BackgroundModern techniques for mandibular reconstruction, such as CAD–CAM, offer new solutions for planning of reconstructive surgery in relation to the aesthetic outcome and the prosthetic rehabilitation. MethodsCAD–CAM reconstruction procedures using vascularised bone free-flap transfers and surgical guides to cut the mandible and fibula were performed in 18 cases of neoplasms. The planned surgery was used to design and manufacture customised surgical devices. ResultsThe mean follow-up was 12 months. All patients, except one, are alive without disease at the time of writing. Reconstructive microvascular flap survival was 100%. No major or minor microvascular complication occurred. No donor site complication was observed. ConclusionsCAD–CAM technology is a very useful way to obtain the native morphology of the mandible, especially when both bi-dimensional and tri-dimensional defects occur. The reconstruction protocol presented offers several benefits and few disadvantages, which are discussed in the article.