Purpose: To answer whether severe vertical alveolar defects can be resolved using the sandwich osteotomy technique with xenograft material as filler, and to evaluate the predictability of the this procedure.

Patients and methods: Ten graft sites (five mandibular and five maxillary) in nine patients, treated in the Department of Oral and Maxillofacial Surgery, Hadassah Medical Center, were included in the study. The patients underwent vertical bone augmentation using the sandwich osteotomy technique filled with xenograft. The degree of bone augmentation was analyzed clinically at surgery, and 4–6 months later from the computerized tomographic images taken just before the dental implants insertion. A trephine histological analysis was performed during implantation on one maxillary site.

Results: The mean vertical bone gain was 6 mm (range 4–10 mm), and it remained stable after 4–6 months. In two cases, further horizontal bone augmentation was needed. All graft sites were rehabilitated using dental implants with satisfactory results. In three cases, gingival porcelain was required for the final prosthesis. Histology revealed vital bone and the remodeling of the filled gap.

Conclusion: The sandwich osteotomy technique appears to be a viable and predictable alternative, resulting in good final results, even for challenging cases.