All-on-X Case Preparation Workflow

1. Initial Assessment and Records (Diagnostic Phase)

• Imaging: A Cone Beam Computed Tomography (CBCT) scan is essential to assess bone volume, density, and anatomical limitations (nerves/sinuses).
• Intraoral Scanning/Impressions: Digital scans or physical impressions are taken of the arch, opposing dentition, and existing dentures to record vertical dimension and tooth position.
• Facial Imaging: Photographs and sometimes 3D face scans are taken to aid in aesthetic design. 

2. Treatment Planning and Digital Design

• Virtual Setup: CAD software is used to combine CBCT data with digital or physical impressions.
• Prosthetic-Driven Implant Planning: Implants are virtually placed in the ideal position to support the future prosthesis.
• Stackable Guide Design: If using guided surgery, a set of 3D-printed stackable guides is designed. This includes:
  • Base Guide: Fixes to the jaw with pins.
  • Bone Reduction Guide: Guides the leveling of bone to create sufficient prosthetic space.
  • Implant Guide: Dictates the precise placement and angle of the implants.
  • Prosthetic Carrier Guide: Assits with accurate seating of the temporary prosthesis.
• Provisional Design: The temporary prosthesis is designed for immediate loading. 

3. Pre-Surgical Preparation

• Prosthesis Fabrication: The temporary (provisional) acrylic or resin prosthesis is fabricated by the lab based on the digital design.
• Component Selection: Multi-unit abutments (MUAs) and surgical components are prepared.
• Patient Education: Discussing the "fit-and-forget" myth to set realistic expectations for the provisional stage. 

4. Surgical Day Workflow

• Tooth Extractions & Reduction: Remaining teeth are extracted, and a bone reduction guide is used to create space for the prosthetic materials.
• Guided Implant Placement: The implant guide is placed on the base guide to perform osteotomies and place implants with high torque (35–45+ Ncm) to allow immediate loading.
• Abutment Placement: Multi-unit abutments are torqued into place to align the seating surface for the prosthesis.
• Provisionalization (Immediate Load): The temporary prosthesis is seated using the prosthetic guide, ensuring a passive fit.
• Occlusion Check: The bite is checked for proper loading and comfort. 

5. Post-Surgical Phase (Heal & Finalize)

Healing Period: The patient wears the provisional prosthesis for 3–6 months to allow osseointegration