Yunus Emre Guner, Varol Çanakçı
Background/Objectives: Horizontal alveolar ridge deficiency is a common clinical challenge in dental implant placement. The osseodensification (OD) technique has been proposed as a minimally invasive alternative to conventional osteotomy. This study aimed to compare the outcomes of OD and conventionally performed ridge-split procedures in terms of implant stability and horizontal bone gain. Methods: In this retrospective study, 65 patients (a total of 268 implants) who underwent simultaneous implant placement with ridge-split procedures were evaluated. Cases were divided into two groups: OD burs (n = 133 implants) and the conventional Esset kit (n = 135 implants). Ridge width was measured at coronal and apical levels using cone-beam computed tomography (CBCT) preoperatively and four months postoperatively. Implant stability was assessed at the time of placement (primary stability) and at four months (secondary stability) using resonance frequency analysis (RFA). Results: Both techniques achieved comparable horizontal bone gain (1.1–1.6 mm; p > 0.05). In the maxilla, the OD group demonstrated a tendency toward higher primary and secondary stability values (p < 0.01). A similar trend was observed for secondary stability in the mandibular posterior region (p < 0.01). The mean Implant Stability Quotient (ISQ) values in the OD group generally exceeded the threshold of 65, considered sufficient for prosthetic loading. Conclusions: The findings suggest that the OD technique may have a favorable effect on implant stability, particularly in regions with low-to-moderate bone density, while providing comparable horizontal bone gain to the conventional method. These results indicate that OD could serve as a potentially useful alternative in the management of horizontal ridge deficiencies; however, its long-term efficacy should be further evaluated in larger, prospective clinical studies.