Activate Altar of Dementia by sacrificing Defiant Greatmaw.
When Defiant Greatmaw dies, its undying ability triggers, returning it from your graveyard to the battlefield with a +1/+1 counter on it.
When Defiant Greatmaw enters the battlefield, its first ability triggers, putting two -1/-1 counters on it.
Defiant Greatmaw's second ability triggers, removing a -1/-1 counter from another creature you control.
Resolve the Altar of Dementia ability from step 1, causing target player to mill cards equal to Defiant Greatmaw's power.
Repeat.
This clever loop relies on Mikaeus, the Unhallowed to grant undying to Defiant Greatmaw, allowing the Greatmaw to return to the battlefield with a +1/+1 counter whenever it perishes. Because Defiant Greatmaw enters the battlefield with two -1/-1 counters from its own ability, state-based actions immediately cause those -1/-1 counters and the +1/+1 counter to annihilate each other, leaving the creature completely clean of counters and ready to repeat the process. By using Altar of Dementia as the sacrifice outlet, you turn this endless resurrection cycle into an unstoppable mill engine that can effortlessly deck target opponents.