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Abstract Implant survival in low bone density patients seems to be possible. However, the quality of evidence is very low, making the recommendation of implant treatment for these patients only feasible with very special precautions. Implants placement using bone condensation with or without self tapping implants in low bone density regions enhances implant stability. On the other hand, Mark IV Branemark dental implants and undersized drilling seem to provide equivalent implant stability, implant survival and marginal bone loss if compared to normal bone. Quality of evidence is however, unclear. 26.2 Implication of research 1. Since the reported quality of evidence was very low when considering implant placement in low bone density regions, properly designed prospective cohort studies with follow up periods not less than 5 years and proper sample size calculation are highly recommended. Adjusted analysis for confounding factors, like prosthetic design, type, material, opposing occlusion, smoking and systemic conditions of the patient should be also considered. 2. There is a tendency for misclassification in the conducted studies, which makes the authors promptly recommend a validated tool to accurately diagnose patients with low bone density or osteoporosis. 3. Well designed RCTs with proper sample size calculation comparing special adopted techniques and conventional ones are still highly recommended |