Piezoelectric Implant Site Preparation versus Osseodensification for Immediate Implant Placement in Mandibular Molars: A New Approach for Septal Expansion

Background: Immediate implant placement (IIP) in mandibular molars is challenged by wide socket dimensions and low bone density. This trial compared piezoelectric implant site preparation (PISP) using the Intralift Kit to osseodensification (OD) with Densah burs for immediate implant placement through septal bone expansion. Methods: Twenty adults with non-restorable mandibular molars were randomly allocated (1:1) to PISP group (n=10) or OD group(n=10). Primary outcomes were insertion torque values using a manual torque wrench and implant stability quotient (ISQ) using resonance frequency analysis (osstell device) measured intraoperatively and at 3 months. Secondary outcome included changes in bone density (Hounsfield units, HU) on CBCT at baseline and 3-month follow up . Data normality was assessed by Shapiro-Wilk; between-group comparisons used independent t-tests, with effect sizes and 95% confidence intervals (CIs). Results: The PISP group showed a slightly higher mean insertion torque compared to the OD group (41.0 ± 3.16 Ncm vs. 39.0 ± 3.94 Ncm), but the difference was not statistically significant (mean difference 2.0 Ncm, 95% CI –5.35 to 1.35; p = 0.227). Bone density gain at 3 months was significantly greater in the PISP group (+330 ± 25.1 HU vs. +282 ± 19.4 HU; mean difference 48 HU, 95% CI 25–71; p < 0.001). No significant between-group differences were found for primary ISQ (mean difference –2.5, 95% CI –6.0 to 1.0; p = 0.16) or secondary ISQ (mean difference –1.7, 95% CI –4.6 to 1.2; p = 0.24). Conclusions: This study demonstrated that piezoelectric implant site preparation (PISP) using the Intralift® Kit is an effective technique compared to osseodensification (OD) for immediate implant placement via septal expansion in mandibular molar sites. Trial registration: NCT06957860 (registered May 5, 2024; retrospectively registered).