Evolution of Dental Rehabilitation in Free Fibula Flap for Segmental Jaw Defects

The free fibula flap has transformed mandibular reconstruction, evolving from simply for bone defect reconstruction to including immediate dental rehabilitation and from a staged to a simultaneous procedure. This paper chronicles the progression from delayed implant placement to the modern-day single-stage "jaw in a day" (JIAD) procedure, enabled by advances in CAD/CAM (computer aided design/computer aided manufacturing) technology, virtual surgical planning, and digital prosthesis. Pioneering work contributing to fibula-jaw reconstruction and rehabilitation from Chang Gung Memorial Hospital is also highlighted. The anatomical study of the fibula osteoseptocutaneous flap makes its clinical application also possible when simultaneous skin/mucosal coverage is needed. The early and vast experience of secondary and primary dental implantation has allowed us to develop and advocate for the "jaw during admission" after several initial attempts at JIAD reconstruction. In this approach, the dental prosthesis is delayed to the day before discharge from the hospital after confirming the success of the transferred fibula. It not only avoids an unnecessary step in complicated fibula flap transfer procedures, but in case of failure, it also mitigates logistical and technical challenges of prosthesis conversion, while maintaining the benefits of immediate dental implant restoration. This review also examines current evidence surrounding implant success, complications like osteoradionecrosis, and outcomes in malignant versus benign cases.