Mandibular reconstruction accuracy has been dramatically improved by VSP in the last years, both in terms of anatomical and functional outcomes. While several osseous flaps have been tested over the years, the fibula free flap still remains the mainstay of mandibular reconstruction for its versatility and biological properties. This chapter presents a systematic analysis of VSP techniques for the mandibular reconstruction using the fibula free flap in which vascular considerations have a key role in defining the appropriate side for harvesting in a variety of scenarios. Moreover, design properties of guides used for fibula harvesting and shaping are discussed and classified. The improvement of metal 3D printing in the surgical field has provided patient-specific prostheses which can be used to replace flap reconstruction or can be combined with flaps as well. Most importantly, the combination of advanced virtual surgical planning techniques with digital dentistry enabled unprecedented control over the occlusal requirements of bone reconstruction, allowing simultaneous implant placement and denture fixation in the fibula flap before it is even transferred to its recipient site.