was harvested with the f ibula. While still perfusing on the leg, the fibula was shaped to fit the defect and three implants were placed in a guided fashion. Straight multiunit abutments and temporary cylinders were placed on the implants. The prefabricated milled plate was fixated on the model with the fibula and prosthesis in place (Fig. 8). The temporary cylinders were picked up in the prosthesis with Luxatemp, and final shaping of the intaglio surface was performed to create a convex cleansable surface. Palaseal was painted on the prosthesis and cured. The fibula vessels were ligated, and the graft was transferred to the head and neck region. The fibula was inset into the mandibular defect using the milled plate and screws. The dental prosthesis was seated on the implants and hand tightened. The skin paddle was sutured to close the oral soft-tissue defect (Fig. 9). Revascularization of the flap was performed by anastomosing the peroneal vessels to the facial artery and common facial vein. Final occlusion was checked to verify the prosthesis was out of occlusion (Fig. 10). Conclusion Virtual surgical planning and pointof-care 3D printing can expedite treatment with predictable results. Immediate implants and provisionalization have previously been performed only for benign disease because of the extra time required to fabricate a prosthesis with traditional methods. Digital design and point-of-care 3D printing eliminates this delay and allows malignant disease to be restored with immediate teeth. However, case selection is critical, because not all patients will be candidates for this surgery. n Fig. 7 Fig. 9 Fig. 8 Fig. 10 dentaltown.com \\ MARCH 2020 DT0320_WilliamsSurgery_MM.indd 81 81 2/18/20 11:12 AMhttp://www.dentaltown.com