It is well documented that implant initial bone fixation, known as primary implant stability, represents the pre-requisite to achieve a successful long-term osseointegration [1].

Many studies demonstrated that the implant primary stability is strictly influenced by host bone density [2], fixture geometry [3, 4], and surgical technique used for preparing bone implant bed [5]. Other studies [6, 7] highlighted that host bone quality and fixture macro geometry as main factors able to influence the primary implant stability.

The implant bone site preparation plays a key role in osseointegration development because it allows to obtain an implant bone bed suitable for the fixture dimensions ensuring primary implant stability.

The excessive surgical trauma prior to implant insertion and the bone temperature rise during standard drilling procedures [8] are other crucial factors modifiable by the surgeon, whose importance is often underestimated.

A minimally traumatic bone drilling is strongly recommended to preserve much bone tissue as possible without impairing its healing potential [9].

To this end, several surgical techniques [10] have been proposed to avoid or reduce bone sacrifice during implant placement procedures to enhance primary implant stability and bone quality.

Some authors suggested to undersize the osteotomic implant site with respect to the implant diameter of about 10% in order to reduce bone cutting and enhance primary implant stability [11, 12].

An alternative to implant drilling procedures is represented by the osteotome technique [13] that aimed to compact the bone with the mechanical action of cylindrical steel instruments along the osteotomic walls. This procedure increases the clinical implant success in poor bone density [14] although fractured trabeculae and debris could cause a delay in osseointegration process [15, 16].

The osseodensification (OD) technique, recently introduced by Huwais et al. [17], used special burs in non-cutting rotation mode in order to move bone inside the osteotomic site instead of removing it. This technique allows to preserve native bone and enhance the bone volume around implants [18] supporting high bone contact with the titanium.