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

  • Andrea RoccuzzoEmail author
  • Sissi Marchese
  • Nils Worsaae
  • Simon Storgård Jensen



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.


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



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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent

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


  1. 1.
    Dierens M, Vandeweghe S, Kisch J, Nilner K, De Bruyn H (2012) Long-term follow-up of turned single implants placed in periodontally healthy patients after 16-22 years: radiographic and peri-implant outcome. Clin Oral Implants Res 23:197–204. CrossRefPubMedGoogle Scholar
  2. 2.
    Buser D, Sennerby L, De Bruyn H (2017) Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions. Periodontol 73(1):7–21. CrossRefGoogle Scholar
  3. 3.
    Rocchietta I, Fontana F, Simion M (2008) Clinical outcomes of vertical bone augmentation to enable dental implant placement: a systematic review. J Clin Periodontol 35(8 Suppl):203–215. CrossRefPubMedGoogle Scholar
  4. 4.
    Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P (2009) The efficacy of horizontal and vertical bone augmentation procedures for dental implants - a Cochrane systematic review. Eur J Oral Implantol 2(3):167–184PubMedGoogle Scholar
  5. 5.
    Milinkovic I, Cordaro L (2014) Are there specific indications for the different alveolar bone augmentation procedures for implant placement? A systematic review. Int J Oral Maxillofac Surg 43:606–625. CrossRefPubMedGoogle Scholar
  6. 6.
    Toti P, Marchionni S, Menchini-Fabris G-B, Marconcini S, Covani U, Barone A (2017) Surgical techniques used in the rehabilitation of partially edentulous patients with atrophic posterior mandibles: A systematic review and meta-analysis of randomized controlled clinical trials. J Cranio-Maxillofac Surg 45:1236–1245. CrossRefGoogle Scholar
  7. 7.
    Elnayef B, Monje A, Gargallo-Albiol J, Galindo-Moreno P, Wang HL, Hernández-Alfaro F (2017) Vertical ridge augmentation in the atrophic mandible: a systematic review and meta-analysis. Int J Oral Maxillofac Implants 32:291–312. CrossRefPubMedGoogle Scholar
  8. 8.
    von Arx T, Hardt N, Wallkamm B (1996) The TIME technique: a new method for localized alveolar ridge augmentation prior to placement of dental implants. Int J Oral Maxillofac Implants 11:387–394Google Scholar
  9. 9.
    Machtei EE (2001) The effect of membrane exposure on the outcome of regenerative procedures in humans: a meta-analysis. J Periodontol 72:512–516. CrossRefPubMedGoogle Scholar
  10. 10.
    Garcia J, Dodge A, Luepke P, Wang HL, Kapila Y, Lin GH (2018) Effect of membrane exposure on guided bone regeneration: a systematic review and meta-analysis. Clin Oral Implants Res 29:328–338. CrossRefPubMedGoogle Scholar
  11. 11.
    Roccuzzo M, Ramieri G, Spada MC, Bianchi SD, Berrone S (2004) Vertical alveolar ridge augmentation by means of a titanium mesh and autogenous bone grafts. Clin Oral Implants Res 15:73–81CrossRefGoogle Scholar
  12. 12.
    Roccuzzo M, Ramieri G, Bunino M, Berrone S (2007) Autogenous bone graft alone or associated with titanium mesh for vertical alveolar ridge augmentation: a controlled clinical trial. Clin Oral Implants Res 18:286–294. CrossRefPubMedGoogle Scholar
  13. 13.
    Roccuzzo M, Savoini M, Dalmasso P, Ramieri G (2017) Long-term outcomes of implants placed after vertical alveolar ridge augmentation in partially edentulous patients: a 10-year prospective clinical study. Clin Oral Implants Res 28:1204–1210. CrossRefPubMedGoogle Scholar
  14. 14.
    Chiapasco M, Zaniboni M, Rimondini L (2007) Autogenous onlay bone grafts vs. alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges: a 2-4-year prospective study on humans. Clin Oral Implants Res 18:432–440. CrossRefPubMedGoogle Scholar
  15. 15.
