Purpose: To clinically and radiographically evaluate the performance of loaded dental implants placed in vertically distracted fibular grafts after mandibular reconstruction, and to evaluate patient satisfaction with implant function and esthetics after oral rehabilitation. Materials and Methods: This retrospective study involved patients who received implants in vertically distracted fibular bone after mandibular reconstruction between February 2006 and January 2008. Clinical assessments were performed 6 months after loading and annually thereafter. Patient satisfaction was evaluated with respect to function, phonetics, facial contour esthetics, and oral hygiene practices. The data were evaluated statistically. Results: Thirty-seven dental implants were inserted in 12 patients (mean age, 42.9 ± 8.0 years). Three patients were completely edentulous and nine were partially edentulous. The low mean plaque score ( 20%) indicated a good level of oral hygiene during the mean follow-up period of 42.1 ± 4.1 months. Probing depths and modified Sulcus Bleeding Index increased slightly at follow-up, but there was no significant difference in either parameter at years 1 and 3. After 1 year, the average marginal bone loss was 0.8 ± 0.3 mm (range, 0.2 to 2.1 mm); this increased to 0.9 ± 0.4 mm (range, 0.5 to 2.4 mm) in year 3, which was not a significant difference. The cumulative survival rate was 100% and the cumulative success rate was 84.8%. Seven of the 12 patients were fully satisfied with the function and esthetics of the restoration. Conclusions: On the basis of the present study, implant placement in vertically distracted fibulae for mandibular reconstruction may be considered a predictable option in terms of mid- to long-term implant survival and success rates.