Functional mandibular reconstruction using digital planning-guided titanium scaffolds combined with vascularized fibula flaps.

Segmental mandibular reconstruction presents a significant clinical challenge that requires addressing structural defects while restoring proper masticatory function and facial esthetics. To optimize this procedure, a novel digital-biomechanical, scaffold-driven double-barrel fibula flap (DBFF) strategy was established and validated using patient-specific, 3D-printed porous titanium scaffolds. The study evaluated three distinct defect models (hemimandibular, central and lateral) through finite element simulations at various postoperative stages under biting forces, alongside a retrospective clinical analysis of 16 patients with a mean follow-up of 15.2 months. The results demonstrated successful progressive load transfer from the scaffold to the fibula, preserved temporomandibular joint biomechanics and marked intra-scaffold osteogenesis. Ultimately, this approach achieved accurate mandibular reconstruction, early dental rehabilitation and high patient satisfaction without mechanical failure or scaffold exposure, concluding that this digitally guided, scaffold-assisted DBFF strategy offers a safe, functional and highly promising solution for clinical application.