The purpose of this study was to assess implant stability in relation to implant design (conical vs. semiconical and wide-pitch vs narrowpitch) using resonance frequency analysis. Twenty patients with bilateral edentulous maxillary premolar region were selected. In one hemiarch, conical implants with wide pitch (group 1) were installed; in the other hemiarch, semiconical implants with narrow pitch were installed (group 2). The implant allocation was randomized. The implant stability quotient (ISQ) was measured by resonance frequency analysis immediately following implant placement to assess primary stability (time 1) and at 90 days after placement (time 2). In group 1, the mean and standard deviation ISQ for time 1 was 65.8 ± 6.22 (95% confidence interval [CI], 55 to 80), and for time 2, it was 68.0 ± 5.52 (95% CI, 57 to 77). In group 2, the mean and standard deviation ISQ was 63.6 ± 5.95 (95% CI, 52 to 78) for time 1 and 67.0 ± 5.71 (95% CI, 58 to 78) for time 2. The statistical analysis demonstrated significant difference in the ISQ values between groups at time 1 (P = .007) and no statistical difference at time 2 (P = .54). The greater primary stability of conical implants with wide pitch compared with semiconical implants with narrow pitch might suggest a preference for the former in case of the adoption of immediate or early loading protocols.