Mandibular Interforaminal Ridge Reorientation for Osteogenic Reinforcement (MIRROR) for knife-edge and hourglass mandibles in the anterior region: a technical note

Severely narrow interforaminal mandibular ridges with knife-edge or hourglass morphology may compromise implant placement despite preserved vertical height. This technical note describes the Mandibular Interforaminal Ridge Reorientation for Osteogenic Reinforcement technique, a same-site approach in which a crestal cortical segment is mobilized and reoriented outward to create a contained tunnel for particulate grafting under a titanium-reinforced dense polytetrafluoroethylene membrane. The surgical workflow includes controlled osteotomies, stabilization of the mirrored segment, tunnel grafting, and tension-free closure. In a consecutive series of five cases, cone beam computed tomography at 6 months showed a mean horizontal gain of 4.08 mm, enabling implant placement in all cases and continuation of the planned prosthetic rehabilitation. Mandibular Interforaminal Ridge Reorientation for Osteogenic Reinforcement may represent a pragmatic option for selected anterior mandibular atrophies with preserved height, avoiding donor-site morbidity. Further clinical studies are required to validate its predictability.