306 OSSEODENSIFICATION IN IMPLANT DENTISTRY ELSAYYAD AND OSMAN
Osseodensification in Implant Dentistry:
A Critical Review of the Literature
Ahmed A. Elsayyad, BDS* and Reham B. Osman, BDS, MSc, PhD†
Downloaded from https://journals.lww.com/implantdent by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 05/06/2022
rimary stability and secondary
P stability of dental implants are
crucial factors for long-term suc-
cess of any implant treatment.1 Pri-
mary stability is highly dependent on
bone quantity and quality and is man-
datory especially in cases of immedi-
ate loading. Bone-implant contact
(BIC) affects both primary and sec-
ondary stability at the time of implant
placement and after osseointegration
respectively. Ottoni et al2 reported
a 20% reduction in failure rate for
every 9.8 N/cm increase in the inser-
tion torque value of single implants.
In an attempt to increase primary
implant stability, several techniques
have been introduced to enhance bone
quality and quantity. Under prepara-
tion of the osteotomy site by using
a drill one size smaller than the
planned implant diameter is one of
the widely used techniques. Degidi
et al3 reported enhanced primary
implant stability with 10% undersized
osteotomy preparation. However,
undersized osteotomy may compro-
mise the dimensions of the healing
chamber between pristine bone and
implant that could decrease the speed
of woven bone filling and thus the
*Resident and MSc Degree Candidate, Department of
Prosthodontics, Faculty of Oral and Dental Medicine, Cairo
University, Giza, Egypt.
†Lecturer, Department of Prosthodontics, Faculty of Oral and
Dental Medicine, Cairo University, Giza, Egypt.
Reprint requests and correspondence to: Ahmed A.
Elsayyad, BDS, Department of Prosthetic Dentistry,
Faculty of Oral and Dental Medicine, Cairo University,
11 Saraya Street, Manyal, Cairo 11553, Egypt, Phone:
+20-10-0957-7101, Fax: 844-331-1657, E-mail:
ahmedelsayyad_91@hotmail.com
ISSN 1056-6163/19/02803-306
Implant Dentistry
Volume 28
Number 3
Copyright © 2019 Wolters Kluwer Health, Inc. All rights
reserved.
DOI: 10.1097/ID.0000000000000884
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Introduction: Osseodensifica-
tion is a technique that aims at bone
preservation and compaction either
through nonsubtractive drilling or
implants with a special thread
design. This can increase quantity
and density of periimplant bone. This
review represents a summary and
a critical appraisal of the studies
regarding osseodensification in the
literature.
Materials and Methods: Three
databases were searched: PubMed
(MEDLINE), Cochrane Library, and
Latin American and Caribbean cen-
ter on health sciences information
(LILACS). Studies were screened by
title/abstract according to predeter-
mined eligibility criteria. Full texts
of 7 eligible articles were read
among which 2 were excluded and
establishment of the secondary bio-
logic fixation. The use of osteotomes
was also attempted to increase bucco-
lingual bone width and periimplant
bone density through the use of
implant-shaped tapered tools. With
the aid of such tools, bone instead of
being removed from the implant bed is
compressed inward.4 However, it is re-
ported that the increase in bone density
is mainly detected at the periapical area
with no influence on the lateral mar-
gins and implant primary stability. Tra-
becular fractures that accompany the
osteotome bone condensation may
trigger osteocyte damage and exten-
sive microfractures, thus resulting in
bone resorption and prolonged period
of healing.5–7
5 articles were included and under-
went qualitative synthesis.
Discussion: Studies advocating
osseodensification are sparse and
mainly animal studies of low evi-
dence level. High risk of bias and
low correlation between used animal
models and human bone were de-
tected in most of the studies.
Conclusion: Although osseoden-
sification seems to be a very promis-
ing technique, the findings are
inconclusive and should be cautiously
interpreted. Well-designed animal
and human studies of longer follow-
up periods are required before im-
plementing such technique in regular
daily practice. (Implant Dent
2019;28:306–312)
Key Words: osteocompaction, osteo-
compression, implant stability
On the other hand, bone compac-
tion at the osteotomy site was also
attempted either through the use of
specially designed dental implants or
bone drilling burs. In 2000, technique
of osteocompaction or osteocompres-
sion was introduced using sinusoidal
thread implant design (LaminOss; Im-
pladent Ltd., Holliswood, NY).8 Lami-
nOss implant uses a round-thread
design, known as a sinusoidal screw
thread profile with a hemispherical
apex. Such a design was claimed to
allow for controlled functional osteo-
compression during surgical instru-
mentation and accordingly maximum
viable bone interface, providing greater
initial stability.8 More recently in 2014,
another technique was introduced and
ELSAYYAD AND OSMAN
is based on an osseodensification dril-
ling concept using a specially designed
bur called Densah Bur (Versah, Jack-
son, MI). In an attempt to overcome
the bone loss associated with subtrac-
tive drilling, nonsubtractive drilling is
adopted in the “osseodensification”
technique. Nonsubtractive drilling can
preserve cut bone trabeculae compress-
ing autografts against periphery and
apex of implant bed rather than leaving
the osteotomy. Osseodensification
technique uses copious irrigation and
a reverse cutting bur with increased
number of lands that can guide the bony
