Effectiveness of Clockwise vs. Counter-Clockwise Osseodensification for Implant Site Preparation

This study aims to compare the primary stability of dental implants placed using two different rotational modes of the Densah burs (Clockwise Cutting vs. Counter-Clockwise Osseodensification) under a fully guided protocol. The primary outcomes are peak insertion torque and immediate implant stability quotient (ISQ).

Inclusion Criteria: * Adult females aged 18 to 70 years. * Able to provide written informed consent. * Clinical indication for two endosseous dental implants at clinically comparable sites in the same participant. * Edentulous sites (healed or not fully healed) with sufficient bone volume. Minor bone augmentation is permitted only if identical at both paired sites. * Comparable paired sites regarding jaw, region, and planned implant diameter and length. The same implant dimensions must be used at both sites. * Bone density corresponding to D2 or D3 (350-1250 HU); dense D1 sites are excluded. * Good oral hygiene and periodontal stability. * Adequate inter-arch space and mouth opening for fully guided surgery. Exclusion Criteria: * Uncontrolled systemic disease. * Pregnancy or lactation. * Previous high-dose radiotherapy to the jaws or current chemotherapy. * Current intravenous antiresorptive therapy (e.g., bisphosphonates). * Heavy smoking (\> 10 cigarettes/day) or substance abuse. * Severe parafunctional habits. * Active infection or untreated periodontitis at the planned sites. * Sites requiring different grafting procedures between the two sides. * D1 dense cortical bone or inability to perform the CCW protocol. * Inability to obtain two comparable eligible sites.