## 1 Introduction  
Osseedingration, a prerequisite for successful implant loading, signifies a direct functional and structural union between the titanium surface and bone [1]. Osseeointegration has been evaluated as the most important predictor of long-term implant success. According to [PERSON] et al. [2], six major factors--implant design, implant surface, implant material, surgical factors such as implant primary stability (IPS), biomechanical factors such as loading conditions, and patient-related factors, including bone density, quality, and volume--play key roles in osseeointegration and implant success [3, 4, 5, 6]. Among these, IPS is a key factor because it is related to all other categories of osseeointegration [7]. IPS is successfully obtained when the micromotion of the implant is less than 50 um to 150 um. Micromotion above this level causes bone resorption and fibrous encapsulation around the implant, leading to implant failure rather than osseeointegration [8, 9]. IPS is achieved only by a mechanical connection between the implant and the bone. After that, a biological remodeling proceeds in approximately 1 mm of the peripheral bone around the implant. This process will reduce the mechanical bone-to-implant contact (BIC), loosen implant stability, and make the area susceptible to micromovement and fibrous integration. However, as the bone is formed, BIC increases again, which is the so-called implant secondary stability [10; 11]. IPS is considerably influenced by the quantity and quality of the bone bed [2; 12]. In particular, bone quality is an important determinant in early fixture loss [13]. Based on previous studies' classification of bone quality by measuring Hounsfield unit (HU) values on computed tomography (CT), type IV bone with poor bone density has a higher implant failure rate than that of type I, II, and III [12; 13; 14; 15; 16]. This is because implants placed in bones with low density, such as the posterior maxilla, have low IPS, and it is potentially difficult to obtain high insertion torque [13; 17]. Trabecular bone has less influence on IPS than marginal cortical bone. Therefore, IPS is difficult to obtain in areas with thin cortical bones and low trabecular bone density, such as the posterior maxilla [12; 13]. Conventional technique, an osteotomy preparation method for implant placement, is a subtractive process that cuts and extracts the bone from the implant bed. Burs of conventional technique also facilitate this removal and are manufactured with a special design (deep grooves) to store the removed bone chips between the drill flutes for potential reuse [18]. One of the most popular methods to increase IPS in low-density bones is the under-drilling technique. It was found that a 10% undersized preparation in low-density bone is sufficient to improve IPS, and there is no significant effect with an additional reduction [19; 20]. Stepped osteotomy was introduced as a modification and proved to be more effective than the conventional technique [21]. According to [PERSON] [22], osteotomes are widely used to increase bone density and aid implant stability. In 2017, [PERSON] introduced the method called the osseedensification technique to increase IPS [23]. Oseedensification drill, which is non-subtractive, contains a specially designed structure with many lands that have large negative rake angles. This serves as a non-cutting edge to increase bone density when expanding the osteotomy and allows the bone to be preserved. These burs are designed to have a tapered shank and a cutting chisel edge, allowing the osteotomy to be expanded and the diameter to be gradually increased as the burs enter deeper. They can be rotated clockwise (cutting direction) to drill bone or counter-clockwise (non-cutting direction) to smoothly compact bone [23].