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Edentulous cases are the most complex surgical guide designs we do — and the ones where a guide matters most. When you're placing 4-6 implants in a completely toothless ridge, there's no anatomical reference point to eyeball. The guide is your only guarantee that the prosthetic platform matches the planned restoration.
A 3D-printed template that fits over the patient's teeth or tissue and directs drill placement during implant surgery. It transfers the digital treatment plan into precise physical drill positions.
What Makes Edentulous Guide Design Different?
In a dentate patient, the intraoral scan captures natural teeth — the guide registers on those teeth. In an edentulous patient, there are no teeth. The guide has to sit on soft tissue or bone, which introduces two challenges:
A 3D surface mesh file format used in dental CAD/CAM. Intraoral scanners produce STL files that capture tooth and gingival surfaces for surgical guide fitting.
- No rigid registration surface — tissue compresses under guide pressure
- No direct surface scan — you can't scan a bare ridge with an intraoral scanner
This is why edentulous cases require a dual-scan protocol or a radiographic template approach — both of which give us the surface morphology we need for guide body design.
Dual-Scan Protocol (Most Common)
| Step | What You Do | What We Receive |
|---|---|---|
| 1 | Patient wears existing denture during CBCT | CBCT with denture as reference |
| 2 | Scan the denture outside mouth (IOS or lab scan) | STL of the denture surface |
| 3 | Upload both files | CBCT + denture STL for merge |
The denture surface becomes the proxy for the tissue surface. We merge the CBCT bone data with the denture scan to create a complete anatomical model.
A 3D imaging technique that captures the jaw, teeth, and bone structure in a single rotational scan. It produces DICOM files used for implant planning, nerve mapping, and surgical guide design.
Alternative: Modified Radiographic Template
If the patient doesn't have an existing denture, you can fabricate a simple acrylic baseplate with radiopaque markers (barium sulfate or gutta percha). The patient wears this during the CBCT.
Tissue-Supported vs. Bone-Supported: Which Guide Type?
| Feature | Tissue-Supported | Bone-Supported |
|---|---|---|
| Seating | On gingival tissue | Directly on bone (requires flap) |
| Stability | Good with fixation pins | Excellent (rigid bone contact) |
| Surgery type | Flapless possible | Always requires full-thickness flap |
| Accuracy | ±1.0-1.5mm | ±0.5-1.0mm (best accuracy) |
| Use case | Standard All-on-4/6 | Complex anatomy, bone reduction needed |
Most All-on-4 cases use tissue-supported guides with fixation pin holes. When bone reduction is planned, bone-supported guides are necessary because the tissue surface changes after reduction.
A full-arch implant rehabilitation protocol where 4-6 implants support a complete fixed prosthesis. It allows immediate loading, meaning patients receive teeth on the same day as surgery.
Planning your first full-arch case? See our All-on-X workflow in action.
What Does a Full-Arch Guide Cost?
| Service | Price | Turnaround |
|---|---|---|
| All-on-X guide (tissue-supported) | From $150 | 3-5 days |
| All-on-X + bone reduction guide | $200 | 3-5 days |
| Zygomatic guide (complex) | $450 | 5-7 days |
| CBCT segmentation (if needed) | $20-50 | 1-2 days |
Every full-arch case includes: implant position planning for all fixtures, angulation optimization for prosthetic access, drilling protocol for sequential osteotomy, and fixation pin placement.
Immediate Loading Considerations
If you're planning immediate loading (provisional prosthesis at surgery), communicate this during the order:
- Implant positions must allow for multi-unit abutment access
- Angulation of posterior implants (typically 30-45° tilt in All-on-4) must clear the prosthetic space
- We can design the guide to include a stackable conversion template for the provisional
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Full-arch cases deserve full-arch planning. Upload your dual-scan files and receive a comprehensive surgical plan.
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