INTRODUCTION
The early stage of bone repair response after dental implant insertion is a complex phenomenon in which the combined action of inflammatory cascade and immune system regulate new bone formation and neo‐angiogenesis.The progressive drilling technique has always been the conventional approach to implant osteotomy, using increasing‐diameter twist drills rotating clockwise from 600 to 2000 rpm under copious irrigation.Piezoelectric implant site preparation (PISP) has been proposed as an alternative technique to improve surgical control, safety, and bone healing response. Piezoelectric devices for bone surgery exploit ultrasonic vibrations of specific tips with three main features: (1) micrometric cutting with easy operative control, (2) selective cutting action on hard tissues, and (3) enhanced surgical visibility due to the cavitation effect of cooling saline solution.Osseodensification drills (OD) is a recently introduced implant site preparation technique based on specially designed drills with large negative rake angles which, rotating counterclockwise, work as non‐cutting edges to expand the implant site and compact bone at the osteotomy walls.However, most studies analyzing OD were conducted in vitro, ex vivo or on an animal model. Well‐designed clinical trials on human subjects are necessary to fully elucidate the potential of this novel technique as an alternative to conventional implant site preparation in daily clinical practice. Therefore, the objective of the present randomized clinical trial was to compare stability changes of implants inserted into sites prepared using OD with implants inserted into sites prepared with PISP during the first 90 days of healing.