All-on-X Laboratory-to-Dentist Guide

A streamlined workflow for predictable full-arch implant restorations

1. Case Kick-Off

What the Lab Needs Why Preferred Format
CBCT (DICOM) + intra-oral/desktop scans Plan implant angulation & prosthetic space HIPAA-secure file-share link
Photographs (frontal, ¾, smile, retracted) Midline, smile line, shade map .JPG/.PNG, ≥ 2 MB
Bite registration / OVD record Verify vertical stop Digital bite scan or polyvinyl matrix
Prescription form with due dates Clarifies prosthetic design, finish, shade Use lab’s digital Rx portal
Tip: Schedule a quick kick-off call (< 10 min) to confirm timelines, materials, and special requests before the surgical date.

2. Collaborative Surgical Planning

  • Lab designs ideal tooth setup in exocad/3Shape.
  • Shared screen review with surgeon/dentist; approve prosthetic envelope.

  • Type: Tissue-supported or bone-reduction guide plus guided drill sleeves.
  • Manufacturing: 3-D printed in autoclavable biocompatible resin; verify sleeve offsets per drill kit.

  • Lab provides STL of surgical guide + offset report 48 h before surgery for clinician’s final check.
Virtual Wax-Up

3. Day-of-Surgery Package

Component Lab Prep Dentist Checklist
Provisional Bridge (PMMA or nano-ceramic) Milled/Printed, polished, intaglio relieved 0.5 mm Radiograph for passive seat; finger-tight 10 N cm screws
Multi-unit Abutments Correct angle/high-profile per plan; labeled by site Torque to OEM spec (25–35 N cm)
Backup Denture 3-D printed monoblock Keep chairside in case of intra-op changes

4. Immediate Post-Op Communication

  • Dentist to Lab: intra-oral photos + post-op pan / PAs showing implant seat.
  • Lab Response: confirm passive fit, suggest adjustments if radiographic gaps > 0.5 mm.
  • If conversion denture was used: return to lab for reinforcement bar within 3 days.
intra-oral photos

5. Transition to Definitive Prosthesis

5.1 Verification & Master Records

  • Use verification jig (splinted Ti bases).
  • One-screw test in model and mouth; if misfit > 150 µm, remake jig.

  • Capture emergence profile for final pontic contouring.

  • 3D printed prototype or milled PMMA; approve OVD, midline, phonetics.
  • Lab receives signed approval form before milling metal substructure.
Verification Jig

5.2 Design & Manufacturing

Stage Material Turnaround*
Framework design & CAM Monolithic zirconia / Ti-bar hybrid 4-5 days
Sintering & stain-glaze — 2-3 days
Final assembly & QC Ti base bonding, torque test, polish 1-2 day
*Typical; rush service by prior arrangement.

6. Seating & Torque Specifications

Interface Torque Notes
Multi-unit abutment → implant 25–35 N cm Use calibrated driver; record serial no.
Prosthetic screw (Ti base) 15 N cm Retorque after 10 min “settling”
Acrylic provisional (if reused) 10 N cm Hand driver only
Always follow the implant OEM if values differ from this table.

7. Maintenance Protocol

Interval Chairside Actions Lab Support
6 months Remove bridge, ultrasonic clean, new PTFE tape, re-torque Supply duplicate provisional to wear during service (> 48 h)
12 months Radiograph bone levels, check occlusion Re-glaze zirconia, polish Ti bases if wear noted
PRN Fracture, screw loosening, peri-implant tissue changes Same-day print of replacement PMMA or screw kit

8. Standard Turnaround & Shipping

Service Lab Days Recommended Courier
Surgical guide 3 Overnight, foam-lined case
Provisional bridge 7 Cold-pack if resin > 30 °C in transit
Definitive zirconia 7 Hard case + desiccant pouch

Digital File Ecosystem

  • Input: DICOM, STL, PLY, JPEG, PDF Rx.
  • Output: STL (surgical guides), 3MF (color prototypes), PDF QC/Torque log.
  • Archive: Cloud vault retained 7 years; request export anytime.

Contact Jesse

Your Surgical Guides Lab Specialist

stomadent.cadcam at gmail.com
(208) 888-1927