Navigating challenges in prosthodontic rehabilitation after long-term delay following fibula free flap reconstruction with a unique overlay removable prosthesis and large vertical dimension increase.

This case report highlights the experience of one maxillofacial surgical patient who delayed prosthodontic treatment for 7 years as they saved to self-fund access to a subsidized prosthodontic service. Without the benefit of a restored opposing dentition for a prolonged period of time, maxillary occlusal plane disruption occurred as a downstream clinical consequence. To manage the complexities arising from delayed presentation, the prosthodontic team developed a highly tailored treatment plan to meet the patient's unique clinical needs, which included fabrication of customized healing abutments, an implant indexing device, and a definitive removable implant-tooth-supported occlusal overlay prosthesis, which incorporated an atypical increase in the vertical dimension of occlusion (VDO) of 12 mm. Following 68 months of follow-up, the patient tolerated the increase in VDO well. Two minor technical complications occurred (denture tooth debond events) and one minor biological complication (localized peri-implant mucositis) within the follow-up period. This report underscores the role of timely prosthodontic involvement in interdisciplinary maxillofacial treatment pathways and advocates for the prioritization of equitable access to specialist prosthodontic services to mitigate preventable challenges in this vulnerable patient cohort.