Purpose: Oral rehabilitation for patients with extensive mandibular defects can be achieved using a vascularized bone flap (VBF) followed by implant placement. This study aimed to evaluate the survival and success rates of implants placed in reconstructed mandibles using VBF and to identify prognostic factors. Materials and Methods: This retrospective study examined patients who underwent reconstruction surgery using VBF followed by implant placement at the Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital, between January 2007 and December 2019. The collected data included age, sex, reconstruction method, number of failed and failing implants, and marginal bone loss. Results: A total of 21 patients with 100 implants were included. The reconstruction methods used were iliac bone flap (n = 5) and fibula flap (n = 16). Ten implants showed abnormal bone resorption, and seven failed. The 5- and 10-year implant survival rates were 95.0% and 91.5%, respectively, and the success rates were 82.8% and 79.5%, respectively. Conclusion: Implant placement after mandibular reconstruction with a VBF is useful and reliable for restoring masticatory function and improving the quality of life and socioemotional problems. Complications such as bone exposure and a...