Background <p>Implant placement in atrophic ridges presents a clinical challenge for surgeons and the results are often unpredictable. Static guided surgery is well-documented in cases where bone is adequate in height and width. However, its application with simultaneous augmentation procedures - such as ridge splitting or osteoperiosteal flap - remains underexplored. This study evaluated three-dimensional accuracy of static guided implant placement after guided ridge splitting or osteoperiosteal flap elevation, using a fully digital, dual-guide surgical protocol.</p> Methods <p>A total of 18 patients requiring horizontal ridge augmentation received 40 dental implants using a dual-guide static protocol. The first surgical guide was used for piezoelectric ridge splitting or osteoperiosteal flap elevation; the second allowed fully guided implant placement. Surgical guides were designed via cone-beam computed tomography (CBCT) and intraoral scan superimposition using BlueSkyPlan^® and in-office 3 Dimensional printing. Accuracy was assessed by comparing planned and actual implant positions on postoperative cone-beam computed tomography scans, measuring linear and vertical deviations at the entry point and apex, and angular deviation. Descriptive and inferential statistics were used to evaluate accuracy and subgroup differences.</p> Results <p>All 40 implants were successfully placed without complications. All implants achieved primary stability and had uneventful healing. Both approaches provided high placement accuracy comparable with values reported in the literature. Comparison between ridge splitting and osteoperiosteal flap techniques revealed no statistically significant differences across coronal, apical, and angular deviation parameters. The osteoperiosteal flap group showed numerically smaller deviations, but the difference was not statistically significant (<i>p</i> &gt; 0.05).</p> Conclusions <p>A fully digital dual-guide static protocol enables accurate implant placement in augmented ridges using guided ridge splitting or osteoperiosteal flap techniques. This digital workflow may serve as a reliable alternative to conventional grafting methods in anatomically compromised sites.</p> Trial registration <p>This Randomized Clinical Trial has been retrospectively registered at Clinical Trials.gov with identification number: NCT07103577 on 2025-07-29.</p>