Comparison of Five Osteotomy Protocols on Implant Stability and Postoperative Anxiety: A Randomized Controlled Trial

ABSTRACT Purpose This randomized controlled clinical trial compared five implant osteotomy techniques—high‐speed drilling (800 rpm), moderate‐speed drilling (300 rpm), ultra‐low‐speed drilling (50 rpm), osseodensification, and bone condensation—with respect to insertion torque (IT), early implant stability quotient (ISQ) progression, and immediate postoperative VAS‐anxiety during early osseointegration. Materials and Methods One hundred healthy adults each received a single identical macrodesign implant and were randomly allocated to five osteotomy protocols ( n = 20/group). Insertion torque was recorded at placement. ISQ was measured at placement (T0), 1 week (T1), 1 month (T2), 2 months (T3), and 3 months (T4). Immediate postoperative patient‐reported anxiety was assessed using a 10‐cm visual analog scale (VAS). Sites exhibiting IT 80. Moderate‐speed drilling (300 rpm) demonstrated the most consistent ISQ increase over time and achieved the highest stability at T4 (adjusted p < 0.05). High‐speed drilling (800 rpm) produced the highest initial IT, particularly in high‐density bone. Osseodensification showed transient mid‐healing ISQ gains, whereas bone condensation exhibited a progressive decline in ISQ values. Immediate postoperative VAS‐anxiety decreased significantly in all groups ( p < 0.001); osseodensification was associated with higher residual anxiety, while bone condensation demonstrated the greatest reduction (adjusted p < 0.05). Conclusions Osteotomy technique influenced both mechanical stability trajectories and immediate postoperative patient‐reported VAS‐anxiety. Moderate‐speed drilling at 300 rpm provided the most balanced stability profile within the 3‐month follow‐up. Osteotomy selection should be individualized according to bone density, mechanical requirements, and patient‐related factors. Trial Registration: ClinicalTrials.gov identifier: NCT07234214