Preservation of the preexisting occlusal plane and vertical dimension in subtotal maxillectomy reconstruction using Jaw-in-a-Day protocol

Maxillary reconstruction following oncologic resection requires the reestablishment of functional occlusion in the absence of conventional dentoalveolar reference landmarks. Although virtual surgical planning has improved precision in fibula free flap reconstruction, the maintenance of the planned occlusal relationship during maxillary Jaw-in-a-Day procedures remains technique-sensitive. This clinical report describes a digitally guided, prosthesis-centered workflow for immediate implant-supported rehabilitation after subtotal maxillectomy. A 69-year-old woman with a history of adenoid cystic carcinoma, radiation therapy, and failing implant-supported prostheses underwent bilateral infrastructure maxillectomy with osteocutaneous fibula free flap reconstruction using a Jaw-in-a-Day approach. Virtual surgical planning was used to orient the reconstructed maxilla and simulate the patient's occlusal plane relative to stable craniofacial reference structures. Implant placement followed a prosthetically driven restorative plan to optimize occlusal stability and biomechanical support. An interim prosthesis was delivered before definitive fixation to establish the occlusal scheme, verify vertical dimension, and guide graft positioning. At 24 months, stable occlusion and functional rehabilitation were sustained, suggesting that craniofacial landmark-guided occlusal plane establishment offers a reproducible and predictable framework for immediate implant-supported maxillary reconstruction when conventional occlusal references are absent.