Dear Editor

First, I would like to thank our colleagues for their interest in the article. In regards to their comments, let us begin by saying that we are in complete agreement that mandibular grafting should be considered as an acceptable option when mandibular atrophy is treated in daily practice, and that we believe that the technique described in our article is an acceptable alternative to bone grafting and yields good long-term results. When a mandibular graft is performed, the main complications encountered are a dehiscence of the wound and vertical resorption of the graft. To avoid these complications, several techniques have been described, such as the sandwich technique, pericranium grafts, and calvarial grafts, all of which have yielded acceptable results. Indeed, calvarial grafts have demonstrated less resorption than iliac crest grafts. The type of grafting used has been shown to be important, but this does not exclude the benefit obtained using techniques such as those cited above.

It should be noted that Iturriaga and Ruiz reported only maxillar grafting in their article, and do not report mandibullar grafting; it is important to remember that there is a known and acknowledged difference between maxillar and mandibular graft resorption.

Otherwise, in our article, we presented inferior alveolar nerve lateralization (IANL) performed with piezosurgery as an alternative approach that has also yielded good results, and we suggest its use for those patients who would prefer minimal surgery and in cases where more aggressive surgery is not recommended. Indeed, with regard to the comparable long-term outcomes of this technique relative to the previously mentioned grafting techniques, IANL performed with piezosurgery should be viewed as at least a suitable alternative technique.

The authors have recently (within the past year) begun to use a bevel shaped osteotomy, and very much appreciate the improved direct vision of the field found in these surgeries. We would like to congratulate our colleagues for moving forward with their implementation of the IANL technique performed with piezosurgery, and encourage them to continue to strive in that regard.