Vertical bone atrophy in the mandible is a challenge when inserting dental implants. In situations where less than 3 mm of residual bone is present but both vestibular tables remain intact, a mandibular split technique can be used. It is a highly predictable and easy to perform technique although borderline situations such as those shown in the present clinical case series with less than 3 mm bone width may be less unpredictable in terms of outcome and long-term implant survival. Therefore, we show a series of extreme cases treated with a technique of splitting, biological reaming and matching of the implant to the recipient bed, which achieves lasting results ten years later.