A Workflow for Fibula Free Flap Maxillomandibular Reconstruction With Immediate Prosthodontic Rehabilitation

Computer-aided surgical planning has improved functional and aesthetic outcomes in maxillofacial reconstructive surgery. Immediate dental implantation is now being increasingly performed in conjunction with the fibula free flap, with high success rates in maxillomandibular reconstructions. The success of this approach relies on careful patient selection, meticulous surgical planning, and prosthetic implementation. Patient-specific surgical templates for resection, repositioning, and implant placement facilitate this process, allowing successful installation of prefabricated prosthetic dental arches during surgery and ensuring a stable postoperative occlusion. Achieving optimal results is contingent upon collaboration among surgical, prosthodontic, and engineering expertise, particularly in the precise computer-aided design/computer-aided manufacturing positioning of bone flaps and implants. This article aimed to introduce a workflow for immediate loading of implants in fibula free flap maxillomandibular reconstruction. The use of a patient-specific implant to improve lower facial contour in mandibular reconstructions and an occlusion-based reverse planning is highly recommended to achieve optimal results.