This study evaluates the influence of conventional versus simplified drilling protocols on bone remodeling after the osteointegration period, marginal bone loss (MBL), and primary implant stability. A randomized, double-blind clinical trial was conducted involving 44 implants in 37 patients over a two-year period. The primary outcome was peri-implant tissue stability, measured as MBL at baseline, 12 months, and 24 months. Secondary outcomes included implant stability, measured via insertion torque, and survival rates. The results indicated no significant differences in initial bone remodeling and MBL between groups after 24 months. Both protocols demonstrated high survival rates, with one implant failure recorded in the simplified protocol group. Although simplified drilling protocols may reduce surgical complexity, concerns about heat generation and reduced adaptability in osteotomy were described in the literature. This study concludes that drilling protocol choice does not significantly impact bone levels during osteointegration, crestal bone maintenance, or implant survival over 24 months, but further research is needed to explore long-term effects and prosthetic factors.