Alveolar bone augmentation for dental implant rehabilitation is one of the greatest challenges for oral and maxillofacial surgeons. Bringing out an inadequate quantity of vertical bone during augmentation compromises correct implant positioning and the resulting prosthetic restoration. Alveolar distraction osteogenesis is now generally used in correcting alveolar ridge atrophy due to trauma, congenital defects, or periodontal defects. Onlay block grafting is a suitable method for restoring the alveolar bony defects. However, it sometimes can become a complicated procedure to repair the horizontal defect accompanying a vertical defect using only bone blocks. This clinical report presents a successful reconstruction of a severe anterior mandibular alveolar bony defect as a result of impacted teeth extraction and periodontal problem in a 50-year-old healthy female patient. The defect was reconstructed with symphysis graft and platelet-rich fibrin in the first step. Vertical alveolar distraction was performed on the grafted site to maintain the suitable bony height 3 months later. Grafted bony segment distraction and the treatment options in similar cases were also discussed in this clinical report among with the literature.