Occlusion-guided versus conventional computer-assisted fibula flap for mandibular reconstruction

Objective The fibula flap has gained popularity in jaw reconstruction in recent years. The restoration of masticatory function after jaw reconstruction is the ultimate goal of repair and reconstruction. Therefore, how to restore the occlusal function of patients to the greatest extent is an urgent problem to be solved clinically. Methods This retrospective study included 50 patients (2018–2023) who underwent computer-assisted fibula flap reconstruction for jaw tumors. Inclusion criteria were fibula flap reconstruction, postoperative CT within 1 week, and normal preoperative occlusion. Patients were divided into experimental and control groups. 3D CT and CT angiography data were used to design guides. The experimental group underwent virtual occlusal reconstruction. Postoperative CT scans were analyzed, and implants were placed according to the preoperative plan (experimental) or existing contour (control). Occlusal efficiency was evaluated, and statistical analysis was performed using SPSS 25 ( P < 0.05). Results The experimental and control groups showed no significant differences in baseline characteristics or operative time. The experimental group had a higher implant rate (88.00% vs. 72.00%, P = 0.036) and masticatory efficiency (92.6% vs. 74.50%, P = 0.024). Morphometric analysis revealed significantly smaller intercondylar distance, intermandibular angle, ramus length, and body length in the experimental group (all P < 0.05). Additionally, 88.00% of patients in the experimental group achieved complete occlusal reconstruction, compared to 72.00% in the control group ( P < 0.05). Conclusion Our data show that the concept of occlusion-reconstruction-oriented jaw repair has good positional stability of the reconstructed jaw after surgery and a good effect of occlusal reconstruction for patients after surgery. Trial registration QYFYWZJJ26812.