Background <p>Low bone quality, as well as narrow ridge width, presents a challenge for implant placement and affects implant stability. To date, the effectiveness of a specific technique to enhance implant stability in low-bone quality, along with ridge expansion, is not well established. This study aimed to evaluate implant stability in low-quality bone using osseodensification technique (OD) versus ridge expanders.</p> Methods <p>Twenty-two patients with one missing upper tooth and low-quality bone were recruited. The osteotomy site was prepared via either ridge expanders or the OD technique. The assessments included primary implant stability and secondary stability at 3 and 6 months, as well as bone width at different vertical levels (2, 4, and 8&#xa0;mm), evaluated preoperatively, baseline (immediately postoperatively), at 3 and 6 months. Additionally, pain outcome (PO) was assessed.</p> Results <p>Intergroup comparisons of implant stability between interventions revealed no statistically significant differences at baseline or 3 months (<i>P</i> &gt; 0.05), whereas there was a statistically significant difference at 6 months (<i>P</i> = 0.0268) in favour of the OD group. The PO revealed no statistically significant differences at baseline or after 1 week (<i>P</i> &gt; 0.05). The ridge width between interventions showed statistically significant differences at baseline and after 3 and 6 months (<i>P</i> &lt; 0.05) at 2, 4, and 8&#xa0;mm in favour of the OD group.</p> Conclusions <p>Considering the significant preoperative difference in crestal ridge width and the short follow-up period, the OD technique appears to be effective in low-quality bone, improving implant stability and enabling the expansion of narrow ridges with minimal postoperative pain.</p> Trial registration <p>This study was registered at clinicaltrials.gov on April 2nd, 2022, with the registration number NCT05330546.</p>