Secondary Reconstruction of Complex Fracture of a Severely Atrophic Mandible with CAD-CAM Plate and Implant Rehabilitation: Case Report and Review of the Literature

Background/Objectives: Fractures of the atrophic mandible still nowadays present significant challenges due to reduced bone volume, poor blood supply, and the absence of teeth as anatomical guides. This case report discusses the use of CAD-CAM (Computer-Aided Design and Manufacturing) technology for the secondary reconstruction of a severely atrophic mandible following the failure of a previous surgical procedure with load-sharing intent. Methods: A 75-year-old female patient with a bifocal mandible fracture after a car accident underwent initial open reduction and internal fixation (ORIF) with miniplates. However, the patient experienced non-union and displacement of the mandibular fragments, necessitating a secondary reconstructive approach. A personalized, patient-specific titanium plate was designed using Virtual Surgical Planning (VSP) and 3D printing, considering the patient’s specific anatomy and the need for rigid fixation. Results: The reconstructive surgery resulted in the restoration of mandibular function, including labial competence and improved kinetics, without complications such as nerve injury or malunion. Implant rehabilitation was completed with the positioning of 2 5-mm implants in the symphyseal segment and an overdenture. Psychological symptoms, including anxiety and PTSD, were also addressed and solved through psychotherapeutic intervention. Postoperative radiologic evaluations and volumetric analysis confirmed optimal positioning and fixation of the plate. Conclusions: This case highlights the effectiveness of CAD-CAM technology in complex mandibular reconstructions, offering improved precision, stability, and patient-specific solutions for challenging fractures in edentulous and atrophic mandibles. The integration of CAD-CAM and VSP represents a promising advancement in maxillofacial surgery, providing significant benefits for both functional and aesthetic recovery.