Implant-supported rehabilitation following maxillary or mandibular reconstruction with vascularized osseous free flaps is frequently compromised by inadequate peri‑implant soft tissues, vestibular obliteration, and scar contracture. This study describes a fully digital workflow for peri‑implant soft tissue management based on a patient-specific CAD/CAM vestibuloplasty stent (PSVS) and reports its preliminary clinical use.

Five consecutive patients who had previously undergone jaw reconstruction with vascularized osseous free flaps underwent subperiosteal vestibuloplasty followed by placement of the 3D-printed PSVS. The device was fixed to the reconstructed bone to guide soft-tissue maturation and stabilize a free gingival graft. Vestibular depth was measured at baseline, 2 months, and 6 months postoperatively.

Vestibular reconstruction was successful in all patients. Mean vestibular depth decreased from 10.6 ± 3.1 mm at baseline to 9.0 ± 3.9 mm after 6 months (mean reduction: 1.5 ± 1.1 mm). All free gingival grafts survived, resulting in a measurable band of keratinized mucosa, while implant-supported cases showed favourable peri‑implant clinical parameters. No implant loss, flap compromise, osteonecrosis, or major complications occurred.

This pilot case series suggests that a patient-specific CAD/CAM vestibuloplasty stent is a feasible approach for vestibular reconstruction and peri‑implant soft tissue augmentation following jaw reconstruction with vascularized osseous free flaps. Larger prospective comparative studies are required to confirm its long-term clinical value.