Slow drilling technique may enhance peri-operative patient-reported outcomes in dental implant surgery

Study design: A randomized, controlled, single-blind clinical trial. Objective: To assess and compare patient-reported outcome measures (PROMs) between low-speed drilling without irrigation and high-speed drilling with irrigation for implant site preparation. Patients and methods: The study adhered to the Declaration of Helsinki principles, obtained approval from the local Ethics Committee, was registered on ClinicalTrials.gov, and was written in accordance with CONSORT guidelines. Included were adult patients with single posterior edentulism who exhibited good oral hygiene, sufficient bone dimensions for implant placement, adequate keratinized mucosa, stable occlusion, and a healthy periodontium. Patients were randomly assigned to either the test group (low-speed drilling (150 rpm) without irrigation) or the control group (high-speed drilling (800 rpm) with irrigation). A single dental implant was placed for each patient, with all surgeries conducted by the same experienced operator according to a standardized protocol. Patient satisfaction during surgery, including drilling-time perception, vibration, pressure, noise, comfort, and drowning sensation, as well as postoperative pain and inflammation, were assessed using a 100-mm visual analog scale. Quality of life (QOL) was evaluated using a 5-graded Likert scale for mouth opening, chewing, speaking, sleeping, daily routine, and job. Follow up extended on daily basis for 7 days. The PROMs were collected and analyzed in a blinded manner by independent researchers and a statistician to prevent bias. Results: The study included 66 patients (33 males and 33 females) with a mean age of 54.5 years. Patients in the test group reported a lower perception of drilling time, vibration, and noise but a higher perception of pressure compared to the control group; however, these differences were not statistically significant. Compared to the test group, patients in the control group experienced significantly greater drowning sensation and lesser comfort measures (p < 0.001). There was a moderate inverse correlation between drowning sensation and comfort (r = -0.57). The real drilling time was significantly longer in the test group compared to the control group (p < 0.001). The test group reported significantly lower pain levels during the first 12 h (p < 0.05), and significantly lower inflammation levels at the second day (p < 0.05) compared to the control group. No significant differences were observed between the groups at any time point for any of the QOL parameters (p > 0.05). Conclusion: For a single implant site preparation, low-speed drilling without irrigation seems to offer greater patient comfort compared to high-speed drilling with irrigation, mainly due to reduced drowning sensation. Patients reported less postoperative pain and inflammation with the low-speed technique. Confirming these findings will require more research.