Background/Objectives: Oral cancer resection often leads to maxillofacial defects and dentition loss, compromising patients’ quality of life. Implant-supported prosthetic rehabilitation offers a reliable solution to restore function, though factors such as bone reconstruction, radiotherapy, and timing of implant placement (immediate vs. delayed) may influence outcomes. This study aimed to evaluate long-term implant survival and rehabilitation timelines in oncologic patients, comparing two cohorts (2005–2014 and 2015–2024) to assess the impact of evolving clinical practices. Methods: A retrospective cohort study was conducted at Hospital General Universitario Gregorio Marañón (Madrid, Spain), including 304 patients who underwent ablative oral cancer surgery and subsequent implant-based rehabilitation between 2005 and 2024. Data on demographics, oncologic treatment, reconstruction, implant timing, and prosthetic rehabilitation were collected. Outcomes were compared using Kaplan–Meier analysis and appropriate statistical tests between the 2005–2014 (n = 122) and 2015–2024 (n = 182) cohorts. Results: A total of 2341 Ticare Implants^® were placed, supporting 281 prostheses. Implant placement during primary surgery increased from 41% to 71% (p < 0.001). The median time from surgery to prosthesis significantly decreased from 24 to 15 months (p < 0.001). Five-year implant survival was 95% in the early cohort versus 97% in the later cohort. Implant survival was comparable between irradiated and non-irradiated patients (~94–96%). Fixed prostheses became more frequent (92% vs. 79%, p = 0.002). Conclusions: Implant-supported rehabilitation in oncologic patients is highly feasible and durable, with improved timelines and functional outcomes associated with early implant placement and modern digital planning strategies.

Background: Computer-aided design and manufacturing (CAD/CAM) technology has been increasingly adopted for mandibular and maxillary reconstruction using fibula free flaps. However, its clinical and economic advantages over the conventional freehand technique remain debated. The objective of this study was to compare perioperative outcomes and institutional costs between CAD/CAM-guided and conventional freehand fibula flap reconstructions. Methods: An ambispective observational study was conducted including patients who underwent mandibular or maxillary reconstruction with an osteocutaneous free fibula flap between 2017 and 2024. Reconstructions were performed either using CAD/CAM-guided virtual surgical planning or the conventional freehand technique. Demographic data, perioperative variables, postoperative outcomes, oncologic margin status, transfusion requirements, and total institutional costs were analyzed. Univariate comparisons were performed between groups, and multivariate linear regression models were used to assess the independent association of CAD/CAM guidance with operative time and hospital length of stay. Results: Fifty-one patients were included (25 CAD/CAM-guided and 26 freehand). CAD/CAM-guided reconstruction was associated with a significantly shorter operative time (542.3 ± 65.8 vs. 604.9 ± 79.5 min; p = 0.0036) and a shorter overall hospital stay (19.6 ± 7.2 vs. 30.6 ± 26.2 days; p = 0.047) in univariate analysis. The need for perioperative blood transfusion was significantly lower in the CAD/CAM group. No significant differences were observed in ICU stay, flap failure, reintervention rate, or postoperative hemoglobin decrease. Although margin status did not differ significantly between groups, a higher proportion of negative margins was observed in the CAD/CAM cohort. In multivariate analysis adjusting for age and perioperative variables, CAD/CAM guidance remained independently associated with reduced operative time, but not with hospital length of stay. Despite higher upfront planning costs, total per-patient cost was lower in the CAD/CAM group due to improved perioperative efficiency. Conclusions: CAD/CAM-guided fibula free flap reconstruction is a safe and effective technique that is associated with reduced operative time and lower transfusion requirements while maintaining comparable oncologic outcomes. When perioperative efficiency gains are achieved, these advantages may offset the higher planning costs, resulting in overall cost savings at the institutional level. CAD/CAM-assisted reconstruction may therefore be particularly advantageous in high-volume oncologic centers and anatomically complex cases.