Navigated Implant Placement Accuracy In Fibular Graft Reconstructed Edentulous Maxillae

Immediate implantation after maxillary tumor resection and fibular reconstruction is limited by the lack of stable landmarks for CBCT-based navigation. This case introduces a novel approach using preoperative orthodontic mini-implants in the zygomatic bone to enable accurate dynamic navigation and one-stage implantation. A 19-year-old male with a 12-year history of painless bilateral facial swelling and nasal obstruction was diagnosed with familial gigantiform cementoma based on clinical, radiographic, and histopathological findings. He underwent total maxillectomy, bilateral fibular flap reconstruction, and dynamic navigation-assisted immediate implantation. Preoperative orthodontic screws (Ormco, USA) enabled accurate CBCT registration and virtual planning, compensating for the absence of dental or bony landmarks. The surgery also included 3D-printed PEEK augmentation (Medprin Regenerative, China) for orbital floor and zygomatic arch reconstruction. Dynamic navigation was performed using the Dcarer® system (Dcarer, China), and dental implants (ASTRA EV, Ø4.2 × 13–17 mm, Sweden) were placed accordingly. Postoperative CBCT confirmed clinically acceptable deviations. The patient showed significant improvement in facial symmetry and chewing function and is now undergoing final prosthetic restoration. This case highlights the clinical value of dynamic navigation in complex maxillary defects where static guides are not feasible. Real-time guidance overcame challenges of soft tissue interference, flap positioning, and implant alignment, enabling prosthetically driven, single-stage implantation. Dynamic navigation supported by preoperative orthodontic markers offers a precise and efficient solution for one-stage maxillary reconstruction and immediate implantation in anatomically challenging cases.