    Zhao K, Wang F, Huang W, Wu Y (2018) Clinical outcomes of vertical distraction Osteogenesis for dental implantation: a systematic review and meta-analysis. Int J Oral Maxillofac Implants 33:549–564. CrossRefPubMedGoogle Scholar
  16. 16.
    Schettler D (1976) Sandwich technic with cartilage transplant for raising the alveolar process in the lower jaw. Fortschr Kiefer Gesichtschir 20:61–63PubMedGoogle Scholar
  17. 17.
    Yeung R (2005) Surgical management of the partially edentulous atrophic mandibular ridge using a modified sandwich osteotomy: a case report. Int J Oral Maxillofac Implants 20:799–803PubMedGoogle Scholar
  18. 18.
    Bianchi A, Felice P, Lizio G, Marchetti C (2008) Alveolar distraction osteogenesis versus inlay bone grafting in posterior mandibular atrophy: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:282–292. CrossRefPubMedGoogle Scholar
  19. 19.
    Kawakami PY, Dottore AM, Bechara K, Feres M, Shibli JA (2013) Alveolar osteotomy associated with resorbable non-ceramic hydroxylapatite or intra-oral autogenous bone for height augmentation in posterior mandibular sites: a split-mouth prospective study. Clin Oral Implants Res 24(9):1060–1064. CrossRefPubMedGoogle Scholar
  20. 20.
    Kamperos G, Zografos I, Tzermpos F, Iatrou I (2017) Segmental sandwich osteotomy of the posterior mandible in pre-implant surgery - a systematic review. Med Oral Patol Oral Cir Bucal 22:132–141. CrossRefGoogle Scholar
  21. 21.
    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, PRISMA-P Group (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group; Cochrane Statistical Methods Group (2011) The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 18(343):d5928. CrossRefGoogle Scholar
  23. 23.
    Felice P, Marchetti C, Iezzi G, Piattelli A, Worthington H, Pellegrino G, Esposito M (2009) Vertical ridge augmentation of the atrophic posterior mandible with interpositional bloc grafts: bone from the iliac crest vs. bovine anorganic bone. Clinical and histological results up to one year after loading from a randomized-controlled clinical trial. Clin Oral Implants Res 20:1386–1393. CrossRefPubMedGoogle Scholar
  24. 24.
    Felice P, Cannizzaro G, Barausse C, Pistilli R, Esposito M (2014) Short implants versus longer implants in vertically augmented posterior mandibles: a randomised controlled trial with 5-year after loading follow-up. Eur J Oral Implantol 7:359–369PubMedGoogle Scholar
  25. 25.
    Felice P, Barausse C, Pistilli V, Piattelli M, Ippolito DR, Esposito M (2018) Posterior atrophic jaws rehabilitated with prostheses supported by 6 mm long x 4 mm wide implants or by longer implants in augmented bone. 3-year post-loading results from a randomised controlled trial. Eur J Oral Implantol 11:175–187PubMedGoogle Scholar
  26. 26.
    Esposito M, Pistilli R, Barausse C, Felice P (2014) Three-year results from a randomised controlled trial comparing prostheses supported by 5-mm long implants or by longer implants in augmented bone in posterior atrophic edentulous jaws. Eur J Oral Implantol 7:383–395PubMedGoogle Scholar
  27. 27.
    Gastaldi G, Felice P, Pistilli V, Barausse C, Ippolito DR, Esposito M (2018) Posterior atrophic jaws rehabilitated with prostheses supported by 5 x 5 mm implants with a nanostructured calcium-incorporated titanium surface or by longer implants in augmented bone. 3-year results from a randomised controlled trial. Eur J Oral Implantol 11:49–61PubMedGoogle Scholar
  28. 28.
    Stellingsma C, Raghoebar GM, Meijer HJ, Batenburg RH (1998) Reconstruction of the extremely resorbed mandible with interposed bone grafts and placement of endosseous implants. A preliminary report on outcome of treatment and patients' satisfaction. Br J Oral Maxillofac Surg 36:290–295CrossRefGoogle Scholar
  29. 29.
    Pelo S, Boniello R, Moro A, Gasparini G, Amoroso PF (2010) Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants. Int J Oral Maxillofac Surg 39:227–234. CrossRefPubMedGoogle Scholar
  30. 30.
