Ordering a Surgical Guide: What to Send for a Guided Implant Case

Guided surgery moves the hard thinking to before the appointment. When the plan is restoratively driven, the implant lands where the crown or prosthesis needs it, and the restorative side of the case gets simpler. Here's how to choose the guide and what ADL needs from you.

Which type of surgical guide does the case need?

guideWORX makes three kinds of guides. The right one depends on what's left in the mouth for the guide to sit on.

Tooth-supported guides

For single sites and short spans with stable teeth on either side. The guide seats on the remaining teeth, which makes it the most straightforward guide to fit and verify chairside.

Bone-supported guides

For cases where there aren't enough stable teeth to seat a guide and the guide needs to sit on bone, typically with fixation pins.

Full-arch and All-on-X guides

For full-arch cases planned around a fixed prosthesis. These guides are planned together with the interim and final prosthesis, so implant positions, multi-unit abutment angles and screw access support the teeth you've planned. For the records the prosthetic side needs, see Sending an All-on-X case.

Not sure which applies? Send the records and we'll recommend one at planning.

What records does the lab need for a surgical guide?

CBCT

• A CBCT in DICOM format covering the full planned site, including adjacent anatomy
• General tip for patients with teeth: scan with the teeth slightly apart if possible, so arches don't overlap on the image
• Remove removable prostheses for the scan unless your protocol uses them as a scanning reference, and tell us which you did
• For edentulous arches, follow ADL's edentulous scanning protocol below

Surface scan

• An intraoral scan (or a model) of the arch that will carry the guide, with clean, complete coverage of the teeth or tissue the guide will sit on
• An opposing arch scan and a bite, so the restoration can be set up in occlusion
• For full-arch cases, a scan of the existing teeth or denture, which is often the best record of tooth position

Implant and surgical details

• Implant system, diameters and lengths you plan to use
• The guided surgical kit and sleeve system you'll use in surgery
• Any sites you've already decided on, or a request for us to propose positions

If an existing implant in the mouth is unknown, start with our free Implant ID request. We typically answer within 24 hours.

Restorative goal

• What will go on the implant: single crown, bridge, or full-arch fixed prosthesis
• Screw-retained or cement-retained preference
• Photos for anterior and full-arch cases (full smile, retracted, lips at rest)

Edentulous CBCT guide scanning protocol (dual scan)

For edentulous cases, Advanced Dental Laboratory's guide planning uses two CBCT scans: one of the patient wearing a scan appliance with spherical markers, and one of the appliance by itself. Follow ADL's protocol:

1. Prepare the scan appliance. A scan appliance is needed. The patient's existing denture is the typical solution, and it must fit well. If the denture fits poorly, reline it chairside with cold-cure acrylic or with light-body impression material.

2. Attach the markers. Attach 6 spherical markers (available at blueskyplan.com) evenly to the buccal and lingual surfaces of the denture.

3. Check fit and occlusion. Check the fit and occlusion of the denture using bite registration material.

4. Scan the patient wearing the denture. Take a CBCT scan of the patient wearing the denture, without the bite registration material, at 90 kV.

5. Scan the denture by itself. Take a CBCT scan of the denture on its own at 70 kV.

Questions about the protocol? Call ADL at 212.889.8812.

How does plan approval work?

We design every guideWORX guide in house. We set up the planned teeth first, merge them with the CBCT and the surface scan, and plan implant positions to support those teeth. Then we send you the plan.

Nothing is printed until you approve it. You can review the plan with our technicians through Remote Design Review, ask for changes to positions, depths or angulation, and sign off when you're comfortable. After approval, the guide is printed and sent to you.

guideWORX guides typically take 4–5 lab days after plan approval; complex cases can take longer. Rush service is available for an added fee.

Why plan the guide and the restoration in one lab?

• The plan follows the teeth. Implant positions are chosen for the restoration, not just the easiest bone.
• No hand-off. The team that plans the guide also designs the crown, abutment or full-arch prosthesis, so the records carry through without being reinterpreted.
• Fewer surprises at restoration. Screw access, emergence and abutment choice are considered before surgery, when they're easiest to change.

See implant restorations and Full-Arch / All-on-X for what we make on the other side of the surgery.

Surgical guide checklist

• CBCT in DICOM format, full site coverage
• Intraoral scan or model of the guide arch
• Opposing arch scan and bite
• Edentulous: well-fitting denture as scan appliance (relined chairside if needed) with 6 spherical markers on the buccal and lingual surfaces; fit and occlusion checked with bite registration material; CBCT of the patient wearing the denture without the bite registration material at 90 kV; CBCT of the denture alone at 70 kV
• Implant system, sizes and guided kit / sleeve system
• Guide type, or a request for our recommendation
• Restorative goal (crown, bridge or full arch; screw- or cement-retained)
• Photos for anterior and full-arch cases
• Surgery date, so we can schedule the plan review