Mandibular Rehabilitation with Fibula Free Flap and Dental Implant: A 4-Year Follow–up

A 21-year-old male with a plexiform-type ameloblastoma in the left mandible underwent decompression, partial mandibulectomy, and reconstruction using a fibula free flap.Virtual surgical planning facilitated precise resection and optimal placement of the fibula graft at the mid-height of the mandible, thereby improving the crown-to-implant ratio.The temporomandibular joint (TMJ) disc was preserved during mandibulectomy to prevent ankylosis and support functional remodeling of the neo-condyle.Postoperatively, malocclusion was managed through intermaxillary fixation, and implant rehabilitation was initiated after a 9-month healing period.At the 55-month follow-up, the patient exhibited stable occlusion, restored mouth opening, and absence of recurrence or complications at the reconstruction or implant sites.The neo-condyle demonstrated rounded contours resembling a natural condyle, and implant osseointegration was achieved without prosthetic complications.This case elucidates the significance of precise fibula flap positioning at the mid-height of the mandible to ensure long-term implant stability.Additionally, it highlights the pivotal role of TMJ disc preservation in facilitating functional recovery.