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Top Secret All on X Scan Protocol

I’ve been looking everywhere (to no avail) to find out how I can put my little intraoral scanner to use for All on X (All on 4) restorative cases.

When I call and ask, most labs have no idea what the heck I’m trying to do. They just want me to send them the case and do it the conventional way.

EVEN the labs that say they are utilizing this digital workflow, still want me to do it the conventional analog way, rather than experiment with my own little scanner.

Other labs want me to use their scanner or purchase a NEW ONE! Eff that. I don’t want to dish out more money if I’ve already got a scanner.

Granted, I haven’t taken the course by Nate Farley or Michael Scherer–life would have probably been easier if I started there first.

But anyway, after one too many All on X restorative appointments and too many dead ends getting help with scanning, I said, “No mas!!”

I had to figure this thing out.

With a beer in one hand and the scanner in another, and many phone calls pestering my lab guy, I think I finally figured out a little workflow.

BTW, digital is not forte. I am not a digital guru. I don’t have all of the toys. AND I haven’t seen any resources online on how to do this. Anyone who has figured this out, hasn’t openly shared the step-by-step instructions.

NOTE: There are definitely better ways of doing this. (Including intra-oral scanning) But I haven’t quite got that figured out yet, to be honest.

I just want to share something that works pretty well for me right now. When I figure out the other stuff, I’ll share that too because you’re part of my tribe.

Your success is my success. Seriously.

Anyway, here it is!

How I did it (Step by Step pictures at the End)

The patient must already have an immediately loaded prosthesis that they are generally happy with.

  1. Take an impression with a luted GC bridge connecting the fixtures.
  2. Bring the patient back to verify your model. You just try the jig back on after the model has been poured. Confirm that the jig fits passively on the model and in the mouth. If it fits passively on the model and the mouth, you can skip step #3.
  3. Send model and jig to the lab to have them correct the cast if necessary.
  4. Take the immediate loaded temporary off and put it onto the stone model.
  5. Create notches in the model to help with scanning
  6. Create an order on your intraoral scanner. I used the Trios 3 Shape Scanner. I had to create an order for a regular bridge. I selected the teeth span and I made sure to select “pre-preparation scan”. I only submitted 2 scans. One of the prepreparation and one of the preparation. The preparation scan is just the scan of your copings. You can get fancier if you want and you can take a bite registration scan if your casts are mounted on an articulator.
  7. Scan the model with the immediately loaded temp
  8. Take the temp off and place copings on each implant site. Make sure that there is “draw” so that there are no undercuts.
  9. Prep the copings with a bur if necessary to create draw. (You don’t actually have to do this. You can use shorter and more tapered copings that allow for better “draw”)
  10. Scan the model with the copings.
  11. Send the scan to the lab for milling of the PMMA mock up. You can skip this step and go straight to the final if the patient was completely happy with the provisional. Just note that you’ll have better occlusion and spend less time adjusting if you do the PMMA try in.)
  12. Try the PMMA in the mouth. If any adjustments are done chairside, send the PMMA back to the lab for a second scan and delivery of final milled prosthesis.

Here’s a picture of the model with my copings ready to be scanned.

This is the prescription set up on my trios scanner. Setting up the right prescription on the software is key!

First, I do the pre-preparation scan with the immediate-load temporary on the model. Notice the notches on the model.

Then I scan my copings. (Remember, I prepped them to remove undercuts.)

TIP: Metal is hard to scan sometimes, so you can use a spray on the copings to make the scan easier. I a light coat of this spray and it works like a charm.

This is how my scan looks on the lab’s end:

Here are the 2 scans overlapped by JJ, my lab dude at LPA Dental Laboratory.

From here, JJ prepares the design of the milled prosthesis and cements it onto the copings I prepared. There other digital workflows aside from this one.

I expect that digital restoration of these cases will become easier in the coming years so that you don’t have to go crazy with so many restorative appointments. There are several companies competing in this space so I expect our options to become simpler and more affordable soon.

I’m super proud of myself for putting my Trios scanner to good use. So I’ve decided to include a picture of me and JJ looking super proud #SUCCESS


If you liked this little tip, you’ll definitely be interested in the upcoming All on X Book (Second Edition). It is basically like the All on X Bible. Full of 400+ pages of tips on surgery, restorative, conversions, and complications. 

The first edition is completely sold out, but you can get on the waitlist for the second edition here. 

I’m going to try to have it ready to go by my birthday, March 31st!

Now go out there and kick some ass. 

Cheers!

Ivan

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