Background: High-quality mandibular reconstruction using vascularized free fibular graft is necessary to provide an osseointegrated dental implant and fixed denture. An appropriate crown–implant ratio is needed, and a good match between bones is extremely important. There are no articles describing the analysis and evaluation of both the fibula and mandible in the same patients. Methods: Computed tomography images of both mandible and fibula of 80 patients were selected in a random manner. We measured bone height of the fibula and mandible at specified points and evaluated the difference of bone height between the fibula and mandible using fibular single or double-barrel grafts. Results: The percentage of patients who had a “good” result for a fibular single graft was only 13.8%. There was no significant difference in bone heights when analyzed by gender. Whether patients were dentulous or not had a large influence on the difference between fibular and mandibular bone heights. Most young patients, but only half of older patients, needed fibular double-barrel grafts. Overweight patients with a high body mass index more often needed fibular double-barrel grafts. Conclusions: For mandibular reconstruction using a fibular graft, preoperative analysis of the patient’s profile and proper use of a fibular single or double-barrel graft contribute to minimizing the difference between the height of the grafted fibula and native mandible and are keys to an ideal reconstruction with good cosmetics and function.
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