## 4 Discussion
After implant insertion, the bone's elastic recoil and spring-back effect on the implant surface improve the mechanical connection between the implant and the surrounding bone. This approach strengthened the implant's primary stability and encouraged more bone healing throughout the 6-month follow-up period, providing good secondary stability. This effect worked with the intact, well-organized, trabecular pattern of the bone surrounding the implant [17; 29; 35; 36]. The osteotome method increases bone density, enabling greater initial implant stability by compressing the bone laterally, surrounding the implant site with osteotomes of gradually increasing diameter [37]. However, after using an osteotome, the bone quality and even the stability around the implant were worse than those seen in the Densah group [38]. With piezosurgery, soft tissues can be preserved, while mineralized tissues can be removed selectively. Piezonsurgery, in particular, permits the surgeon to work directly on the Schneiderian membrane, making it safe for membrane elevation with no impact on implant stability or bone density [39; 40]. Bone height measurements in the three groups did not differ at baseline although there were variations in the three groups after 6 months. Densah and piezo revealed the lowest mean bone height, whereas osteotome displayed the greatest mean bone height measurement. The amounts of bone growth in the three groups varied significantly after 6 months. Contrary to a study that found no discernible difference in outcomes between the osteotome and piezosurgery techniques [24]; the osteotome group had the highest mean bone growth. The Densah and piezosurgery groups did not differ in a statistically significant manner; both had the lowest mean bone gain readings. One criterion for implant success was the result in the marginal bone levels around the implants. For implant success, less than 1.5 mm of bone loss during the first year, less than 0.2 every year, and a maximum of 2 mm over 5 years were recorded [41]. Radiographic evaluation by CBCT for crestal bone loss revealed that, at the buccal and palatal sides, as well as overall, there were no significant differences among the three groups [24]. Autogenous bone has reportedly been found to be the best choice for bone reconstructive therapy [42; 43]. Bone substitutes are frequently used to avoid the morbidity brought on by the use of autogenous bone. Therefore, xenograft was used in the current investigation to increase success and predictability [44; 45]. In one patient who underwent piezosurgery, just one membrane perforation was clinically seen; however, as previously reported [24], this perforation had no negative effects. The implant survival rate was 100%, comparable to or greater than that seen in prior investigations involving sinus floor elevation. The residual alveolar ridge's insufficient height is not a substantial cause of implant failure, but trauma, infection, or contamination during surgery may contribute to this unfavorable outcome [24; 30; 46; 47]. Complications such as trauma, bleeding, sinus membrane perforation, and maxillary sinusitis were seen least often in the osseodensification group. The piezosurgery group suffered from one membrane perforation but did not show any unfavorable consequences, while one osteotome patient showed benign paroxysmal positional vertigo (BPPV). The Densah technique had the shortest surgery time among the three groups. One of the study's limitations is the smaller sample size. Although 6 months is considered feasible to demonstrate post-treatment changes, a longer period could provide a more distinct outcome. Therefore, future studies should focus on a larger sample size and longer follow-up period. Furthermore, it would be interesting to see the effectiveness of these techniques at other sites in the oral cavity.