All-on-4 Surgical Guide Service: Full-Arch Design from €150

A full-arch guide costs €150 per arch and arrives in 48 hours. But the first real decision in an All-on-4 case is not price or turnaround — it is what the guide is going to sit on. A guide that rests on tissue which will not exist by the time you place implants is worse than no guide at all. This is how we plan full-arch cases, and where they genuinely get difficult.

What Makes Full-Arch Different

A single-unit guide has teeth on both sides to sit on. A full-arch guide often has nothing: the teeth come out during the same appointment, and the tissue underneath moves when you retract it.

That changes the problem from "where do the implants go" to "how does the guide know where it is". Everything else in a full-arch plan follows from that answer — support type, fixation pins, whether one guide is enough, and how many appointments the case really takes.

The second difference is the posterior tilt. All-on-4 tilts the distal implants to avoid the sinus and the nerve while pushing the AP spread as far back as possible. A tilted implant is unforgiving of angular error: a small deviation at the sleeve becomes a large one at the apex, which is exactly where the anatomy you are avoiding sits.

Guide Types for Full-Arch Cases

Tissue-Supported

The standard choice when the arch is already edentulous and the tissue is stable. The guide rests on mucosa and is held by fixation pins — usually three or four, positioned where they will not collide with implant sites or with the tilted posterior trajectories.

Fixation pins are not optional here. A tissue-supported guide without pins moves under hand pressure, and everything the guide was supposed to control moves with it.

Bone-Supported

For cases where a flap is raised anyway and the mucosa is too mobile or too thin to reference. The guide seats directly on bone, which is the most accurate reference available — at the cost of a wider flap than some cases need.

We use bone support where the plan already involves reflection, not as a way to solve a soft-tissue problem that pins would solve.

Stackable

Three guides that reference one another: a base fixed to the arch, a reduction guide that defines the new bone level, and a placement guide that goes on top. This is the answer when bone reduction is part of the plan — because once you have reduced the ridge, every reference the original guide used has changed.

Stackable systems cost more (€450) and are worth it precisely in the cases where they are needed: bone reduction, immediate loading with a prosthetic plan already fixed, or cases where the restorative space has to be created rather than found.

Pre-Extraction Guides

When teeth come out during the same appointment, the placement guide cannot sit on tissue it has never seen. A pre-extraction guide is designed alongside the placement guide from the same scan: it seats on the remaining teeth, sets the fixation pins, and hands the position over to the placement guide after the extractions. The pair is €200.

How We Design a Full-Arch Case (Step by Step)

Step 1: Upload and Case Description

as a DICOM series, intraoral or model scan as STL, PLY or OBJ, and — for full-arch work — a description of the prosthetic plan. Immediate load or delayed, screw-retained or bar, which teeth are coming out. This is the case where the order form details actually change the design.

Step 2: Anatomical Mapping

Bone volume across the whole arch, the inferior alveolar nerve and mental foramina, the sinus floors, and the anterior loop. On full-arch mandibular cases the loop is the structure that most often moves an implant, and it is worth resolving before the plan is built rather than after.

Step 3: Prosthetic-Driven Placement

Implants are placed to the restoration: AP spread, emergence through the prosthesis, screw access where you want it. Then we check that against the bone and tell you where the two disagree. In a full-arch case they usually do somewhere — the question is which compromise you prefer, and that is your call rather than ours.

Step 4: Guide Engineering

Support type, fixation pin positions clear of implant trajectories, sleeve specification for your kit, inspection windows to confirm seating. On stackable cases, the reduction plane is defined here and the three components are keyed to one another.

Step 5: Interactive Review

You receive the plan: positions, tilt angles, depths, AP spread, pin positions, and the reduction plane where applicable. Nothing is finalised until you approve it, and revisions before approval are included.

Step 6: Delivery

Open STL files, printable on any SLA or DLP printer with your own resin, plus the surgical report. For stackable cases you receive each component separately, keyed to fit.

Full-Arch Service vs. In-House Planning

Planning full-arch cases in-house is entirely possible, and some practices do it well. The arithmetic is worth being honest about: software licence, the hours of a trained person per case, and the learning curve on tilted posterior planning — which is a different skill from single-unit work.

At €150 per arch with a 48-hour turnaround, outsourcing usually wins on cost until the case volume is high enough to keep an in-house planner busy. Where in-house wins is control over the schedule when a case changes at short notice.

Manufacturer-linked full-arch planning services sit substantially higher, commonly €250–600 per case, and tie the plan to one implant system. Since full-arch cases are exactly where mixing systems is least likely, that lock-in matters less here than elsewhere — but the price difference does not go away.

Real Talk: When Full-Arch Guides Get Complicated

Immediate Extraction with Immediate Loading

The hardest combination in guided surgery. The guide has to reference teeth that are about to be removed, transfer that reference to a fixation-pin position, and survive the change in tissue. Pre-extraction guides solve the reference problem; nothing solves the fact that this is a long appointment with a lot of decisions in it.

Severe Bone Reduction

Once you plan to remove several millimetres of ridge, a single guide is not enough — the placement guide would seat on bone that no longer exists. This is what stackable systems are for, and cases that need reduction but try to avoid the cost usually end up freehanding the final positions.

Very Thin or Very Mobile Mucosa

A tissue-supported guide relies on the mucosa being a stable reference. Where it is not — thick mobile tissue, or a long-edentulous flat ridge — pins alone may not be enough, and bone support with a flap is the more honest plan.

Opposing Arch Not Accounted For

Full-arch plans occasionally arrive with no information about what the arch will occlude against. Screw access and emergence both depend on it. If the opposing arch is also being restored, tell us, because the two plans constrain each other.

Anterior Loop and the Distal Tilt

The mandibular distal implants are tilted to gain AP spread, and the anterior loop is what limits how far they can go. When the CBCT resolution does not resolve the loop clearly, we plan conservatively and say so in the report rather than assuming the best case.

Pricing

Case	Price per arch	Turnaround
Tissue-supported full-arch	€150	48 h
Bone-supported full-arch	€150	48 h
With pre-extraction guide	€200	48 h
Stackable (base + reduction + placement)	€450	48 h

Express 24-hour turnaround adds 30%. Both arches in one case are priced as two arches, because the design work is per arch. The full list is in our European price breakdown.

FAQ

What is the difference between All-on-4 and All-on-X here?

None, for design purposes. Four, five or six implants per arch are planned the same way; the number changes the AP spread and the prosthetic plan, not the workflow or the price.

Can you design a guide for immediate extraction cases?

Yes. The pre-extraction guide is designed alongside the placement guide from the same scan, and the pair is €200.

When do I need a stackable guide?

When bone reduction is part of the plan. Once the ridge level changes, a single placement guide has no valid reference left.

Do you plan the tilted posterior implants?

Yes — tilt angle, AP spread and clearance from the sinus and the nerve are part of the plan you review before approval.

Which implant systems do you support for full-arch?

All major systems, with the sleeve specified for whichever guided kit you own. Name the system and the kit on the order.

Do I pay before the design?

No. You review the plan, request changes, and pay only once you approve it.