Changing Paradigms in Implant–Prosthetic Rehabilitation in Free Fibula Flap (FFF) Reconstruction: Tracing the Transition Toward Digital Workflows

The free fibula flap (FFF) is a reference reconstructive option, particularly for extensive mandibular defects. This narrative review examines the evolution of implant–prosthetic rehabilitation from conventional free-hand reconstruction to prosthetically driven digital workflows. A structured, non-systematic search of PubMed/MEDLINE, Scopus, and Web of Science included English-language publications from 1989 to May 2026. Early approaches were limited by anatomical discrepancies, unfavorable implant positioning, excessive prosthetic space, and difficult peri-implant maintenance. Surgical refinements, including double-barrel reconstruction and soft-tissue procedures, improved rehabilitative conditions in selected cases. Virtual surgical planning, CAD/CAM guides, patient-specific fixation, and guided implant placement subsequently enabled closer coordination of reconstruction, implant positioning, and prosthetic design, supporting immediate protocols such as Jaw-in-a-Day. However, the available evidence remains heterogeneous and predominantly retrospective. Although digital workflows may improve accuracy and operative efficiency, their superiority in terms of long-term biological, prosthetic, functional, and patient-reported outcomes has not been conclusively demonstrated. Emerging technologies, including augmented reality, robotics, artificial intelligence, and digital twins, remain largely preliminary.