Abstract : The focus of implant site preparation has shifted toward techniques that aim not only to preserve but also to enhance the quality and density of bone around the implant. Three groups with 8 implants in each group (with a total number of 24 Implants) were selected. All patients had missing maxillary posterior teeth in the maxilla that have poor bone density. Implant site preparation was different in these groups. First group depending on Densah bur in preparation, second group depending on reverse drilling technique and third group depending on conventional drilling technique. After nine months postoperatively, there was an increase in the peri-implant bone density in three groups with superior advantage for conventional technique, and changes with no significant difference in term marginal bone loss after 6 and 9 months. Regarding primary stability the Densah group has the best results. The study concluded that the Densah bur drilling technique is found to have a superior advantage in term of primary stability which may help in immediate loading planning in medium and soft trabecular bone qualities.