    Dottore AM, Kawakami PY, Bechara K, Rodrigues JA, Cassoni A, Figueiredo LC, Piattelli A, Shibli JA (2014) Stability of implants placed in augmented posterior mandible after alveolar osteotomy using resorbable nonceramic hydroxyapatite or intraoral autogenous bone: 12-month follow-up. Clin Implant Dent Relat Res 16:330–336. CrossRefPubMedGoogle Scholar
  31. 31.
    Felice P, Barausse C, Barone A, Zucchelli G, Piattelli M, Pistilli R, Ippolito DR, Simion M (2017) Interpositional augmentation technique in the treatment of posterior mandibular atrophies: a retrospective study comparing 129 autogenous and heterologous bone blocks with 2 to 7 years follow-up. Int J Periodontics Restorative Dent 37:469–480. CrossRefPubMedGoogle Scholar
  32. 32.
    Rachmiel A, Emodi O, Rachmiel D, Israel Y, Shilo D (2018) Sandwich osteotomy for the reconstruction of deficient alveolar bone. Int J Oral Maxillofac Surg 47:1350–1357. CrossRefPubMedGoogle Scholar
  33. 33.
    Papaspyridakos P, Chen CJ, Singh M, Weber HP, Gallucci GO (2012) Success criteria in implant dentistry: a systematic review. J Dent Res 91:242–248. CrossRefPubMedGoogle Scholar
  34. 34.
    Pjetursson BE, Thoma D, Jung R, Zwahlen M, Zembic A (2012) A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clin Oral Implants Res 23(Suppl. 6):22–38. CrossRefPubMedGoogle Scholar
  35. 35.
    Hjalmarsson L, Gheisarifar M, Jemt T (2016) A systematic review of survival of single implants as presented in longitudinal studies with a follow-up of at least 10 years. Eur J Oral Implantol 9(Suppl 1):S155–S162PubMedGoogle Scholar
  36. 36.
    Donati M, Ekestubbe A, Lindhe J, Wennström JL (2018) Marginal bone loss at implants with different surface characteristics. A 20-year follow-up of a randomized controlled clinical trial. Clin Oral Implants Res 29:480–487. CrossRefPubMedGoogle Scholar
  37. 37.
    Bae SY, Park JC, Shin HS, Lee YK, Choi SH, Jung UW (2014) Tomographic and histometric analysis of autogenous bone block and synthetic hydroxyapatite block grafts without rigid fixation on rabbit calvaria. J Periodontal Implant Sci 44:251–258. CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Papaspyridakos P, De Souza A, Vazouras K, Gholami H, Pagni S, Weber HP (2018) Survival rates of short dental implants (≤6 mm) compared with implants longer than 6 mm in posterior jaw areas: a meta-analysis. Clin Oral Implants Res 29(Suppl 16):8–20. CrossRefPubMedGoogle Scholar
  39. 39.
    Annibali S, Cristalli MP, Dell’Aquila D, Bignozzi I, La Monaca G, Pilloni A (2011) Short dental implants. J Dent Res 91:25–32. CrossRefPubMedGoogle Scholar
  40. 40.
    Starch-Jensen T, Nielsen HB (2018) Prosthetic rehabilitation of the partially edentulous atrophic posterior mandible with short implants (≤ 8 mm) compared with the Sandwich osteotomy and delayed placement of standard length implants (> 8 mm): a systematic review. J Oral Maxillofac Res 9(2):e2CrossRefGoogle Scholar
  41. 41.
    Jensen OT, Kuhlke L, Bedard JF, White D (2006) Alveolar segmental sandwich osteotomy for anterior maxillary vertical augmentation prior to implant placement. J Oral Maxillofac Surg 64:290–296. CrossRefPubMedGoogle Scholar
  42. 42.
    Laviv A, Jensen OT, Tarazi E, Casap N (2014) Alveolar sandwich osteotomy in resorbed alveolar ridge for dental implants: a 4-year prospective study. J Oral Maxillofac Surg 72:292–303. CrossRefPubMedGoogle Scholar
  43. 43.
    Mounir M, Mounir S, Abou-Elfetouh A, Shaker MA (2017) Assessment of vertical ridge augmentation in anterior aesthetic zone using onlay xenografts with titanium mesh versus the inlay bone grafting technique: a randomized clinical trial. Int J Oral Maxillofac 46:1458–1465. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Oral and Maxillo-facial SurgeryCopenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
  2. 2.Department of Periodontology, School of Dental MedicineUniversity of BernBernSwitzerland

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