A 59-year-old woman with a severely atrophied right mandible was treated with the sandwich osteotomy technique filled with autologous bone graft harvested by a cortical bone collector from the ramus.

The requirements of the Helsinki Declaration were observed, and the patient gave informed consent for all surgical procedures. After local infiltration of anaesthesia (mepivacaina plus adrenaline 1:200,000), buccally and lingually to the defect area, a single vertical incision was initiated at the distal margin of the mesial tooth (43) to the defect. The second incision was carried out distally about 3 cm far from the first (Fig. 1). The soft tissues were elevated from the bone through the tunnelling mechanism cranially, mesially and distally in a subperiosteal plane. The elevator of Zucchelli (Stoma®—Storz am Mark GmbH, Emmingen-Liptingen, Germany) was used for the subperiosteal dissection.

However, the entire periosteum could be preserved to ensure adequate vascularisation of the future bone cranial segment.

A horizontal osteotomy of the edentulous mandibular bone was then made with a piezoelectric device (Mectron Medical, GE, Italy). The tip MT1-10 was used to perform the osteotomy. The segmental mandibular sandwich osteotomy (SMSO) was finished by two (mesial and distal) slightly divergent vertical osteotomies (Fig. 2). The horizontal osteotomy was located at least 2 mm below the ridge bone and approximately 2 mm above the mandibular canal. The vertical mesial osteotomy was made 2 mm distal to the last tooth and 2 mm above the mental foramen. Also, the mesial vertical muco-periosteal incision is necessary to place the incision 2 mm distant from the mental foramen. The bone fragment remains anchored to the lingual and crestal periostea. The entire bone fragment was displaced cranially, and the desirable position was obtained.

The length of the segments was matched to the deficient, resorbed alveolar ridge. The segment was displaced crestally to the desired three-dimensional place and fixed with 0.8 mm thickness, pure titanium, L-Plate with 2.4 mm titanium matrix mandible cortex screws—self-tapping tip (Synthes GmbH Eimattstrasse, Oberdorf, Switzerland; Fig. 3). The gap was filled completely with autologous bone chips harvested from the mandibular ramus by a cortical bone collector (Safescraper Twist, Meta, Italy). No barrier membranes were used to protect the grafts. The vertical incisions were closing with interruptive suturing of the flaps with a resorbable material (Polysorb 3-0, Covidien LLC, MA, USA). In this way, the suture will not fall on the osteotomy line of the jaw; the result will be a better predictability of soft and hard tissue healing (Fig. 4). Orthopantomography (OPG) was performed immediately after the procedure (Fig. 5).