An alternative to a mandibular block, is a remote incision with a tunneling approach to gain width of the mandibular bone. The tunneling technique can best be described below:
1. Begin with vertical incision in unattached gingiva.
2. Use of thumb to resist the tearing of tissue while reflecting unattached gingiva.
3. Continue reflecting attached gingival tissue on buccal of ridge and on occlusal of ridge using thumb to resist tearing of buccal tissue.
4. Use of dull instrument to relieve lingual attached tissue fibers starting posteriorly and coming anteriorly to reduce risk of instrument penetrating the lingual tissue.
5. Continued use of dull instrument over on the ingual aspect of the ridge relieving mylohyoid muscle fibers.
6. Place bone graft mixture under the tissue barrier using a dull instrument to push bone graft mixture over on to the lingual side of bony ridge.
7. Use the thumb-and-forefinger to mold the graft material under the tissue to equalize the width of the graft.