trabeculae through the osteotomy with
less chatter.9 Osseodensification is re-
ported to double the insertion torque10
and increase bone width by 2- or 3-folds
compared with regular cutting11 and
thus suggested to be a great tool in areas
of poor bone quality or quantity to
enhance implant stability.
Despite the claimed advantages of
the osteocompaction/osseodensification
techniques, no evidence exists in the
literature regarding the efficacy of
such technique in improving the peri-
implant bone quantity as well as
density and subsequently the initial
implant stability. Therefore, the aim
of the present review is to critically
evaluate all the studies in the litera-
ture regarding osseodensification
and its influence on implant stabil-
ity, bone gain, and density in an
attempt to draw evidence-based
recommendations.
MATERIALS AND METHODS
Search Strategy
A thorough literature search of the
electronic databases; PubMed (MED-
LINE), Cochrane Library, and Latin
American and Caribbean center on
health sciences information (LILACS);
was performed to identify the relevant
articles. The search was conducted up to
February 2018 using free text and
controlled vocabulary (MeSH) terms.
The following key words were used:
“Osseodensification,” “bone densifica-
tion,” “osseocompaction,” “bone com-
paction,” “osteocompression,” “dental
implants,” and “Densah bur.” The elec-
tronic search was complemented with
hand search of the following journals:
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IMPLANT DENTISTRY / VOLUME 28, NUMBER 3 2019
Clinical Implant Dentistry and Related
Research, Clinical Oral Implants
Research, European Journal of Oral Im-
plantology, Implant Dentistry, Journal
of Clinical Periodontology, Journal of
Dental Research, Journal of Oral and
Maxillofacial Implants, and Journal of
Oral and Maxillofacial Surgery. More-
over, the website of Densah Bur (Ver-
sah) was also searched.
One author (A.A.E.) performed the
search independently and screened the
titles and abstracts for relevance. Then,
the 2 authors (R.B.O. and A.A.E.)
screened the full text of the selected
relevant articles based on predeter-
mined inclusion and exclusion criteria.
Any disagreement was solved by con-
sensus or even consultation of a third
party.
Inclusion and Exclusion Criteria
The studies were selected if they
met the following inclusion criteria:
studies in the English language up to
February 2018, randomized or non-
randomized clinical trials, prospective
or retrospective studies as well as
in vivo and in vitro animal studies that
reported on osteocompaction/
osseodensification as a tool of improv-
ing periimplant bone quantity as well as
bone density and implant stability.
Exclusion criteria included: studies
that used other techniques to increase
bone stability (such as osteotomes or
undersized osteotomy preparation) as
well as case reports, case series, and
review of literature papers. There were
no restrictions regarding the date of
publication.
Data Extraction
A data extraction form was adopted
to collect the following study informa-
tion: (1) title, (2) authors, (3) year of
publication, (4) technique of osseoden-
sification, (5) number of implants
placed, (6) outcomes measured, BIC,
bone area fraction occupancy (BAFO),
percentage of bone volume (%BV)
analysis, bone mineral density, and
temperature increase, and (7) follow-
up period.
Quality Assessment
All the included studies were ani-
mal studies; hence, the 2 authors
individually assessed them using the
307
SYstematic Review Centre for
Laboratory animal Experimentation
(SYRCLE)’s risk of bias tool for animal
studies,12 which consist of 10 points.
According to each question, the
study was graded as: high risk, low risk,
or unclear risk. Any disagreement
between the authors was solved by con-
sulting a third party.
RESULTS
Thorough literature search yielded
371 articles from PubMed, 382 articles
from LILACS, and 27 articles from
Cochrane library. All articles were
exported to Mendeley reference man-
ager (Elsevier, Amsterdam, The Neth-
erlands), and after the removal of
duplicates, 425 articles were extracted.
After initial screening of extracted
articles by title/abstract, 418 articles
were excluded because they did not
match the eligibility criteria. Seven
articles were fully read,8,10,11,13–16 of
which 2 were excluded15,16 from the
qualitative synthesis. One of the
excluded studies employed osteotomes
for bone expansion15 while the other
study presented a review on various
techniques used for the enhancement
of implant stability.16 The prisma flow
diagram in Figure 1 represents a sum-
mary of the process of data extraction
and synthesis.
Characteristics of Included Studies
Table 1 presents an overview of the
included studies. The 5 studies included
were animal studies; 4 were in vivo on
a sheep model,8,10,13,14 and 1 was an
in vitro study11 performed on a tibia
bone specimen obtained from pork.
They were published in 2000,8
2016,10,14 and 2017.11,13 Of the 4
in vivo studies: 2 were performed on
a sheep hip model,10,14 1 was performed
on a sheep cervical spine,13 and the last
study did not specify the animal model
used.8 In the included studies, variable
number of implants were placed: 30,14
72,11 20,10 144,13 and 8 implants8 with
different follow-up periods: 6
weeks,13,14 2 months,10 3 months,8
and non-mentioned.11 Counterclock-
wise (CCW) osseodensification by
Densah Bur (Versah) was used compar-
ing it with regular drilling10,13 or with
308 OSSEODENSIFICATION IN IMPLANT DENTISTRY ELSAYYAD AND OSMAN

