Mandibular reconstruction in oncologic surgery using free bone flaps allows restoration of facial symmetry, preservation of key orofacial functions, and facilitation of adjuvant treatments. Despite these advances, dental rehabilitation remains challenging. Implant-supported prostheses seem to improve functional outcomes compared with conventional removable prostheses; however, there is still no consensus regarding optimal implantation strategies.

This technical note proposes a structured, implant-oriented decision-making framework for mandibular reconstruction using free fibula flaps. It integrates key components, including three-dimensional bone positioning, soft tissue management, and guided implant placement within a prosthetically driven planning approach. The framework aims to standardize the integration of implant planning into the reconstructive workflow, from virtual planning to surgical execution.

By providing a pragmatic and reproducible strategy, this work contributes to improving the predictability of prosthetic rehabilitation while maintaining oncologic safety standards.