Background <p>Immediate loading protocols are increasingly popular, but the complex anatomy of the posterior maxilla presents challenges. Comparative studies on the effects of hyaluronic acid (HA) and atorvastatin gel (ATV) on bone density in this region are limited. This study aimed to compare the impact of topical HA and ATV gels on bone density around immediately loaded implants in the posterior maxilla.</p> Materials and methods <p>Twenty-one patients were randomly and equally assigned to three groups (<i>n</i> = 7 per group): Group I (Control): Received implants without any coating. Group II (HA group): Received implants coated with HA gel. Group III (ATV group): Received implants coated with atorvastatin (ATV) gel. Clinical evaluation of implant stability was conducted at the time of insertion and at 3 and 6 months postoperatively. Peri-implant pocket depth (PPD) and modified sulcus bleeding index (mSBI) were also assessed. Radiographic evaluation of buccal bone density (BD) was performed using cone-beam computed tomography (CBCT) immediately after implant loading and again at 6 months. All clinical and radiographic data were subjected to statistical analysis.</p> Results <p>After 6 months, there was a statistically significant increase in buccal bone density in both Group II (HA) and Group III (ATV) compared to the control group (<i>p</i> = 0.001). No significant difference was found between the HA and ATV groups. There were no statistically significant differences among the three groups regarding implant stability, PPD, or mSBI (<i>p</i> &gt; 0.05).</p> Conclusion <p>HA and ATV gels increased buccal bone density but did not significantly improve implant stability or peri-implant health versus controls.</p> Trial registration <p>The study was listed on <a href="http://www.clinicaltrials.gov">www.clinicaltrials.gov</a> with registration number (NCT06976866) on 09/05/2025.</p>