Abstract
This study aimed to compare the clinical performance of autogenous bone blocks with customized and noncustomized bovine bone blocks for horizontal alveolar ridge augmentation. Forty‐eight participants with deficient alveolar ridges were divided into threegroups (
n
= 16): Group I (autogenous bone graft), Group II (noncustomized bovine bone block), and Group III (customized bovine bone block). Graft success, postsurgical complications, bone formation, and resorption rates were recorded and analyzed after 6 months. Patient satisfaction and postoperative pain were assessed using a visual analog scale. A total of 39 bone blocks were integrated successfully. Survival rates for Groups I, II, and III were 100% (95% CI: 79.4%–100%), 75.0% (95% CI: 47.6%–92.7%), and 68.8% (95% CI: 41.3%–89.0%), respectively (
p
= 0.07). Dehiscence, screw exposure, and partial bone loss were the most common postoperative complications. Bone formation and resorption did not differ significantly between groups (
p
= 0.61 and
p
= 0.12, respectively). Group I experienced significantly higher pain from day 3 to day 7 compared to other groups (
p
p
= 0.003). Patient satisfaction was highest in Group III (91%). Within the limitations of this prospective comparative study, onlay grafting with bovine bone blocks demonstrated clinically acceptable outcomes for horizontal ridge augmentation, with resorption rates comparable to autogenous grafts. However, the observed survival differences did not reach statistical significance, and the wide confidence intervals reflect the limited sample size, suggesting that clinically meaningful differences cannot be excluded. Customized bovine bone blocks showed similar clinical performance to noncustomized blocks with higher patient satisfaction. Larger randomized controlled trials with longer follow‐up are warranted to confirm these findings.