The answer first
Short answer: An All-on-X case needs three things from you: accurate implant positions, a verified bite at the planned vertical dimension, and enough photos and references to set the teeth where the face needs them. At the final stage, that means verified full-arch implant records, which we get through our partners OptiSplint and Scan Logic by IPD. If you send all three at each stage, the lab can deliver a passive, esthetic prosthesis with fewer appointments.
Full-arch work is planned, not just made. We've supported All-on-four for more than 25 years. Difficult full-arch cases very often trace back to a record that was missing or couldn't be trusted. Here's what to send and when.
What records does the lab need for an All-on-X case?
Implant and component information
- Implant system, platform and diameter for every site
- Multi-unit abutment (MUA) brand, angle and collar height, if MUAs are placed
- Scan bodies or impression copings used
- Final torque values from surgery
Use our Implant ID form if you're unsure of a system.
Scans
- Intraoral scans of both arches, plus the existing dentition or denture
- Pre-op scans before extraction. These are often the best record of the patient's tooth position, midline and incisal display.
- A soft-tissue scan of the healed ridge for the final stage
- An extraoral scan of the interim prosthesis, if one exists
A verified record of implant positions
Intraoral scanners capture a full arch by stitching many images together. Across long edentulous spans, with few anatomic landmarks, small stitching errors can add up. That's why full-arch finals need a verified record of implant positions, not just an intraoral scan of scan bodies.
For verified full-arch implant records, we partner with OptiSplint and with Scan Logic by IPD. Both are options, and we'll help you choose the one that fits your workflow.
Bite and vertical dimension
- A bite record at the planned vertical dimension of occlusion, not just the patient's habitual closure
- For an immediate case, the denture or a record base can serve as the reference for VDO and tooth position
- Notes on any change you want from the current prosthesis: more or less VDO, length, lip support
Photos
- Full face at rest and in a full smile
- Retracted frontal view
- Lateral profile
- Lips at rest, to show incisal display
- Close-up of the smile with the existing teeth or prosthesis in place
These let us set the incisal edge, midline, occlusal plane and the transition line between pink and white where they belong. A model alone can't tell us that.
For guided surgery
- CBCT in DICOM format
- An intraoral scan or model for merging
- Planned implant positions or a request for us to plan them
How does an All-on-X case move through the lab, stage by stage?
Every surgeon's protocol differs, and so does each case. This is a typical sequence. Timing depends on the case, and we'll map it with you at planning.
- Planning. You send the CBCT, scans, photos and goals. We set up the teeth digitally based on the face and the plan, then merge them with the CBCT so implant positions are driven by the final restoration. If the case is guided, the guideWORX surgical guide is designed here.
- Surgery and the interim prosthesis. Implants and MUAs are placed. For the interim prosthesis, we do immediate conversions chairside, or we deliver the temporary prosthesis the next day. Either way, send or capture records of the MUA positions and the bite at surgery. They become the reference for everything that follows.
- Healing. The patient heals under your surgeon's protocol, commonly several months before final records. Note anything you want changed from the interim prosthesis: phonetics, esthetics, cleansability, fractures.
- Final records. Take verified full-arch implant records (OptiSplint or Scan Logic by IPD), plus the tissue scan, opposing arch, bite at the confirmed VDO and updated photos. A scan of the interim prosthesis in the mouth is the most useful reference we can get, because the patient has already been living with it.
- Design review and try-in. We design the final from the records and the interim prosthesis, and review it with you remotely if you like. The try-in is a printed prototype that also serves as a verification jig, so you confirm esthetics, phonetics, occlusion and passive fit in one step before the final is milled.
- Final prosthesis. We mill and finish the final in house: zirconia/porcelain, porcelain/metal or high-impact acrylic/metal. Chairside support at your office is available.
- Delivery. Torque the prosthetic screws to the manufacturer's specification, check occlusion in all excursions, and confirm the patient can clean under the prosthesis.
Every full-arch case is planned individually; we map out the stages and timeline with you during case planning.
How do guideWORX surgical guides fit in?
guideWORX is our surgical guide service. It connects the surgical plan to the final prosthesis, so implants go where the teeth need them, not just where the bone is easiest.
- Restoratively driven planning: we place the teeth digitally first and plan implant positions to support them, which helps keep screw access channels in favorable positions.
- Design you can review: the plan and guide design can be reviewed with our technicians through Remote Design Review before anything is printed.
- The full range of guides: from tooth-borne single-site guides to full-arch, bone-borne pinned implant guides.
- Case planning and collaboration: we plan with you and your surgeon, not just print a file.
- One lab from plan to final: the same team that plans the guide designs the interim and final prostheses, so the records carry through without being reinterpreted.
guideWORX guides typically take 4–5 lab days, and complex cases take longer.
All-on-X case checklist
Planning
- CBCT (DICOM)
- Intraoral scans of both arches and the existing teeth or denture
- Full-face, smile, retracted, profile and lips-at-rest photos
- Goals: prosthesis type, desired changes, surgeon's protocol
- Guided surgery requested? Implant system and kit
Surgery and the interim prosthesis
- Implant system, platforms and MUA details for every site
- MUA position record and bite at surgery
- Interim prosthesis plan: chairside immediate conversion or next-day temporary
Final
- Verified full-arch implant records (OptiSplint or Scan Logic by IPD)
- Soft-tissue scan
- Opposing arch scan
- Bite at the confirmed VDO
- Scan of the interim prosthesis, plus notes on what to change
- Updated photos
- Final material: zirconia/porcelain, porcelain/metal or acrylic/metal
- Complete Rx, including the requested try-in and delivery dates
FAQ
Can I use an intraoral scan alone for an All-on-X final?
How do you verify implant positions for the final?
Which full-arch prosthesis materials do you offer?
Do I need a surgical guide for All-on-X?
How long does an All-on-X case take at the lab?
Planning a full-arch case? Talk to us before surgery. It's the cheapest point to get the teeth, the implants and the records aligned. Send a full-arch case, read more about Full-Arch / All-on-X, or see how guideWORX surgical guides fit into your plan.
Written by Advanced Dental Laboratory, 274 Madison Avenue, New York. General guidance for dental professionals; always follow the manufacturer’s instructions for use.