Microvascular surgical techniques are able to provide a sound foundation that will create a morphology that provides the prosthodontist the opportunity to restore the patient with a partially or totally resected mandible with an implant anchored prosthesis that is nearly as functional as the natural dentition. The utilization of improved technologies makes this treatment much more predictable for the surgeon and the prosthodontist. 3D model imaging prior to surgery and grafting have been a tremendous value. Prosthetically a problem with the thick skin paddles from the fibula or scapula graft is obtaining adequate tissue healing with the available standard height healing caps or utilizing the option of a two stage surgical approach. The use of CAD scanning to fabricate healing caps up to 18 mm height has proven to be a significant advantage when utilized through the myo-cutaneous grafts from the fibula or scapula. Additionally due to the size of many of the defects the prosthesis must be large to replace much of the lost hard and /or soft tissues. The milled CAD/CAM or titanium laser welded components and resulting restoration are superior in many ways to the pervious traditional techniques and offer the patient an excellent outcome and predictable restoration.

Several mandibular reconstruction patients will be presented demonstrating the advantages of custom healing abutments, CAD/CAM fabricated titanium frameworks and titanium laser welding techniques utilizing titanium components.

Conflict of interest: I periodically lecture for Straumann.