Objective <p>The study aims to assess the applicability and safety of using a fully digital workflow for the application of bi-axial alveolar distraction osteogenesis in the posterior mandibular region.</p> Materials and methods <p>This study included 7 patients with vertically deficient posterior mandible managed with the utilization of a bi-axial distractor and the implementation of a double scan computer-guided virtual planning protocol. The neurosensory safety of the procedure was assessed using an inferior alveolar nerve conduction test. Radiographic assessment was conducted for vertical bone gain, degree of alveolar segment tilt, bone density, and crown to available bone for implantation ratio appraisal.</p> Results <p>Full neurosensory recovery was documented for all patients one month after the activation period. Vertical bone gain reported a statistically significant difference across the radiographic follow-up (<i>P</i> = 0.001). The mean bone density showed a statistically significant difference throughout the study period (<i>P</i> = 0.001) while the degree of tilt of the distracted segment showed insignificant differences (<i>P</i> = 0.072). Crown-to-available bone for implantation ratio showed a statistically significant change post-distraction (<i>P</i> = 0.018).</p> Conclusion <p>Virtual planning and computer-guided workflow for the application of vector-dictating distraction osteogenesis in the posterior mandible showed a predictable application, ease of operation execution, neurosensory safety, and maintenance of the transport segment buccolingual orientation.</p> Trial registration <p>Trial was registered at clinicaltrials.gov [NCT05602909/ 2022-10-14].</p>