*2.3.1 Clinical assessment*

Thorough medical and dental histories were taken from all patients presented in the study project. General clinical assessment of oral hygiene and gingival and periodontal health in terms of gingival color, contour, size, and consistency was documented. The height and width of the available bone around the potential site of the dental implant were assessed using a bone caliper.

### *2.3.2 Preoperative radiological screening assessment*

An orthopantomogram (OPG) and intraoral periapical radiograph (IOPA) were taken preoperatively during patient selection and were kept in the patient's record; they gave an indication about the location and proximity of the vital structures and anatomical landmarks, bone quality, quantity and the presence of sufficient bone height and width in terms of mesiodistal dimension around the dental implant, absence of pathological lesions that may affect the outcome of dental implant success (periapical cysts, granulomas, osteomyelitis), and the angulation and position of the potential dental implant in relation to the adjacent teeth.

#### *2.3.3 Operative techniques*

All patients underwent two stages of implant surgeries. Stage I implant surgery was performed in which one SPI dental implant (THOMMEN Medical SPI ELEMENT MC INICELL) bone level type with a length of 9.5 mm and a diameter of 4 mm was positioned in the maxillary edentulous premolar area in each patient of the 22 sample size. A stage II implant surgery was carried on after 2 months of implant placement in which the dental implant had to be uncovered and impression was taken for crown installation.

#### *2.3.3.1 Group I (ultrasound) group*


#### **Figure 2.**

*The therapeutic ultrasound machine Gymna Pulson® 330 with intraoral probe and actual setting parameters on display.*


#### **Table 1.**

*Intraoral ultrasound device: technical specifications of the ultrasound signal.*

**Figure 3.** *Ultrasound therapy delivered using probe on the buccal aspect of the implant site.*
