A functional outcome after head and neck cancer resection is aimed at restoring speech and swallow. Dental reconstruction greatly facilitates this, particularly by enabling the patient to chew food. The authors reinforce the need for careful presurgical planning with treatment dependent on the level of edentulousness and the type of defect. Whilst jaw reconstruction with bone harvest and free flaps are commonplace, a toothless jaw is becoming an increasingly unacceptable endpoint. The utility of ilium or fibula twinned with osseointegrated implants is discussed in detail as well as roles for biologic reconstructions. Interestingly, the advent of cone beam CT with virtual surgery simulators and computer guided implantation has the potential for excellent outcomes. The authors also acknowledge the difficulty in reconstructing intra-oral skin. Taken together, the variety of treatment options for functional reconstruction (and decisions about biological vs prosthodontics) means there is a need for careful planning with an MDT approach and this is reiterated towards the end of the article.