Simplifying the All-on-X Workflow: A Guide to Streamlined Provisionalization

All-on-X procedures are known for their complexity. One of the biggest challenges is the patient’s understandable desire for aesthetically pleasing and functional fixed provisionals on the day of surgery. Traditionally, this has been achieved by affixing an immediate denture to new implants with multi-unit abutments (MUAs) and temporary cylinders, followed by contouring the intaglio of the denture for proper hygiene. Thankfully, modern digital tools offer alternatives that simplify this step and eliminate the need for conversion.

The Role of Guided Surgery in All-on-X

One of the first decisions in an All-on-X procedure is whether to use a freehand or guided approach. While freehand techniques have delivered acceptable results for years, guided surgery can optimize implant positioning. By using a combination of an intraoral scanner (IOS) and a CBCT scanner, you can gather all the records necessary for a guided approach. Tools like the Simpliguide Plus™ from NDX nSequence support guided alveoplasty and implant placement at an affordable price.

Advancing Provisionalization with Digital Workflows

After placing the implants and MUAs, the next step is provisionalization. Digital workflows, using only an IOS scanner, have revolutionized this process. You can deliver passive, aesthetic provisionals the day after surgery without conversion with affordable alternatives, such as Optisplint®.

A Streamlined Surgical and Restorative Process

To leverage these workflows, follow these steps:

1. Two Weeks Before Surgery:
   1. Capture full-mouth scans and photos of the patient’s current dentition at the desired final jaw relationship.
   2. Work with your NDX Full Arch laboratory to design and approve the patient’s new smile.
2. On the Day of Surgery:
   1. Place temporary abutments outside the surgical field for alignment purposes and then scan the existing dentition and those temporary abutments.
   2. Perform alveoplasty and implant/MUA placement.
   3. Use precision MUA scan bodies to capture the MUAs’ positions relative to the temporary implants.
   4. Remove the scan bodies and scan the bare MUAs and surrounding tissue, ensuring alignment with the temporary implants.
3. Submitting Scans:
   1. Send these scans (Existing dentition / temporary abutments, MUA scan bodies and bare MUAs/tissue) to your NDX Full Arch laboratory.

A Streamlined Provisionalization Process

Your laboratory will align the new scans of the MUAs and scan bodies with the preoperative situation, adapting the approved smile design to the new implant positions. From there, you have two options:

• In-Office Printing: Receive a STL file to print and finish the provisional in about 90 minutes.
• Laboratory Manufacturing: Receive a completed provisional within 24 hours. 

Either way, provisionalization becomes as simple as attaching the finished provisional to the MUAs—no conversion necessary!

Simplify Your All-on-X Practice

If this streamlined workflow sounds like a solution to a major challenge in your All-on-X practice, please reach out to your NDX Full Arch specialist. They can guide you through various digital workflows, including those mentioned here, to help you and your patients achieve the best possible results.