Results

Demographic distribution

The study included 20 subjects, of whom seven were males and 13 were females. The D3 group included three males and seven females, while the D4 group included four males and six females. The mean age of the total sample was 41.3 ± 13.0 years. The mean age was 43.6 ± 11.6 years in the D3 group and 39.0 ± 14.5 years in the D4 group (Table 1).

Group | Sample size | Males | Females | Mean age ± SD | Age range
Overall sample | 20 | 7 | 13 | 41.3 ± 13.0 years | 22–68 years
D3 bone group | 10 | 3 | 7 | 43.6 ± 11.6 years | 22–62 years
D4 bone group | 10 | 4 | 6 | 39.0 ± 14.5 years | 22–68 years

Peri-implant bone density

The preoperative mean peri-implant bone density was 481.5 ± 99.5 HU in D3 bone and 332.9 ± 78.1 HU in D4 bone, with a statistically significant difference between the groups (p = 0.002). Immediately after implant placement, the mean peri-implant bone density increased to 578.8 ± 150.0 HU in D3 bone and 466.7 ± 80.0 HU in D4 bone. The immediate postoperative difference between D3 and D4 bone remained statistically significant (p = 0.049). At the four-month postoperative interval, the mean peri-implant bone density further increased to 689.4 ± 193.7 HU in D3 bone and 588.7 ± 105.6 HU in D4 bone. Although D3 bone continued to show higher mean density values, the intergroup difference at four months was not statistically significant (p = 0.166) (Table 2).

Time interval | D3 bone, mean ± SD (HU) | D4 bone, mean ± SD (HU) | Mean difference (HU) | P-value | Significance
Preoperative | 481.5 ± 99.5 | 332.9 ± 78.1 | 148.7 | 0.002 | S
Immediate postoperative | 578.8 ± 150.0 | 466.7 ± 80.0 | 112.2 | 0.049 | S
Four months postoperative | 689.4 ± 193.7 | 588.7 ± 105.6 | 100.6 | 0.166 | NS

Intragroup analysis showed a progressive increase in peri-implant bone density in both D3 and D4 bone groups. In D3 bone, the mean peri-implant bone density 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 (Figure 3).

Figure 3: Bar chart showing peri-implant bone density changes in D3 bone at preoperative, immediate postoperative, and four-month postoperative intervals.HU = Hounsfield units; L1 = at the crestal level; L2 = 5 mm above L1; L3 = 5 mm above L2

In D4 bone, the corresponding increase was from 332.9 ± 78.1 HU preoperatively to 466.7 ± 80.0 HU immediately postoperatively and 588.7 ± 105.6 HU at four months (Figure 4).

Figure 4: Bar chart showing peri-implant bone density changes in D4 bone at preoperative, immediate postoperative, and four-month postoperative intervals.HU = Hounsfield units; L1 = at the crestal level; L2 = 5 mm above L1; L3 = 5 mm above L2

These findings indicate that osseodensification produced a progressive improvement in peri-implant bone density in both bone types.

Alveolar ridge width

The mean alveolar ridge width increased in both groups after osseodensification. In D3 bone, the mean ridge width increased from 8.2 mm preoperatively to 8.9 mm immediately postoperatively and 9.8 mm at four months. In D4 bone, the mean ridge width increased from 8.0 mm preoperatively to 8.5 mm immediately postoperatively and 8.8 mm at four months. Although D3 bone showed a slightly greater increase in ridge width compared with D4 bone, the intergroup differences were not statistically significant (Table 3).

Time interval | D3 bone, mean ± SD (mm) | D4 bone, mean ± SD (mm) | Mean difference (mm) | P-value | Significance
Preoperative | 8.2 ± 2.4 | 8.0 ± 1.7 | 0.2 | 0.802 | NS
Immediate postoperative | 8.9 ± 2.1 | 8.5 ± 1.5 | 0.5 | 0.571 | NS
Four months postoperative | 9.8 ± 2.3 | 8.8 ± 1.4 | 0.9 | 0.291 | NS

Level-wise assessment showed that ridge width gain was more pronounced at the mid-apical and apical levels than at the crestal level. In D3 bone, ridge width at L1 increased from 7.0 mm preoperatively to 7.9 mm at four months, while L2 increased from 8.3 mm to 10.1 mm and L3 increased from 9.3 mm to 11.3 mm. In D4 bone, ridge width at L1 increased from 7.0 mm to 7.2 mm, while L2 increased from 7.8 mm to 8.9 mm and L3 increased from 9.1 mm to 10.4 mm. These findings show that the dimensional gain was greater in the deeper trabecular regions than in the crestal region (Table 4).

Level | D3 preoperative width (mm) | D4 preoperative width (mm) | P-value | Inference | D3 immediate postoperative width (mm) | D4 immediate postoperative width (mm) | P-value | D3 four-month width (mm) | D4 four-month width (mm) | P-value
L1 | 7.0 | 7.0 | 0.992 | NS | 7.0 | 7.1 | 0.889 | 7.9 | 7.2 | 0.363
L2 | 8.3 | 7.8 | 0.684 | NS | 9.3 | 8.6 | 0.475 | 10.1 | 8.9 | 0.198
L3 | 9.3 | 9.1 | 0.845 | NS | 10.5 | 9.8 | 0.409 | 11.3 | 10.4 | 0.483
Mean | 8.2 | 8.0 | 0.802 | NS | 8.9 | 8.5 | 0.571 | 9.8 | 8.8 | 0.291