Background: Head and neck reconstruction following ablative surgery results in alterations to maxillofacial anatomy and function. These postoperative changes complicate dental rehabilitation. Methods: An innovative modular, stackable guide system for immediate dental rehabilitation during mandibular reconstruction is presented. The virtual surgical planning was performed in Materialise Innovation Suite v26 and Blender 3.6 with the Blenderfordental add-on. The surgical guides and models were designed and manufactured at the point of care. Results: The duration of the surgery was 9 h and 35 min. Good implant stability (>35 Ncm) and a stable occlusion were achieved. After 9 months of follow-up, the occlusion remained stable, and a mouth opening of 25 mm was registered. The dental implants showed no signs of peri-implant bone loss. Superposition of the preoperative planning and postoperative position of the fibula parts resulted in an average difference of 0.70 mm (range: −1.9 mm; 5.4 mm). Conclusions: The in-house developed stackable guide system resulted in a predictive workflow and accurate results. The preoperative virtual surgical planning was time-consuming and required extensive CAD/CAM and surgical expertise. The addition of fully guided implant placement to this stackable guide system would be beneficial. More research with longer follow-ups is necessary to validate these results.

Background: Mandibular reconstruction poses challenges in achieving functional and aesthetic outcomes. Effective oral rehabilitation is crucial for restoring function and improving quality of life; however, the altered neomandibular anatomy complicates oral hygiene, increasing the risk of peri-implant complications and making successful rehabilitation more difficult. This study introduces a novel approach combining vestibuloplasty with patient-specific implant-retained splints to enhance oral health and improve rehabilitation outcomes. Methods: Three patients underwent mandibular reconstruction with a free vascularized fibula flap (FFF). After 6 months of osseointegration, vestibuloplasty and soft tissue refinement were performed, with a split-thickness skin graft placed on the FFF periosteum. An implant-retained splint was secured to the abutments for two weeks to support soft tissue healing. Implant survival, bone loss, and peri-implant health were evaluated over a 2-year follow-up. Results: A total of 12 implants were placed, primarily in the neomandible (83.3%), with a 100% survival rate. Implant survival was assessed. Implant survival was assessed based on established criteria for clinical success, including stability, presence of pain, bleeding on probing (BOP), pocketdepth, bone loss and lack of peri-implant radiolucency. Functional outcomes included normal mouth opening, laterotrusion, and protrusion. Pocket depths ranged from 3 to 4 mm, except for one implant in cases 1 and 2. The mean BOP was 51.7%. Conclusions: This case series introduces a surgical technique that combines CAD/CAM and vestibuloplasty to optimize dental rehabilitation in mandibular FFF reconstructions, demonstrating safe thinning of soft tissues for improved oral hygiene and survival.

By using virtual surgical planning (VSP) and 3D printed guides, complex maxillofacial defects can be reconstructed with high accuracy and predictability. A fully digital workflow resulting in a modular all-in-one 3D printed guide system for fibula osteotomies, bone segment positioning, fully guided dental implant placement and dental prosthesis fixation for mandibular reconstruction was developed at Ghent University Hospital. A follicular ameloblastoma of the left mandible was resected in a 28-year-old male. The defect was reconstructed with a two-segment fibular free flap with immediate placement of three dental implants and immediate implant loading with a screw-retained bridge. A split thickness skin graft and Elemental PerioPlast were used as wound dressing. Comparison of the preoperative planning with the postoperative CT-scan showed a deviation immediately after surgery, which was no longer present at the 6-month follow-up. The patient achieved a stable occlusion and 44 mm mouth opening and reported high satisfaction. This case illustrates that fully digital, immediate mandibular reconstruction with simultaneous implant placement and prosthetic rehabilitation is feasible and accurate and enhances early functional recovery. Future improvements in intraoperative validation may further refine accuracy and reproducibility in complex oncologic reconstructions.

Background: Severe maxillary atrophy often precludes placement of conventional dental implants and frequently requires invasive bone augmentation procedures. This prospective pilot study evaluated a treatment concept using immediately loaded 5.2-mm ultra-short implants connected by a patient-specific CAD/CAM inter-implant bar system (VD CLIC BAR^®) to support maxillary overdentures. Methods: Thirteen completely edentulous patients with severe maxillary atrophy (Cawood–Howell Class V or VI) were treated with six to eight immediately loaded 5.2-mm ultra-short implants connected by a patient-specific CAD/CAM inter-implant bar (VD CLIC BAR^®) supporting a maxillary overdenture. The primary outcome was implant survival. Secondary outcomes included oral health-related quality of life (OHIP-14), self-reported chewing ability (VAS), implant stability (Periotest), and prosthetic rehabilitation. Results: A total of 96 initial implants and 8 additional implants were placed following early implant failures. The primary implant survival rate after two years was 83.3%. Implant failures occurred predominantly during early healing and were unevenly distributed across the cohort. Early failures were managed by placement of additional ultra-short implants, enabling definitive implant-supported rehabilitation in all patients. Periotest values demonstrated a significant increase in implant stability over time (p < 0.001). Median OHIP-14 scores improved from 32.0 (IQR 20.0–44.0) at baseline to 4.0 (IQR 1.0–20.0) at two years (p = 0.006). Median chewing ability at two years was 82.7 (IQR 50.1–91.9). Conclusions: This prospective pilot study demonstrates the feasibility of an immediately loaded treatment concept using 5.2-mm ultra-short implants splinted with a patient-specific CAD/CAM inter-implant bar (VD CLIC BAR^®) to support maxillary overdentures in patients with severe maxillary atrophy. Although early implant failures occurred and required placement of additional ultra-short implants in some patients, all patients ultimately achieved functional implant-supported rehabilitation. These preliminary findings require confirmation in larger controlled studies with longer follow-up.