A secure implant primary (mechanical) stability is positively associated with a successful implant integration and long-term successful clinical outcome. Therefore, it is essential to assess the initial stability at different time-points to ensure a successful osseointegration. The present study critically reviews the factors that may play a role in achieving a successful initial stability in dental implants. Databases were searched from 1983 up to and including October 2013 using different combinations of various keywords. Bone quality and quantity, implant geometry, and surgical technique adopted may significantly influence primary stability and overall success rate of dental implants.