Objectives In the reconstruction of maxillary or mandibular continuity defects in dentate patients, the most favourable treatment is placement of implant-retained crowns or bridges in a bone graft that reconstructs the defect. Proper implant positioning is often impaired by suboptimal placement of the bone graft. This case describes a new technique of a full digitally planned, immediate restoration, two-step surgical approach for reconstruction of a mandibular defect using a free vascularised fibula graft with implants and a bridge. Procedure A 68-year-old male developed osteoradionecrosis of the mandible. The resection, cutting and implant placement in the fibula were virtually planned. Cutting and drilling guides were 3-D printed, and the bridge was computer aided design-computer aided manufacturing (CAD-CAM) milled. During the first surgery, two implants were placed in the fibula according to the digital planning, and the position of the implants was scanned using an intra-oral optical scanner. During the second surgery, a bridge was placed on the implants, and the fibula was harvested and fixed in the mandibular defect, guided by the occlusion of the bridge. Conclusion Three-dimensional planning allowed for positioning of a fibula bone graft by means of an implant-supported bridge, which resulted in a functional position of the graft and bridge.</p
