Fully 3-dimensional digitally planned reconstruction of a mandible with a free vascularized fibula and immediate placement of an implant-supported prosthetic construction.

BACKGROUND Reconstruction of craniofacial defects becomes complex when dental implants are included for functional rehabilitation. We describe a fully 3-dimensional (3D) digitally planned reconstruction of a mandible and immediate prosthetic loading with a fibula graft in a 2-step surgical approach. METHODS A 54-year-old man had development of osteoradionecrosis of the mandible. The resection, cutting and implant placement in the fibula were virtually planned. Cutting/drilling guides were 3D printed, and the suprastructure was computer-aided design and computer-aided manufacturing milled. RESULTS For the first operation, the implants were inserted in the fibula, and the position was registered by an optical scanning technique that defined the final planning of the suprastructure. For the second operation, the osteoradionecrosis was resected, the fibula was harvested and, with the denture fixed on the preinserted implants, placed in the mandibula guided by the occlusion. CONCLUSION It was possible to plan a mandibular reconstruction with immediate prosthetic loading completely by 3D virtual techniques.