In cases of atrophic mandible, the distance to the mandibular canal and the transverse decrease in bone is an anatomic limitation for prosthetic rehabilitation with dental implants. The gold standard for treatment of this mandibular atrophy continues to be autologous bone grafting [1, 2].

A relatively modern technique for vertical bone augmentation is sandwich osteotomy. Schettler and Holtermann first described this technique, with promising results [3]. The sandwich technique has been proved to be relatively safe, with successful long-term results, in both the mandible and the maxilla [4,5,6,7,8,9,10]. The technique is executed by segmentalising the alveolar bone through a minimal vestibular incision (similar to osteotomies such as alveolar distraction osteogenesis), transporting the segment attached to the periosteum to the desired three-dimensional planned area and fixing it with plate and screws. Most studies have used autogenous bone graft as the filler for the created gap.

To the best of our knowledge, the present study is the first to use sandwich osteotomy to obtain both vertical and transversal bone gain flapless; in more detail, the authors used the tunnel technique of the soft tissue without a full-thickness flap to perform the described mandibular osteotomy to improve hard and soft tissue healing.