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To optimize this procedure, a novel digital\u2013biomechanical, scaffold-driven double-barrel fibula flap (DBFF) strategy was established and validated using patient-specific, 3D-printed porous titanium scaffolds. The study evaluated three distinct defect models (hemimandibular, central and lateral) through finite element simulations at various postoperative stages under biting forces, alongside a retrospective clinical analysis of 16 patients with a mean follow-up of 15.2\u2009months. The results demonstrated successful progressive load transfer from the scaffold to the fibula, preserved temporomandibular joint biomechanics and marked intra-scaffold osteogenesis. Ultimately, this approach achieved accurate mandibular reconstruction, early dental rehabilitation and high patient satisfaction without mechanical failure or scaffold exposure, concluding that this digitally guided, scaffold-assisted DBFF strategy offers a safe, functional and highly promising solution for clinical application.<\/jats:p>","DOI":"10.1093\/rb\/rbag181","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:15:12Z","timestamp":1786965312000},"source":"Crossref","is-referenced-by-count":0,"title":["Functional mandibular reconstruction using digital planning-guided titanium scaffolds combined with vascularized fibula flaps"],"prefix":"10.1093","volume":"13","author":[{"given":"Huawei","family":"Liu","sequence":"first","affiliation":[{"name":"Medical School of Chinese PLA , Beijing 100853,","place":["China"]},{"name":"Department of Stomatology, The First Medical Center, Chinese PLA General Hospital , Beijing 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