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Objectives: To compare optical values in the osteotomy gap created after a Tibial Tuberosity Advancement (TTA) treated with autogenous cancellous bone graft (ACBG), extracorporeal shock wave therapy (ESWT), a combination of ACBG and ESWT, and absence of both ACBG and ESWT using densitometry. Methods: Dogs presenting for surgical repair of a cranial cruciate ligament rupture were randomly assigned to one of four groups; TTA with ACBG (TTA-G), TTA with ACBG and ESWT (TTA-GS), TTA with ESWT (TTA-S), and TTA with no additional therapy (TTA-O). Mediolateral radiographs at 0, 4 and 8 weeks after surgery were evaluated to compare healing of the osteotomy gap via densitometry. An analysis of variance (ANOVA) statistical analysis was used to compare the densitometric values between groups. Results: At 4 weeks after surgery, a significant difference in osteotomy gap density was noted between TTA-GS (8.4 millimeters of Aluminum equivalent [mmAleq]) and TTA-S (6.1mmAleq), and between TTA-GS (8.4 mmAleq) and TTA-O (6.4 mmAleq). There were no significant differences noted between groups at the 8 week recheck. Clinical Significance: There were no significant differences in the osteotomy gap density at 8 weeks after surgery regardless of the treatment modality used. The combination of ACBG and ESWT may lead to increased density of the osteotomy gap in the first 4 weeks after surgery. Densitometry using an aluminum step wedge is a feasible method for comparison of bone healing after TTA in dogs.