Background : Optimal functional and aesthetical mandibular reconstruction with free flaps remains a challenge. With the introduction of virtual treatment planning and CAD/CAM manufacturing in the last decade, a true revolution occurred towards planning of microvascular tissue transfer.

Methods : The purpose of this presentation is to give an overview of the current possibilities: (1) Imaging and virtual planning of resection and reconstruction; (2) presurgical bending of reconstruction plates based on CAD/CAM manufactured 3D models or templates of the mandible; (3) pre-bended reconstruction plates; (4) individual customized CAD/CAM manufactured reconstruction plates; (5) surgical osteotomy templates and guides; and (6) image-guided implant surgery.

Results : The different steps in clinical workflow are discussed: (1) image acquisition with or without markers; (2) image processing; (3) virtual planning of bony and soft tissue resection and reconstruction; and (4) transfer of the treatment plan towards the operation theatre. The different treatment possibilities are demonstrated by clinical cases.

Conclusion : virtual treatment planning and CAD/CAM manufacturing offer a major benefit in individual planning of mandibular reconstruction with free tissue transfer towards optimal patient function and aesthetics. Key words : virtual planning; 3D mandibular reconstruction; CAD/CAM manufacturing