<p>The anterior or esthetic region frequently exhibits compromised bone volume and quality, posing challenges for implant placement. Attaining optimal implant stability while preserving or augmenting ridge dimensions is essential for both functional success and long-term esthetic outcomes. Osseodensification, a biomechanical site preparation technique, compacts rather than removes bone, potentially enhancing stability and facilitating ridge expansion. Our research aimed to compare osseodensification with conventional manual bone expanders in enhancing implant stability and ridge expansion in the esthetic zone. A randomized controlled clinical trial was conducted on eighteen patients missing a maxillary anterior tooth with moderate horizontal ridge deficiency (3–4&#xa0;mm width, ≥ 10&#xa0;mm height). Participants were equally allocated into two groups: Group I (osseodensification), where sites were prepared using Densah burs in densifying mode, and Group II (manual expanders), prepared with Microdent expanders. Implants were assessed for primary stability at placement and secondary stability at 16&#xa0;weeks using resonance frequency analysis. Cone-beam computed tomography was performed at baseline and 16&#xa0;weeks to evaluate ridge expansion, bone density, and marginal bone loss. Both groups demonstrated significant intra-group increases in ridge width and bone density. No significant differences were noted between groups in ridge expansion or marginal bone loss. However, osseodensification yielded significantly higher secondary stability values compared with expanders. Within the study’s limitations, osseodensification enabled safe ridge expansion and simultaneous implant placement in the esthetic zone, providing superior stability without observed complications. It represents a predictable, minimally invasive technique that supports successful and esthetically favorable implant outcomes.</p><p><i>Trial registration</i> NCT06667778 retrospectively on 31/10/2024, Clinicaltrial.gov.</p>