Redesigning Computer-aided Design and Manufacturing Guides for Mandibular Reconstruction: Dental Reference Cap and Synchronized Screw-Hole Guides.

Computer-aided design/manufacturing with a free fibula flap has improved mandibular reconstruction, yet the adoption of patient-specific mandibular plates remains limited by cost and regulatory barriers. Premade mini-plates (MPs) are inexpensive and widely available but lack contouring capacity, making positional accuracy essential. We developed an innovative computer-aided design/manufacturing guide system incorporating a dental reference cap and synchronized screw-hole guides to bridge the gap between virtual planning and surgical execution. The dental reference cap anchors the guides to residual teeth, enhancing stability without requiring extensive bone contact and reducing tumor spillage risk. Synchronized screw holes repurpose temporary fixation points as reference sites for positioning guides on both the mandible and fibula. This enables the fibular segments to be assembled into a single reconstruction block before transfer, minimizing drilling, preserving periosteal vascularity, and achieving precise alignment with the mandibular defect. A 42-year-old man with right lower alveolar squamous cell carcinoma underwent mandibular reconstruction using this system. Postoperatively, he tolerated a full diet with stable occlusion, and functional outcomes remained favorable at 15 months. Quantitative analysis demonstrated a mean deviation of 1.94 mm, a root mean square of 3.27 mm, and 73.9% of vertices within ±2 mm. Key mandibular landmarks were reproduced with submillimeter accuracy. By integrating a dental reference cap and synchronized screw-hole guides, this system achieves accuracy comparable to patient-specific mandibular plates while retaining the cost-effectiveness and accessibility of MPs, offering a practical and reproducible solution for mandibular reconstruction.