Primary implant stability and bone preservation are critical determinants of successful osseointegration, particularly in sites with low bone density. Conventional drilling removes bone and may reduce stability, whereas osseo-densification is a non-subtractive technique that compacts bone to enhance its density and strength.

Objective:

To compare osseo-densification and conventional drilling techniques in terms of implant primary stability, peri-implant bone density, and marginal bone loss during early healing.

Methods:

A double-blinded, randomized split-mouth clinical trial was conducted on eight participants requiring bilateral maxillary implants (n = 16 sites). Each patient received one implant using the osseo-densification technique (Densah burs, counterclockwise mode) and one using conventional sequential drilling. Cone-beam computed tomography (CBCT) was used to evaluate bone density and marginal bone levels at baseline, three, and six-months post-placement. Implant stability was measured immediately after insertion using resonance frequency analysis (Osstell ISQ). Data were analysed using t-tests and repeated-measures ANOVA (p < 0.05).

Inclusion Criteria:

• • Systemically and medically healthy adults (>18 years old) of either sex.

  • Presence of a single missing tooth in the anterior or posterior maxilla with a minimum alveolar bone width of 6 mm, indicated for delayed implant placement.
  • Bone quality corresponding to D3-D4 density as determined by cone-beam computed tomography (CBCT).
  • Adequate keratinized mucosa of at least 3 mm in width (measured from the gingival margin to the mucogingival junction).
  • Intact buccal periodontal tissues, including bone, soft tissue, and ligament integrity.
  • Good oral hygiene and compliance with follow-up visits.

Exclusion Criteria:

• • Systemic medical conditions that could compromise surgical healing or osseointegration (e.g., uncontrolled diabetes mellitus).

  • Regular use of medications known to interfere with bone metabolism or healing, such as anticoagulants, antiplatelet agents, or systemic glucocorticoids.
  • Pregnancy or lactation in female participants.
  • Heavy smoking habits (>10 cigarettes per day), alcohol abuse, or recreational drug use.
  • Current or previous history of periodontal disease affecting adjacent teeth.
  • Active periodontal or periapical infection at the intended implant site.