Case report Fig. 1 Fig. 2 80 A 57-year-old patient developed an ulcerative mass in her left retromolar trigone (Fig. 1). The biopsy revealed moderately differentiated squamous cell carcinoma. A CT scan showed osseous erosion indicating invasion into the mandible. I decided to perform a segmental mandibulectomy, neck dissection and reconstruction with a microvascular fibula flap. The patient was concerned about the anticipated loss of her two molars, in addition to the second premolar previously removed; therefore, she was planned for immediate implants in the fibula with immediate loading of provisional teeth. A presurgical workup included a conebeam CT of the mandible and an optical scan of the upper and lower dentition. A CT scan of the fibulas was obtained for virtual surgical planning. The plan included a fibula graft positioned above the inferior border of the mandible, but with adequate restorative space for the prosthesis. Three implants were planned for these two molars because postoperative radiation was scheduled (Fig. 2). A prosthesis was created in Blue Sky Plan software (Fig. 3) and 3D printed using NextDent MFH resin (Fig. 4). An additional model was created of the mandible defect with an occlusal splint to position the prosthesis in proper occlusion (Fig. 5). The entire construct was pieced together to verify accurate fit of all components (Fig. 6). In the operating room, the specimen was removed using cutting guides on the mandible to make osteotomies in the planned positions. Frozen sections of soft tissue and marrow showed clear margins (Fig. 7). The left fibula was harvested with the peroneal artery and veins. Because of the oral soft-tissue defect, a skin paddle Fig. 3 Fig. 5 Fig. 4 Fig. 6 MARCH 2020 // dentaltown.com DT0320_WilliamsSurgery_MM.indd 80 2/18/20 11:12 AMhttp://www.dentaltown.com