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Functional and aesthetic mandibular reconstruction can be achieved in a single operation by means of a double-barreled fibula osteoseptocutaneous free flap with dental implants loaded simultaneously into the upper barrel. The aim of this study was to evaluate the quality and result of such reconstruction.From 2005 to 2007, 10 patients underwent segmental mandibular defect reconstructions with double-barreled fibula osteoseptocutaneous flaps and simultaneous dental implantations. Implant marginal bone loss, clinical mucosal changes, marginal plaque indices, bleeding on probing, and pocket probe depth were evaluated at an average of 22.2 months after implant functional loading.Ten patients with a total of 25 osseointegrated implants were evaluated. The mean implant marginal bone loss was 0.18 ± 0.18 mm (range, 0 to 0.6 mm) at the mesial surfaces and 0.25 ± 0.2 mm (range, 0 to 0.6 mm) at the distal surfaces. Probing pocket depth was shallower for implants protected by palatal mucosal grafts (2.56 ± 0.54 mm) than by skin flaps (3.50 ± 0.90 mm) (p < 0.05). There was a significant difference in marginal bone loss between palatal mucosal grafts (0.11 ± 0.09 mm) and skin flaps (0.29 ± 0.23 mm) (p < 0.05). Bleeding on probing was more prominent when pocket depth exceeded 5 mm and occurred more frequently in skin flap–protected than in keratinized mucosa graft–protected implants.The one-stage combined surgical method is safe and reliable. Both oral function and mandible contour were good. Firmly attached gingiva-like palatal mucosal grafts prevent periimplant soft-tissue inflammation and facilitate maintenance of oral hygiene.Therapeutic, V.