Reconstruction of both maxillary and mandibular defects requires scientific knowledge and surgical skills in soft tissue procedures as well as bone grafting techniques. The classic mandibular continuity defect can be reconstructed today with excellent predictability using straightforward cancellous marrow with platelet rich plasma growth factor additions within crib containments of allogeneic bone, rigid reconstruction plates, or even titanium basket cribs. Each location has its own surgical approach and challenges. Reconstructing the hemimandibular defect with a missing condyle may require a costochondral graft, a titanium condylar replacement, or an allogeneic condyle in combination with cancellous marrow. Defects across the mid-line require cribs that duplicate the arch form and have unique fixation requirements. Trauma defects often require a preliminary “set-up” surgery to debride foreign bodies and sequestra as well as align the remaining bone segments. Thin severely resorbed mandibles can be reconstructed to bone heights of 15 mm with a tenting concept using dental implants along with cancellous marrow grafting techniques. Each of these examples illustrates a separate soft tissue management, bone regeneration concept and a functionality of the reconstruction to mature and maintain the bone graft. Maxillary reconstruction today may require only an obturator denture. However, in patients where the obturator denture leaks, does not seal, or lacks sufficient retention, biologic reconstruction becomes necessary. This often takes the form of a temporalis muscle flap to provide vascular soft tissue and to close any oral-antral or oral-nasal communication. Bone grafting via cortical cancellous blocks lag screwed into host maxillary bone and supplemented with additional cancellous marrow and platelet rich plasma reconstructs the alveolar processes of the maxilla with excellent outcomes. The early placement of dental implants and their immediate or early loading will mature and maintain the bone via functional loading. Maxillary contour grafting and orbital/nasal grafting is best accomplished with calvarial bone grafts, which have a similar contour to the maxilla and have a reduced remodeling volume loss due to their diploic vascular channels. References Carlson ER, Marx RE: Mandibular reconstruction with particulate bone and cancellous marrow grafts. Factors resulting in predictable reconstruction of the mandible, in Washington P, Evan J (eds): Controversies in Oral and Maxillofacial Surgery. Philadelphia, PA, Saunders, 1994, chap 24, pp 288–300 Marx RE, Schellenberger T, Wimsatt J, et al: Severely resorbed mandibles, predictable reconstruction with soft tissue matrix expansion (tent pole) grafts. J Oral Maxillofac Surg 60: 2002. Marx RE, Schiff WJ, Saunders TM: Reconstruction and rehabilitation of cancer patients, in Fonseca RA, Davis HW (eds): Reconstructive Pre-Prosthetic Oral and Maxillofacial Surgery. Philadelphia, PA, Saunders, 1995, chap 31, pp 1057–1133