Advanced mandibular atrophy is a serious surgical reconstruction challenge. Previous experience with an inferior border approach has been favorable. Predictably successful osseointegrated implants ultimately allow loading of the healed grafts. The technique described uses a freeze-dried, gamma-irradiated cadaver mandible packed with autogenous iliac crest bone. An extraoral approach allows augmentation without disrupting use of an intraoral prosthesis during healing. The incidence of infection and resorption can be reduced. Fewer problems with neurosensory disturbances common with some of the superior border, or sandwich osteotomy, grafting techniques were experienced. The use of implants to ultimately load the bone should result in less resorption than in those techniques using a conventional removable prosthesis. Keywords: advanced mandibular atrophy, composite cadaver mandibular autogenous bone, extraoral approach, inferior border graft