The Influence of the Degree of Dental Implant Insertion Compression on Primary Stability Measured by Resonance Frequency and Progressive Insertion Torque: In Vitro Study

<b>Background</b>: This study aimed to evaluate the primary stability, according to the insertion torque value (ITV) and resonance frequency analysis (RFA), of dental implants placed in standardized blocks of bone quality equivalent to type II-A bone, using three surgical undersized protocols of 0.2 mm, 0.5 mm, and 0.8 mm, considering different dental implant diameters and lengths. <b>Methods</b>: One hundred and twenty dental implants (DIs) of different diameters (3.5, 3.8, 4.5, and 5.0 mm) and lengths (8.5, 10.0, 11.5, 13.0, and 15.0 mm) placed in polyurethane blocks equivalent to type II-A bone, according to the Lekholm and Zarb classification modified by Rosas et al., were examined with three surgical protocols of under-milling of 0.2, 0.5, and 0.8 mm. The ITV and the RFA were the determinants of primary stability, and their respective values were recorded as Ncm and the implant stability quotient (ISQ) immediately after the placement of the DIs. These were evaluated according to each surgical insertion protocol, length, and diameter of the DI under a multivariate analysis model (MANOVA). Statistical significance was set at <i>p</i> < 0.05. <b>Results</b>: It was observed that the average of the ITV was significantly higher when a 0.8 mm under-milling protocol was used (63.2 ± 14.9 Ncm) (<i>p</i> < 0.001). However, the ITV was significantly lower when a 0.2 mm under-milling protocol was used (25.1 ± 8.3 Ncm) (<i>p</i> < 0.001). On the other hand, the ISQ did not present significant differences (<i>p</i> = 0.166) when comparing the 0.2 (67.6 ISQ ± 5.4 ISQ), 0.5 (65.8 ISQ ± 3.4 ISQ), and 0.8 (65.7 ISQ ± 4.0 ISQ) under-milling protocols in the evaluation of the primary stability of the dental implant. The multivariate effect size (η<i>p</i>² = 0.639) indicated that the variability detected in the insertion torque and the ISQ, at the same time, was explained by 63.9% (<i>p</i> < 0.001) due only to the compression protocol, while the implant diameter explained this variability by 27.0% (η<i>p</i>² = 0.270) (<i>p</i> < 0.001) and the implant length only significantly explained this variability by 12.1% (η<i>p</i>² = 0.121) (<i>p</i> = 0.030). Finally, any interaction between the compression protocol, implant diameter, and length did not influence insertion torque variability or the ISQ (<i>p</i> > 0.05). <b>Conclusions</b>: It can be concluded that when the surgical protocol for subpreparation is optimal according to the prepared bone bed, regardless of the diameter or length of the dental implant used, primary stability was assured according to the ITV and the RFA in 63.9%. This finding allows us to recommend carrying out a correct analysis of bone quality in order to subsequently select the most appropriate surgical protocol for the subpreparation of the bone bed to achieve better primary stability of the dental implant.