The sandwich osteotomy technique to treat vertical alveolar bone defects prior to implant placement: a systematic review



The aim of this systematic review was to investigate the predictability of the sandwich osteotomy technique to provide sufficient alveolar bone height for dental implant therapy in vertically atrophic jaws.

Material and methods

A MEDLINE (Pubmed), EMBASE and Cochrane Library electronic search and a manual search were performed until July 2018. Any clinical study published in English, reporting data on at least 10 patients rehabilitated with implant-supported dental prostheses after vertical ridge augmentation by means of the sandwich osteotomy technique and followed for at least 12 months after loading, was included. Data on study and patients’ characteristics, interventions provided, implant and prostheses survival rates and complications were extracted from the included studies. Each study design was evaluated using the Cochrane Collaboration’s tool for assessing risk of bias.


Initially, 415 records were identified, from which 10 full-text articles could be included in the final qualitative analysis. Implant survival rate after a mean follow-up of 3.7 years (median: 3 years; range: 1–7 years) was 94% (median: 93%; range: 91–100%). Peri-implant mean marginal bone resorption was 1.6 mm (median: 1.4 mm; range: 0.6–4.7 mm). The calculated mean alveolar bone height available at the time of implant placement was 11.3 mm (median: 11.5 mm; range: 7.8–16 mm). A temporary sensory disturbance of the inferior alveolar nerve was the most commonly reported complication following the sandwich osteotomy.


The present systematic review documents that implant survival rate after mandibular vertical ridge augmentation using the sandwich osteotomy technique is high after up to 5 years of loading. The complication rate can be considered moderate and has predominantly a transient nature. Data on the long-term behavior of the augmented bone and inserted implants are missing.

Clinical relevance

The present technique can be considered a reliable treatment option in cases of moderate vertical bone deficiency of the posterior mandible to provide suitable conditions for later implant placement. Intra- and post-operative complications do not seem to jeopardize the final outcome.

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The authors express their gratitude to Ms. Michela Scotti (Librarian, University of Torino, Italy) for her valuable help in the database search process.

Funding information

The study was self-funded and no external funding was received by any of the authors. Andrea Roccuzzo is the recipient of a 3-year scholarship from the Clinical Research Foundation (CFR) for the Promotion of Oral Health, Brienz, Switzerland.

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Correspondence to Andrea Roccuzzo.

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The authors declare that they have no conflict of interest.

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Due to the nature of the present study with no patients’ involvement, ethical committee approval was not sought.

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To perform the present study, informed consent was not required.

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Roccuzzo, A., Marchese, S., Worsaae, N. et al. The sandwich osteotomy technique to treat vertical alveolar bone defects prior to implant placement: a systematic review. Clin Oral Invest (2020).

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  • Pre-implant surgery
  • Dental implant
  • Segmental osteotomy
  • Sandwich osteotomy
  • Interpositional graft