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OBJECTIVES
In the reconstruction of maxillary or mandibular continuity-defects of (dentate) patients, the most favourable treatment goal 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 vascularized 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/drilling guides were 3D printed and the bridge was CAD/CAM milled. During the first surgery, 2 implants were placed in the fibula according 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.

CONCLUSIONS
3D 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.