Fig. 1. Prisma flow chart showing search strategy from 3 databases. After removal of the duplicates, studies were screened based on
predetermined inclusion and exclusion criteria. The included studies were then read full text and assessed for eligibility to undergo qualitative
synthesis.

both regular and clockwise osseodensi-
fication (extraction drilling),11,14
whereas one study used sinusoidal
thread implant design for bone compac-
tion.8 The outcomes measured in the 5
articles were as follows: insertion tor-
que values using digital torque
meter,13,14 resonance frequency analy-
sis using Osstell system,11 and implant
secondary stability (removal torque val-
ues [RTV]) using universal testing
machine.10,11,13 In addition,
BIC,10,11,13,14 BAFO,13,14 and %BV10
were assessed by histological analysis.
Bone mineral density8,11 was also mea-
sured using microcomputed tomogra-
phy11 and histological analysis.8,11
Temperature increase was also
measured.11
In 2000, Valen and Locante8 re-
ported that LaminOss osteocompres-
sive implants (Impladent Ltd.)
produced 2.5 times greater bone lami-
nation without evidence of bone necro-
sis compared with regular implants.
The immediately loaded LaminOss im-
plants had twice the bone density at the
implant-bone interface compared with
the nonloaded counterpart. Both results
were obtained 3 months after implants
placement. The authors attributed the
increase in bone density to the sinusoi-
dal thread implant design that stimu-
lated a flow of electric current between
the cells known as streaming potential
creating a highly stimulatory environ-
ment for osteoblasts. Only 8 implants
were used in this study, and there was
no mention of the animal model em-
ployed in the study.
In a sheep hip model, Lahens et al14
reported that CCW osseodensification
resulted in an increase in insertion tor-
que values and %BIC from 25 up to 100
N/cm and from 50% to 70% respec-
tively when compared with regular dril-
ling. Both increased values were
statistically significant. However, BA-
FO showed higher values for the paral-
lel implants compared with the conical
implant type with no significant differ-
ence between the 2 drilling techniques.
On the other hand, using the same ani-
mal model, Trisi et al10 reported no sig-
nificant difference in the %BIC
between the regular drilling and CCW
osseodensification groups. %BV was

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 ELSAYYAD
Table 1. Summary of the Eligible Studies That Underwent Qualitative Synthesis
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

Author’s Outcomes Measured

Name, Technique
Year Type of Study of No. of Follow-

AND
of and Animal Osseoden Implants up Secondary Temperature
Publication Model sification Placed Period Insertion Torque Stability %BIC BAFO %BV, Density Increase

OSMAN
Lahens Animal study CCWOD 30 6 wk R ¼ 25 N/cm; N/A R ¼ 50%; No significant N/A N/A
et al, (sheep hip CCW ¼ 100 N/cm CCW ¼ 70% difference
201614 bone)
Trisi et al, Animal study CCWOD 20 2 mo N/A CCW showed No significant N/A CCW showed N/A
201610 (sheep hip 30%–40% difference 30%
bone) increased increase in
implant %BV
stability in
terms of
RTV
and
lower VAM
Huwais In vitro animal CCWOD 72 N/S ISQ was doubled in RTQ was R ¼ 22%–26%; N/A Crust of high- Nonsignificant
and study the CCW group more than CCW ¼ 64%– density difference
Meyer, (porcine tibia doubled in 72% bone
201711 specimen) the CCW surrounded

