Case Report: Advanced prosthodontic rehabilitation using implant-assisted partial denture guided by the neutral zone...

Rehabilitation of partially edentulous patients following fibular free-flap reconstruction presents significant functional and biomechanical challenges due to altered soft tissue morphology, reduced vestibular depth, and compromised load-bearing capacity. In cases involving extensive tissue loss, fixed prosthetic designs may be limited in their ability to support the tongue and cheeks, while implant-assisted removable partial dentures (IARPDs) offer better hygiene access and prosthetic flexibility. This case report describes a prosthetically driven approach that integrates CBCT-guided planning with advanced conventional prosthodontic techniques. After the fibula and overlying skin graft had sufficiently healed, a customized impression protocol was used to accommodate the irregular, highly resilient grafted soft tissues. Denture tooth placement was guided by the neutral zone concept to ensure functional harmony with the surrounding muscles. A radiographic splint with barium sulfate markers enabled prosthetically guided implant planning, resulting in the placement of three implants using a fully guided approach. A removable partial denture retained by stud attachments was selected, given the extent of tissue loss and the need for improved peri-implant hygiene. Intraoral activation of the attachments stabilized the distal extension during functional loading. Because the grafted tissues were mobile, a functional impression was performed to accurately capture the prosthetic-bearing area and facilitate relining, as conventional selective pressure techniques are insufficient in such conditions. The definitive prosthesis demonstrated improved retention, occlusal harmony, and functional stability, resulting in greater patient comfort and masticatory efficiency. This case highlights the potential value of prosthetically driven planning, functional impression techniques, and neutral zone-guided tooth placement in supporting functional rehabilitation and favorable clinical outcomes in reconstructed mandibles after oncologic resection.