Digital-Guided Functional Reconstruction Of The Mandible And Implant Rehabilitation

This case describes the management of a 38-year-old male diagnosed with cemento-osseous dysplasia in the left mandible. A digital-guided protocol involving lesion resection, vascularized iliac bone grafting, autonomous robotic-assisted implant placement, and CAD/CAM prosthodontics achieved favorable clinical outcomes. The patient presented with left submandibular swelling. Intraoral examination showed no significant abnormalities, while CBCT revealed a 24×28×27 mm multilocular osteolytic lesion (31-34 region) with trabecular thickening, buccal cortical discontinuity, and "honeycomb" architecture. Digitally designed osteotomy, bone harvesting, and implant-oriented positioning guides were fabricated preoperatively. Under general anesthesia, digital-guided en bloc resection and vascularized iliac bone grafting were performed for mandibular reconstruction. Nine months postoperatively, implant positions were planned using a diagnostic prosthesis. Autonomous robotic surgery achieved precise implant placement (mean deviation <0.5 mm). Following 3 months of submerged healing, a keratinized mucosal graft was performed. Mandibular reconstruction in osseous pathologies requires prosthetically driven planning of bone volume, occlusal relationships, and keratinized tissue preservation. This case highlights two critical strategies: Implant-oriented surgical guides optimized graft dimensions and osteotomy margins. Autonomous robotic system ensured prosthetically ideal implant positioning. The integration of keratinized tissue augmentation and digital prosthodontics addressed common complications in grafted bone rehabilitation. Comprehensive digital workflows—combining implant-driven reconstruction planning, robotic surgery, and CAD/CAM prosthetics—enable predictable restoration of both biomechanical function and esthetic form in complex mandibular rehabilitation cases. This protocol demonstrates clinical efficacy in managing graft-related biological challenges while ensuring long-term implant success.