IMPLANT DENTISTRY / VOLUME 28, NUMBER 3 2019

group the implants
(universal in the CCW
testing group
machine)
Lopez et al, Animal study CCWOD 144 6 wk R ¼ 35 N/cm; R ¼ 150 N/ R ¼ 35%; R ¼ 40%; N/A N/A
201713 (sheep spine) CCW ¼ 65 N/cm cm; CCW ¼ CCW ¼ 50% CCW ¼
225 N/cm at 6 mo 70% at 6
mo
Valen and Animal study LO 8 3 mo N/A N/A N/A N/A 2.5 times more N/A
Locante, (N/S type) bone
20008 density
in the LO
group
Data extracted was: type of study and animal model, technique of osseodensification, number of implants placed, follow-up period, and outcomes measured.
CCWOD indicates counterclockwise osseodensification; LO, LaminOss osteocompressive implants; N/A, nonavailable; N/S, nonspecified.

309
310 OSSEODENSIFICATION IN IMPLANT
30% higher for the osseodensification
group, which was statistically signifi-
cant. The osseodensification group also
showed 30%–40% higher implant sec-
ondary stability in terms of RTV and
lower values of actual micromotion
analysis (VAM).
Huwais and Meyer11 compared 3
preparation techniques: CCW osseoden-
sification, osseous CW extraction, and
standard drilling in porcine tibia plateau
bone samples. Both the osseous extrac-
tion and osseodensification drilling was
performed with a new tapered, multif-
luted bur design. The bur was used in
a reverse rotating CCW and a CW direc-
tion for osseodensification and osseous
extraction drilling techniques, respec-
tively. CCW drilling enabled the preser-
vation and creation of a compact layer of
bone in the osseodensification technique.
The authors reported no significant dif-
ferences in implant stability quotient
(ISQ) or temperature increase among
the 3 groups. The insertion and RTV
were doubled or even more than doubled
in the osseodensification group com-
pared with the other 2 groups. Micro-
computed tomography showed a crust
of compact bone (0.1–0.3 mm) along
the edges and at the bottom (0.5–1 mm)
of osseous densification osteotomies. %
BIC increased by approximately 3 times
from 22% to 26% up to 64% to 72% for
implants prepared with osseous densifi-
cation compared with standard drilling.
Lopez et al13 placed fixation devi-
ces in the cervical vertebrae of 12 sheep
using regular and osseodensification
drilling. The insertion torque values
increased and were almost doubled
from 35 to 65 N/cm in the regular and
the osseodensification drilling groups
respectively. The pull-out strength
measured in terms of RTV similarly
increased from 150 to 225 N/cm in the
regular and osseodensification drilling
groups, respectively. %BIC and % BA-
FO were significantly higher in the os-
seodensification group. In both groups,
%BAFO decreased from 0 to 3 weeks
because of the remodeling process fol-
lowed by an increase in recorded values
from 3 to 6 weeks’ time interval. The
authors concluded that this study was
limited by 6 weeks’ time interval, which
necessitates the need for further studies
of a longer follow-up period.
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DENTISTRY
Methodologic Quality
The 5 included studies were as-
sessed according to the SYRCLE’s risk
of bias tool for animal studies,12 which
consist of ten questions (Table 2). Ac-
cording to each question, the study was
graded as: high risk, low risk, or unclear
risk if the answer to the question was no,
yes, or unclear, respectively, for this
category. Hooijmans et al12 do not rec-
ommend calculating a summary score
for each individual study because it as-
signs “weights” to specific categories in
this tool. In addition, they also recom-
mended using only applicable catego-
ries out of the 10 domains for
