All-on-X Surgical Guides: What the Lab Needs and What You Get Back

Clinically reviewed by Jacob Shrayman, DDS, a general dentist who places implants using TrueGuide surgical guides in his own practice.

An All-on-X case is not a bigger single-implant case. Everything that keeps a single guide honest is gone the moment the arch is edentulous or about to be: no solid neighbors, no hard stop, no short span. TrueGuide Lab plans full-arch work around that fact. Here is what changes, what we need from you, and what comes back.

What changes when the arch goes full

Three things. The guide has nothing rigid to sit on, so it gets pinned. The bone usually has to come down before the implants go in, so the case needs more than one guide. And the provisional has to be ready the same day, so the prosthetic design has to be finished before anybody drills.

That is the whole difference. A single-tooth guide borrows its accuracy from the teeth around it. A full-arch guide has to carry its own.

Why full-arch cases get a stackable system

A stackable system is a base that pins to the arch and stays put, with layers that index to it: a bone reduction layer, a drill layer, and often a carrier for the provisional. One reference, one seat, from the first pin through conversion.

On a single-guide full-arch case, every step re-seats on tissue that has just been cut, flapped or reduced. The mouth is not the same shape it was ten minutes ago. That is where the error comes from, and pins on a base are what take it out.

Restorative space decides the case

Measured from the implant platform to the opposing occlusal plane: a screw-retained acrylic-titanium hybrid wants about 15 mm. A splinted bar overdenture, about 11 mm. An unsplinted Locator-style overdenture, about 7 mm.

If the space comes up short, you find out at conversion, on the day, with the patient in the chair. That is the argument for a guided bone reduction instead of an estimated one. The reduction is planned against the final prosthesis, not against the bone you happen to see.

What we need from you

A CBCT in DICOM, not a rendered JPEG. An intraoral scan of the arch, or a scan of the existing denture if the patient wears one. The opposing arch and a bite. Photos, full face and retracted. And the Rx with the implant system and platform noted, plus whether you want the guide sleeved or sleeveless.

If the patient is still dentate and the teeth are coming out, we need the arch as it is now. The plan is built on the pre-extraction anatomy and the base is designed to survive losing it.

The provisional

Full-arch temporaries print in Rodin Titan, a ceramic nanohybrid with over fifty percent ceramic filler, on an Ackuretta SOL Plus. It is built for hybrids and long-span provisionals, which is the part of the case that takes the most abuse in the first six months.

How the case runs

You send the case. A technician checks the merge before planning starts, because a bad registration is inherited by everything downstream. Then a plan review on a call, with revisions until you approve it. Nothing prints before you say go.

A standard guide ships 48 hours after approval. A stackable full-arch set depends on the design and the material, and the technician sets that date with you on the review call rather than guessing at it here.

Frequently asked questions

Do you make All-on-X surgical guides?

Yes. TrueGuide Lab builds full-arch guides for All-on-X and All-on-4 style cases, including stackable systems with a pinned base, a bone reduction layer and a drill layer.

Do I need a stackable guide for All-on-X?

If you are reducing bone, yes. Once the ridge changes shape, a single guide has nothing to re-seat on. The stack keeps every layer indexed to one pinned base.

Do you make the bone reduction guide too?

Yes, as part of the stack. The reduction is planned against the final prosthesis so the restorative space is there when you convert.

How much restorative space does a full-arch case need?

From the implant platform to the opposing occlusal plane: about 15 mm for a screw-retained acrylic-titanium hybrid, about 11 mm for a splinted bar overdenture, about 7 mm for an unsplinted Locator-style overdenture.

What is the All-on-X provisional printed in?

Rodin Titan by Pac-Dent, a ceramic nanohybrid with over fifty percent ceramic filler, printed on an Ackuretta SOL Plus.

What records do you need for a full-arch case?

CBCT in DICOM, an intraoral scan of the arch or of the existing denture, the opposing arch, a bite, photos, and the Rx with the implant system and platform noted.

Do you work with my implant system?

All of them. Note the system and platform on the Rx and the guide is built to it.

Is a full-arch guide as accurate as a single-tooth guide?

No. Edentulous cases run larger deviations than partial ones. That is exactly why full-arch work gets pins, a base and wider planning margins.

How fast is a full-arch case?

A standard guide ships 48 hours after you approve the plan. A stackable set depends on the design and the material, and the date is set with you at the plan review.

Send a case at trueguidedental.com, or call us at 201 255 4233 and ask for a plan review.