From Resection to Rehabilitation in One Day: Digital Workflow for Mandibular Reconstruction with Fibular Free Flap and Immediate Dental Rehabilitation Using CAD/CAM Guides at the Point of Care

TL;DR

A digital workflow using 3D printed guides enables accurate mandibular reconstruction and immediate dental rehabilitation in a single day.

Contribution

A modular all-in-one 3D printed guide system for fibular free flap mandibular reconstruction with immediate implant placement and prosthetic rehabilitation is developed and tested.

Findings

The digital workflow achieved high accuracy and predictability in mandibular reconstruction.

Immediate implant placement and prosthetic rehabilitation resulted in stable occlusion and high patient satisfaction.

Postoperative deviations observed initially were resolved by the 6-month follow-up.

Abstract

By using virtual surgical planning (VSP) and 3D printed guides, complex maxillofacial defects can be reconstructed with high accuracy and predictability. A fully digital workflow resulting in a modular all-in-one 3D printed guide system for fibula osteotomies, bone segment positioning, fully guided dental implant placement and dental prosthesis fixation for mandibular reconstruction was developed at Ghent University Hospital. A follicular ameloblastoma of the left mandible was resected in a 28-year-old male. The defect was reconstructed with a two-segment fibular free flap with immediate placement of three dental implants and immediate implant loading with a screw-retained bridge. A split thickness skin graft and Elemental PerioPlast were used as wound dressing. Comparison of the preoperative planning with the postoperative CT-scan showed a deviation immediately after surgery, which was no longer present at the 6-month follow-up. The patient achieved a stable occlusion and 44 mm mouth opening and reported high satisfaction. This case illustrates that fully digital, immediate mandibular reconstruction with simultaneous implant placement and prosthetic rehabilitation is feasible and accurate and enhances early functional recovery. Future improvements in intraoperative validation may further refine accuracy and reproducibility in complex oncologic reconstructions.

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