Effect of Osseodensification on Ridge Expansion and Bone Density for Implant Placement in the D3 and D4 Bone of the Posterior Maxilla: A Comparative Study

Background Implant placement in the posterior maxilla is often challenging because of reduced bone density, limited ridge width, and compromised primary stability, particularly in D3 and D4 bone. Conventional osteotomy preparation is subtractive and may further reduce available trabecular bone support. Osseodensification is a bone-preserving osteotomy technique that compacts autogenous bone along the osteotomy walls and may improve peri-implant bone density and ridge dimensions. This study aimed to evaluate the effect of osseodensification on alveolar ridge expansion and peri-implant bone density during implant placement in the D3 and D4 bone of the posterior maxilla. Methodology An institution-based, comparative clinical study was conducted among 20 patients requiring implant-supported fixed prosthetic rehabilitation in the posterior maxilla. Patients were categorized into D3 and D4 bone groups based on preoperative cone-beam computed tomography (CBCT) assessment. Implant osteotomy was performed using Densah burs according to the osseodensification protocol. Peri-implant bone density and alveolar ridge width were measured at the crestal, mid-apical, and apical levels using CBCT at preoperative, immediate postoperative, and four-month postoperative intervals. Intergroup and intragroup comparisons were performed using appropriate statistical tests, with significance set at a p-value <0.05. Results The mean peri-implant bone density in D3 bone increased from 481.5 ± 99.5 HU preoperatively to 578.8 ± 150.0 HU immediately postoperatively and 689.4 ± 193.7 HU at four months. In D4 bone, the mean peri-implant bone density increased from 332.9 ± 78.1 HU preoperatively to 466.7 ± 80.0 HU immediately postoperatively and 588.7 ± 105.6 HU at four months. The intragroup increase in peri-implant bone density was statistically significant in both groups. The mean alveolar ridge width increased from 8.2 mm to 9.8 mm in D3 bone and from 8.0 mm to 8.8 mm in D4 bone. The ridge width gain was more evident at the mid-apical and apical levels than at the crestal level. No significant correlation was observed between age or gender and the evaluated parameters. Conclusions Osseodensification significantly improved peri-implant bone density and produced measurable alveolar ridge expansion in both D3 and D4 bone of the posterior maxilla. The technique appears useful for implant site preparation in low-density posterior maxillary bone. Further controlled clinical studies with larger sample sizes and longer follow-up are required to validate these findings.