individual assessment of each study.
The 5 included studies were also as-
sessed according to the Animal
Research: Reporting of In Vivo Experi-
ments (ARRIVE) checklist for report-
ing animal studies.17
Valen and Locante8 placed 8 im-
plants in a nonspecified animal model.
The study published in 2000 did not
obviously follow the “ARRIVE”
checklist and had an unclear risk of
bias in all 10 categories included in
the SYRCLE’s risk of bias tool for ani-
mal studies. The other 4 studies fol-
lowed the SYRCLE’s risk of bias tool
with some limitations.10,11,13,14 The
baseline characteristics were similar
where the intervention and the control
groups were carried on the same ani-
mal model (split study design).
Accordingly, allocation sequence gen-
eration and concealment, animals’ ran-
dom housing for the study groups and
random selection of animals for out-
come assessment were not required.
Blinding of investigators was
impractical.
High risk of attrition and selective
outcome reporting biases was detected
in study by Lahens et al.14 One subject
in this study had postoperative infection
after implant placement and was
excluded by the authors during out-
come assessment. In addition, address-
ing incomplete outcome data was not
performed where no animal was added
to compensate for this drop out. In the
same context, performance bias was
found in the study by Trisi et al.10 The
authors placed 5 versus 3.8 mm diame-
ter implants in the intervention and con-
trol groups, respectively.
ELSAYYAD AND OSMAN
The reason for choosing a specific
animal model and its reference to
human biology was mentioned only in
2 studies11,13 and nonspecified in the
other 2 studies.10,14 The location and
the time for conducting the study were
not mentioned in the 4 included animal
studies.10,11,13,14 Huwais and Meyer11
reported statistical difference despite
having a P value of more than 0.05.
Three studies reported that the study
design and small sample size repre-
sented limitations of their
studies.10,11,13
Conflict of interest was present and
clearly reported in one study10 and was
present and not mentioned in another
study.11 In the study by Trisi et al,10
the authors reported that one of the co-
authors is a consultant for Cortex Den-
tal Implants system (Cortex, Shlomi,
Israel) used in the study. On the other
hand, it was not mentioned that one of
the coauthors is the inventor of the Den-
sah Bur (Versah) used in the study by
Huwais and Meyer.11
DISCUSSION
This critical review was conducted
to explore the influence of osseodensi-
fication technique achieved either
through the use of nonsubtractive dril-
ling or implants of specially designed
macrogeometry on enhancing implant
stability through increasing the periim-
plant bone density and quantity.
Apart from the article included in
this critical review on the osteocompac-
tion technique achieved through the use
of a specially designed LaminOss
implant system,8 only one more article
presenting 2 case reports and clinical
considerations of such a system could
be found in the literature.18 Currently,
such an implant design is commercially
available under a different brand name
“PhysioLock Osteocompressive
Implant System.” However, well-
designed animal or clinical trials could
not be found in the literature to support
the efficacy of such a design.
Traditional osteotomy preparation
for implant placement is considered to
be a subtractive approach that cuts and
removes bone tissue from the implant
site. By contrast, osseodensifying burs
are designed to forward bone chips and
ELSAYYAD AND OSMAN IMPLANT DENTISTRY / VOLUME 28, NUMBER 3 2019 311

