Abstract
INTRODUCTION AND IMPORTANCE: The reconstruction of large anterior maxillary defects poses a significant challenge due to the complex three-dimensional anatomy and functional demands of the midface. While autogenous bone grafts are the gold standard, vascularized free flaps, particularly the fibula, offer superior outcomes for large defects. This case report highlights the application of computer-aided design and computer-aided manufacturing (CAD/CAM) technology to enhance the precision and predictability of such reconstructions. CASE PRESENTATION: A 22-year-old male presented with a substantial anterior maxillary defect following resection for ameloblastic carcinoma. The reconstruction was performed using a virtual surgical plan to guide the harvest and inset of a vascularized fibula osteocutaneous flap. Pre-bent patient-specific plates and 3D-printed surgical guides were utilized. The procedure was successful, with uneventful healing. Five months post-reconstruction, four dental implants were placed into the fibula graft using a guided surgical protocol, achieving good primary stability. Subsequent prosthetic rehabilitation resulted in the successful restoration of function and aesthetics. CLINICAL DISCUSSION: This case illustrates that a CAD/CAM-guided approach allows for the precise translation of a virtual plan to the operating room, ensuring optimal graft positioning and contour. The integration of a vascularized fibula flap provided a viable bony foundation for endosseous implants, enabling definitive prosthetic rehabilitation. The digital workflow streamlines the surgical process, reduces intraoperative unpredictability, and facilitates a prosthetic-driven treatment plan from the outset. CONCLUSIONS: CAD/CAM-guided vascularized fibula graft reconstruction is a highly effective method for managing complex maxillary defects. The technology enables accurate anatomical restoration and creates ideal conditions for dental implant placement, ultimately leading to successful functional and aesthetic rehabilitation. This approach underscores the critical importance of interdisciplinary collaboration and advanced digital planning in modern maxillofacial reconstruction.