## 2 Case Descriptions
### Case 2  
An 84-year-old patient was referred due to persistent purulent drainage located in the lower right quadrant of the oral cavity. The patient also complained of ipsilateral inferior lip paresthesia. There was a documented history of osteoporosis and hypertension, and the patient had previously been medicated with weekly alendronic acid taken orally for 15 years, interrupted 16 months before referral. Dental extractions from the lower right quadrant had been carried out by a general dental practitioner 12 months before the referral due to dental caries, with no history of previous infection. There was no history of head and neck radiotherapy or oncological disease. Intraorally, a fistula that probed to bone was observed in the lower right quadrant, with associated purulent discharge but without obvious bone exposure (Figure 2a). OPG and CT scans showed an osteolytic lesion in the lower right quadrant affecting the alveolar and basal bone (Figure 2b,c). The patient intervention followed the same protocol described for the first case, with the pre-treatment phase (VSP and CAD/CAM production one month post-referral), the surgical intervention phase (one month after the pre-treatment), and the follow-up phase (one year post-surgery). The CAD/CAM guidelines regarding the cross-sectional material dimensions for the design and manufacture of the customized reconstruction plate were: a titanium \"C\" shaped plate design with a length of 76 mm, height of 8 mm, and thickness of 2.5 mm (Figure 2d). Figure 2: Case 2: **(a)** Preoperative intraoral view: a fistula that probed to bone was observed in the lower right quadrant, with associated purulent discharge. **(b)** Pre-operative OPG, showing a lytic lesion in the right mandibular body. **(c)** Pre-operative CT scan (coronal view), showing the inferior extension of the lytic lesion, involving the alveolar canal. **(d)** Stereolithographic model of the mandible and CAD/CAM reconstruction plate 76 mm in length, 8 mm in height, and 2.5 mm thick. **(e)** VSP for the marginal excision of necrotic bone, with a CAD/CAM cutting guide and fixation with a customized reconstruction plate. We calculated 6 mm of reminiscent bone after resection surgery. **(f)** Intraoperative view during the transbuccal fixation of the two-part cutting guide. **(g)** Intraoperative view after intraoral-transbuccal plate fixation. **(h)** Intraoral view at one year post-surgery, without bone exposure, fistulae, or purulent drainage. **(i)** OPG at one year post-surgery, showing ideal plate adaptation and signs of bone remodeling in the operated area. **(j)** Postoperative Computerized Tomography scan at one year post-surgery, showing the adaptation of the plate and the absence of fracture. After pre-operative VSP (Figure 2e) with the KLS Martin Individual Patient Solutions software (KLS Martin IPS Service S.L., San Sebastian, Spain) the patient was submitted for the CAD/CAM surgical guide-aided excision of necrotic bone with a piezoelectric handpiece (NSK VarioSurg3(r), NSK Ltd., Tokyo, Japan), fixation with a customized reconstruction plate (KLS Martin GmbH + Co. KG, Freiburg, Germany), and the interposition of a pedicled buccal fat pad flap over the osseeous defect. Once again, surgery was carried out under general anesthesia and through a combined intraoral-transbuccal approach. Antibiotic prophylaxis with amoxicillin/clavulanic acid 875 mg/125 mg, taken orally every 8 h, was initiated 3 days before surgery and suspended 7 days after surgery. Unlike in Case 1, a thinner, two-component cutting guide was used, which facilitated its intraoral insertion, handling, and fixation (Figure 2f,g). Surgery was well-tolerated and no complications were reported, allowing for an early hospital discharge the following morning. The patient remained asymptomatic and no signs of bone exposure, fistulae, or purulent discharge were observed up to the final follow-up of the present report at one year post-surgery (Figure 2h).