Table 2. SYRCLE’s Risk of Bias Tool for Assessing Included Animal Studies
SYRCLE’s Risk of Bias Lahens et al, Trisi et al, Huwais et al, Lopez et al, Valen et al,
Tool for Animal Studies12 201614 201610 201711 201713 20008
1) Allocation sequence generation N/A N/A N/A N/A Unclear
2) Similar groups at baseline ✓ ✓ ✓ ✓ Unclear
3) Allocation concealment N/A N/A N/A N/A Unclear
4) Animals’ random housing N/A N/A N/A N/A Unclear
5) Blinding of care givers/investigators N/A N/A N/A N/A Unclear
6) Random selection for outcome assessment N/A N/A N/A N/A Unclear
7) Blinding of outcome assessor Unclear Unclear Unclear Unclear Unclear
8) Addressing incomplete outcome data ✗ ✓ ✓ ✓ Unclear
9) Results free of selective outcome reporting ✗ ✗ ✗ ✗ Unclear
10) Study free of other problems causing high ✗ ✗ ✓ ✓ Unclear
risk of bias
According to each of its ten questions, the study was graded as: high, low, or unclear risk if the answer to the question was no, yes, or unclear, respectively, for this category.
N/A indicates nonrequired or nonapplicable.

debris inward the implant bed through
the osteotomy with less chatter.
The included studies were in favor
of osseodensification technique com-
pared with regular drilling in terms of
enhancing bone quality and quantity.
However, the articles on this topic are
sparse, mainly animal studies present-
ing low level of evidence with high and
unclear risks of bias. The follow-up
periods, animal models used, outcomes
measured, and the measuring tools were
different among the included studies,
which make the crossover comparisons
between the studies difficult. Sample
size calculations were not performed at
the outset of the study design, which
makes most of the findings
inconclusive.
Nonspecified and different animal
models were used in different studies.
Lahens et al14 and Lopez et al13 selected
a sheep hip model because of its low
density and large size that allows for
placement of multiple implants
with minimal number of animals to be
sacrificed. However, the reference of
sheep to human biology and how the
results can be compared with human
mandible or maxilla was not men-
tioned. Huwais and Meyer11 chose
a porcine tibia plateau bone samples
placed in epoxy potting because it is
a simple homogenous bone model
despite the fact that it does not represent
the anatomical shape of the mandible or
maxilla.
Trisi et al10 reported a 30% increase
in %BV around dental implants inserted
in low-density bone using osseodensi-
fication drilling technique when
compared with conventional one,
which may play a role in enhancing
implant secondary stability (increased
RTV) and reduce micromotion (lower
VAM). However, it should be pointed
out that the implants used in the osseo-
densification group had a larger diame-
ter compared with implants used in the
control group (3.8 vs 5 mm). Although
the authors argued that different
implant diameters were selected
because of fear of bony dehiscence in
the conventional drilling group, this
represents a high risk of performance
bias. The larger diameter implants had
26% more surface area according to the
manufacturer, which could have influ-
enced the results reported in favor of the
osseodensification group.
In their study, Huwais and Meyer11
concluded that CCW osseodensifica-
tion drilling significantly increased
insertion and RTV compared with stan-
dard or extraction drilling. No signifi-
cant differences in ISQ readings or
temperature increase were demon-
strated among the test and control
groups. Nonetheless, the authors
claimed that implants in osseodensified
sites exhibited better stability based on
indirect evidence from insertion torque
data. The authors removed the cortical
bone before performing the study with
no obvious reasons. The presence of
cortical bone may have produced differ-
ent results regarding temperature
increase. For statistical comparisons, P
value more than 0.05 was considered
significant.
Sporadic case series and case re-
ports on the osseodensification drilling
technique are also available in the
literature and similarly providing very
limited evidence on the efficacy of the
technique.
In a case series on 20 patients, it
was found that Densah Bur is effective
in the breach of sinus floor with auto-
grafting in cases of low residual ridge
height. An increase in bone height from
4.18 6 1.25 mm up to 13.58 6 1.06 mm
6 months postoperatively was reported
together with an increase in implant sta-
bility due to densification of residual
bone.18
Lipton et al19 placed 28 implants
using the osseodensification technique
in 3 groups of patients: having 3 to
4 mm (group 1), 5 to 6 mm (group 2),
and 7 to 8 mm (group 3) buccolingual
bone width. The 3 groups showed 75%,
27%, and 17% increase in bone width,
respectively. The average insertion to-
que was 61 N/cm, whereas the average
ISQ value was 77.
Hofbauer and Huwais20 reported
an implant insertion torque of more than
50 N/cm and ISQ of 67 and 81 after 3
and 6 weeks, respectively, when a single
implant was placed in premolar region
having 3-mm buccolingual bone width
using CCW osseodensification. In
another case report, a Ø3.7 mm implant
was inserted in a partially edentulous
ridge 2.5 to 3 mm in buccolingual
dimension using Piezosurgery for ridge
splitting along with CCW osseodensifi-
cation. The ISQ measured at the time of
surgery and 10 weeks postoperatively
was 49 and 67, respectively.21
In the light of the low level of
evidence on the osteocompaction/

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312 OSSEODENSIFICATION IN IMPLANT
osseodensification technique limited to
animal studies with high risk of bias,
case reports, and case series, the ques-
tion of whether osseodensification in-
creases implant primary stability is still
open to debate. There is a call for well-
designed in vivo animal and human
studies of longer follow-up periods to
enable evidence-based
recommendations.
CONCLUSION
Studies regarding osseodensifica-
tion are sparse in the literature and are
mainly limited to animal studies and
case reports of low evidence level.
Although osseodensification seems to
be a promising technique for increasing
bone quantity and quality, the findings
are inconclusive and should be inter-
preted with caution. Well-designed
in vivo animal and human studies of
longer follow-up periods are required
before such a technique can be imple-
mented in regular daily practice.
DISCLOSURE
The authors claim to have no
financial interest, either directly or
indirectly, in the products or informa-
tion listed in the article.
APPROVAL
Neither approval from institutional
review board (IRB) nor ethics review
committee was received. It does not
apply in this case because it is a critical
review and not a clinical study.
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