CAD-CAM (computer aided design and computer aided manufacturing) is an exciting field in the functional and accurate reconstruction of oral cavity defects. This is a prospective study from Italy based on data from 20 consecutive mandibular reconstructions from 2011 to 2015. An additional 20 patients that had the conventional ‘freehand ‘reconstruction were used as controls. The mean reconstruction time for the freehand reconstructions was 63.8 (range 45-79) minutes and 30.7 (range 21-41) minutes for the CAD-CAM cases. Interestingly no microvascular complications occurred in the CAD-CAM cases and in the freehand a complete loss of the flap and one loss of the paddle was noted. Finally the authors cost the CAD-CAM was estimated as €3,500. The cost of the regular mandibular reconstruction plate for the free hand group was €500. The money saved from the time gained and theatre cost (estimated as €30 per minute) was €3,450. Thus it was cost neutral. In addition to having better outcomes there were fewer complications and shorter hospital stay. This is a poignant study in difficult economic times and demonstrates that the appropriate use of technology and investment will lead to better outcomes and is cost effective in the longer term.