The main objective of this systematic review was to compare primary and secondary implant stability between placement with piezoelectric osteotomy and conventional drilling, comparing marginal bone losses as a secondary objective. An electronic search was conducted using PubMed (MEDLINE), Scopus, and Cochrane Library (Wiley) databases, besides a manual search. A total of 153 articles were retrieved, 39 from Pubmed, 44 from Scopus, and 70 from the Cochrane Library. After removing duplicates, 112 articles (1 from the manual search) were screened, and 9 were finally selected for qualitative and statistical analyses. Piezoelectric surgery is a predictable alternative to conventional drilling for dental implant placement. Medium/long-term survival rates and marginal bone losses are similar between piezoelectric osteotomy and conventional drilling, and there is no difference in ISQ values for primary stability. However, implants placed with ultrasound showed a lower decrease in implant stability quotient (ISQ) during the osseointegration period and a higher ISQ value for secondary stability. This study contributes further information on peri-implant bone tissue at 3 and 6 months after implant placement with piezoelectric osteotomy or conventional drilling and provides an updated meta-analysis of comparative studies.