Defects and bone loss in the maxilla and mandible pose significant challenges for dental rehabilitation. This paper focuses on complex cases of bimaxillary dental rehabilitation, where traditional dental implant protocols were not feasible in at least one jaw. Four patients were examined conceptually, where conventional dental implant placement (n = 20) was combined in either the same or opposite jaw with a patient-specific subperiosteal implant (n = 5). This study evaluates aspects such as primary stability, prosthodontic restoration, complications, and soft tissue management over the observation period. None of the five patient-specific subperiosteal implants (IPS Implants^® Preprosthetic; KLS-Martin Group, Tuttlingen, Germany) experienced failure or showed any loosening of screws, with the longest observation period extending to 68 months. These implants were securely fixated away from the posts, without any biomechanical restrictions on loading from the time of insertion. Planning and manufacturing, including the initial suprastructure, followed a fully digital workflow. The number of screws required for multivector fixation ranged from 13 to 22. All dental implants placed remain functional, definitive prosthodontic restoration has been performed, and no stability loss or peri-implantitis has been observed. The IPS Implants^® Preprosthetic emerges as a valuable consideration when conventional implant dentistry protocols encounter limitations.

Secondary mandibular reconstruction using fibular free flaps (FFF) is a technical challenge for surgeons. Appropriate operation planning is crucial for postoperative quality control and is notably necessary for the (re-) achievement of a physiological condylar position, and the sensible expansion and shaping of the transplant. Computer-assisted planning may help to reconstruct mandibular defects in a patient-specific and precise manner. Herein, we present a newly-developed workflow for secondary mandibular reconstruction using FFF; it comprises digital planning and in-house manufacturing to perform precise secondary mandible reconstruction. This method utilizes a newly designed positioning device to ensure the precise positioning of the fibula segments in relation to each other and the mandibular stumps. The presented in-house-printed positioning device made it possible to achieve digital planning with high precision during surgery.

Background: Reliable assessment of cervical lymph node metastases remains a key challenge in the management of oral squamous cell carcinoma (OSCC). While elective ipsilateral neck dissection (ND) is widely accepted, the benefit of contralateral ND and the influence of tumor site on metastatic risk remain incompletely defined. This study aimed to evaluate patterns of lymphatic metastases, the diagnostic accuracy of preoperative staging, and the therapeutic relevance of ipsilateral and contralateral ND. Methods: A retrospective single-center cohort study was conducted including 287 patients with histologically confirmed OSCC treated between 2013 and 2019. Patterns of lymph node metastases were analyzed with respect to tumor localization and clinicopathological factors. Multivariate binary logistic regression was performed to identify predictors of cervical lymph node metastases. The diagnostic accuracy of preoperative staging was evaluated using histopathological findings as the reference standard. Results: Tumor localization and histopathological grading significantly influenced the occurrence of lymph node metastases. OSCC of the maxilla demonstrated a significantly lower observed rate of cervical and occult metastases compared with other tumor sites. Occult metastases were detected in 16.9% of primary tumor cases, with only two contralateral occult metastases observed. The calculated number needed to treat (NNT) was 6 for ipsilateral elective ND and 74 for contralateral elective ND. Preoperative staging showed limited diagnostic accuracy, with a negative predictive value of 0.83 and a positive predictive value of 0.65. Conclusions: Elective ipsilateral ND remains an essential component in the surgical management of OSCC due to the considerable rate of occult metastases and the limited reliability of preoperative staging. In contrast, the benefit of contralateral elective ND appears limited in patients without midline-crossing tumors. Maxillary OSCC and well-differentiated tumors demonstrated a significantly lower metastatic risk, supporting a more individualized risk-adapted approach to neck dissection in selected cases.