (95% confidence interval 0.72-5.95; P = 0.024). The data showed that sites prepared with osseodensification resulted in higher implant torque and primary stability of the implant (ISQ) immediately postoperative. However, longitudinal data were insufficient to allow a meaningful statistical analysis of ISQ trends over time.
Marzorati et al. (Sun,) studied this question.