Fig. 1: Preop Panorex shows tumor of the anterior mandible. BLE Starting with preop The preoperative workup consisted of obtaining a CBCT of the head and a CT scan of the patient's fibula to use in the virtual planning. Implant positioning was included in the virtual plan to establish ideal position and angulation (Fig. 2). The final virtual construct included the fibula, implants, and a milled titanium plate with screw holes placed in customized locations and angulations (Fig. 3). A cutting guide was generated to make cuts in the mandible at predetermined locations. An additional cutting guide for the fibula served as an implant drill guide, as well as a template to shape the fibula and form the new mandible (Fig. 4). A milled titanium plate was created to allow the bone segments to be affi xed to the residual mandible. The fi nal 3-D construct was printed with planned implant positioning to allow preoperative fabrication of a hybrid dental prosthesis (Fig. 5). Fig. 2: Virtual plan showing three fibula segments and six implants angled to emerge through the occlusal surface of the preoperative dentition. Fig. 3: The final virtual construct with fibula, implants and custom-milled titanium plate. The surgical process Surgery began with removing the affected portion of the mandible using the cutting guides to perform osteotomies in predetermined locations. For an ameloblastoma, a minimum of 1 centimeter of bone beyond the radiographic margin is removed to ensure complete tumor eradication. Fig. 4: The fibula cutting guide with slots to cut the fibula into three segments. Six guide holes are for implants and an additional six guide holes are for placement of fixation screws. Fig. 5: Printed model of neomandible with implants and custom-milled titanium plate. dentaltown.com \\ OCTOBER 2016 71http://www.dentaltown.com