Discussion
The present study has been carried out to analyze the influence of the surgical technique on the primary implant stability. The results found support that dental implants placed after conventional drilling obtained lower ISQ values than those placed with underpreparation techniques or the use of expanders in poorer quality bones.In the literature, it has been shown that torque, ISQ, and therefore PS depend on the quality of implant-bone contact in the cortical part and this is influenced by the surgical technique used, the macroscopic design of the implant, and bone quality [Regarding the relationship between bone quality and primary stability, our results show that higher ISQ values were associated with type II and III bone quality and lower ISQ values with type IV bone quality, according to several authors. Several works have shown that bones with more cortical density and less medullary component have higher ISQ values [In the present study, it has also been possible to verify the relationship between the ISQ values and the surgical technique used for the placement of the implants. Higher stability results have been obtained when underpreparation or expanders are used compared to conventional drilling, especially in cases of lower bone density. These results are consistent with two RCTs [This study has corroborated by RCT that there is a relationship between bone quality and PS. Secondly, it has shown that stability in terms of ISQ improves in certain types of bone by modifying the surgical technique. The clinical application of these results could be that once the bone density of the receptor area has been radiographically determined, we can predict the torque that will reach our implant if we perform conventional drilling. Therefore, if we detect a low bone quality, we can modify our surgical procedure and opt for an alternative technique that provides us with a higher final ISQ. The alternative bed preparation techniques to conventional drilling proposed are the use of motorized expanders and underpreparation. These techniques, highlighting underpreparation, significantly increase the primary stability of an implant when placed in low-density bone.