Maxillary Anterior Horizontal Ridge Reconstruction using Computer-Guided Ridge Split and Expansion: A Randomized Clinical Trial with a 2-Year Follow-up.
OBJECTIVES This randomized clinical study aimed to assess implant placement accuracy and radiographic outcomes of computer-guided versus freehand ridge split and expansion with simultaneously inserted implants in patients with horizontally deficient maxillary anterior ridges over a 2-year follow-up period. METHODS Twenty-two volunteers were randomly allocated (1:1) to either a computer-guided or a freehand group. The primary outcome was implant placement accuracy. Secondary outcomes included postoperative complications, marginal bone loss, horizontal ridge width changes, and peri-implant defect resolution. All parameters were evaluated radiographically at baseline, immediately after surgery, and at 3, 6, 12, and 24 months. RESULTS The computer-guided group demonstrated lower angular deviation versus the freehand group (1.45 ± 0.43° vs. 10.02 ± 3.24°; p < 0.001) and entry point deviation (0.54 ± 0.19 mm vs. 2.16 ± 0.31 mm; p < 0.001). Depth deviation showed a non-significant difference. Three, six, and twelve months after surgery, the freehand group exhibited higher marginal bone loss (1.02 ± 0.13, 1.57 ± 0.13, 1.58 ± 0.13, and 1.73 ± 0.17 mm, respectively) than the computer-guided group (0.27 ± 0.13, 0.35 ± 0.13, 0.36 ± 0.13, and 0.39 ± 0.15 mm, p < 0.001). The computer-guided approach also was associated with minimal ridge collapse and enhanced peri-implant defect fill. CONCLUSIONS The present preliminary findings suggest that computer-guided ridge split and expansion were associated with improved implant placement accuracy and peri-implant hard tissue preservation compared with the conventional freehand approach over 2 years. Both techniques achieved successful implant outcomes without major complications. However, these observations should be interpreted cautiously as preliminary evidence requiring external validation, given the limited sample size, single-operator design, and mid-term follow-up duration. Multicenter studies with larger cohorts and longer follow-up are required before confirming definitive clinical superiority. CLINICAL SIGNIFICANCE The present preliminary findings suggest that integrating the digital workflow into ridge split and expansion may enhance surgical precision and peri-implant hard tissue stability in narrow maxillary ridges. Nevertheless, the potential advantages of the guided approach require confirmation through larger, well-designed clinical trials before recommending widespread, routine clinical implementation. CLINICAL TRIAL REGISTRATION The study was prospectively registered in the ClinicalTrials.gov registry (Identifier: NCT06135506) on 11/11/2023 under the title "Artificial Intelligence/Computer Guided Ridge Splitting for Treating Horizontal Ridge Defects." CLINICALTRIALS gov PRS: Record Summary NCT06135506.