Mandibular reconstruction with single barrel vascular free fibula flap and implants-borne fixed prosthesis: usage of a modified healing abutment

Recent developments in computer-aided surgical planning and manufacturing provide a promising solution to large-scale maxillofacial reconstruction. However, proper dental prosthetic rehabilitation based on osseointegrated implants in cases with single barrel fibula flap is still a challenge. We report one patient with recurrent mandibular ameloblastoma underwent large-scale mandible resection and reconstruction with single vascular free fibula flap. By using computer-aided surgical planning, 6 implants were precisely placed on the fibula graft with limited bone quantity. To address soft tissue hypertrophy and recurrent mucositis, we fabricated a computer-aided design and computer-aided manufactured (CAD/CAM) screw-retained tooth-like healing abutments, which efficiently helped the transepithelial tissue formation of the implants. Finally, the patient was restored using a screw-retained fixed prosthesis with CAD/CAM titanium frame. A 24-month follow-up showed that all implants were in normal function with no obvious peri-implantitis or prosthesis failure. Although further investigation on this technique might be needed, this report illustrated the successful treatment strategy of a computer-aided mandibular reconstruction with single barrel vascular free fibula flap and implants-borne fixed prosthesis.