The All On X Revolution: Transforming Dental Practices Through Collaboration

mm Written by Andrew Sedler

Staying updated with the latest procedures and techniques is paramount for delivering exceptional patient care. One such innovative approach that is revolutionizing dental practices is the All On X process. This advanced method of full-arch rehabilitation offers patients a fixed prosthesis supported by four or more implants, providing a stable and long-lasting solution for those with missing teeth.

Understanding the All On X process is crucial, but knowing how to effectively collaborate with the dental lab to ensure the best possible outcomes for your patients is equally important. Burbank Dental Lab is one of the most highly rated experienced dental labs in the All On X process and has a proven track record of excellence and innovation in full-arch rehabilitation.

The Bite Registration

An accurate bite is fundamental to the success of the All On X procedure, as it directly impacts the functionality, comfort, and longevity of the final prosthesis. An accurate bite involves precise occlusal records and a thorough analysis of the patient’s bite dynamics. A well-aligned bite ensures the prosthesis functions seamlessly with the patient’s natural oral movements.

An incorrect bite can lead to uneven pressure distribution on the implants, causing discomfort, increased wear on the prosthetic teeth, and even implant failure over time. With accurate bite records, dentists can collaborate effectively with the dental lab to design prostheses that provide optimal occlusal balance for the long-term success of the All On X treatment.

The All On X Revolution: Transforming Dental Practices through Collaboration - Burbank Dental Lab - CA

Pre-op impressions and a bite registration should be taken before any teeth are removed. If the patient is wearing a denture, it is imperative that the denture fit well and be an acceptable prosthesis to the patient.

Any issues should be identified and corrected before moving forward.

Course: Live Patient Surgical Hands-On Course - Burbank Dental Lab

Edentulous Patients Recording The Vertical Dimension of Occlusion (VDO)

For those who do not have teeth, VDO can be captured using a bite rim and base plate. To calculate the VDO for edentulous patients, do the following:

  • Measure RVD – Use a Willis bite gauge or a similar instrument to measure the distance between a fixed point on the nose and a fixed point on the chin. This is the resting vertical dimension (RVD).
  • Estimate the VDO – Subtract 2-4 mm from the RVD measurement to estimate the VDO. This accounts for the freeway space (the space between the teeth when the jaw is at rest).
  • Wax rims preparation – Create maxillary and mandibular wax rims on the record bases. Ensure they are contoured to support the lips and facial structures properly.
  • Adjust the wax rims to the desired plane of occlusion. Mark the midline and smile line on the wax rim.
  • Once the patient is comfortable and phonetics have been checked, measure the VDO again using the the Willis gauge.
The All On X Revolution: Transforming Dental Practices through Collaboration - Burbank Dental Lab - CA
The All On X Revolution: Transforming Dental Practices through Collaboration - Burbank Dental Lab - CA
Phase 1: Invisalign

Implant Placement

Best practices for implant placement and angulation are critical to the success of the All On X procedure. Precise implant placement involves careful planning and execution to ensure the implants are positioned in areas of sufficient bone density and volume. Correct angulation is crucial for the biomechanical stability of the implants, for ensuring that the prosthesis aligns properly with the patient’s bite and jaw dynamics, and that it fits perfectly and meets the functional and aesthetic needs of the patient.

The All On X Revolution: Transforming Dental Practices through Collaboration - Burbank Dental Lab - CA

Abutment Options for All On X

In All On X cases, selecting the appropriate type of multi-unit implant abutment is important for achieving optimal prosthetic results. There are several types of multi-implant abutments available, each designed to meet specific clinical needs and patient requirements. Choosing the right type of abutment can be discussed with the Burbank Dental Lab implant team to ensure the choices meet all of the case criteria. The types of abutment options include:

  • Custom multi-unit abutments – They are typically fabricated using CAD/CAM technology and offer the highest level of precision and customization, ensuring a perfect fit and optimal aesthetics. They are ideal for cases with unique anatomical challenges or where superior esthetics are paramount. Multi-unit abutments facilitate the connection of the prosthesis to multiple implants with ease, improving the stability and distribution of occlusal forces.
Smart1 Abutments - Titanium
  • Straight abutments – These, on the other hand, are standard components available in various sizes and angulations, providing a cost-effective solution with reliable performance for straightforward cases.
  • Angulated abutments – These are particularly useful in All On X procedures, as they allow for the correction of implant angulation to achieve proper prosthetic alignment, especially in cases where implants must be placed at an angle due to anatomical constraints.
All On X Success Guide

Provisionalization

Creating a PMMA (polymethyl methacrylate) provisional for temporization provides patients with a temporary yet functional and aesthetically pleasing solution while the implants heal. PMMA provisionals offer several advantages, including ease of fabrication, adjustability, and cost-effectiveness. This prosthetic serves as a test drive to ensure proper fit and function. The patient can wear this for an extended period of time and relay any issues prior to the final prosthesis being fabricated. Here are four key considerations when creating a PMMA provisional:

  • Ensure precise impressions or digital scans are taken to create a well-fitting PMMA provisional that aligns correctly with the patient’s anatomy and occlusion.
  • Adjust the provisional to achieve an accurate bite, ensuring even distribution of occlusal forces to prevent undue stress on the healing implants.
  • Customize the PMMA provisional to closely match the patient’s natural teeth in color, shape, and size, providing a visually appealing temporary solution.
  • Focus on making the provisional comfortable for the patient to wear and functional for daily activities such as eating and speaking, ensuring a positive experience during the healing phases of prostheses is well documented.

By carefully addressing these factors, dentists can provide their patients with high-quality PMMA provisionals that support successful outcomes and patient satisfaction.

The Final Prosthetic

Once the implants have osseointegrated and the patient has approved either an existing denture or a functional PMMA provisional, the final restorations can be created. The final restoration in All On X cases begins with taking precise final impressions for an accurate and well-fitting prosthesis. The final impressions can be taken either with traditional methods or digitally. With either method, ensure the following:

The All On X Revolution: Transforming Dental Practices through Collaboration - Burbank Dental Lab - CA
  1. Take impressions of both the mandibular and maxillary arches. These impressions must include the vestibules and palate in the maxillary and the vestibules and retro-molar pads in the mandible.
  2. Take an accurate bite registration.
  3. Scan the denture – The scan quality will determine how precise the details (fit and design) will translate to the final product.
    – Take a separate scan of both the maxillary and mandibular dentures.
    – Take a scan of them together interdigitated.
  4. Scan the intaglio/soft tissue all the way back past the rugae. Note: It is essential to provide the laboratory with landmarks throughout the process to provide a reference.
  5. Have the patient wear the dentures and scan all the way down to the vestibule to provide the following:
    – The final design
    – The vertical dimension of occlusion
    – Orientation of vital landmarks

Prosthetic Material Options

The choice of material for the final prosthesis plays a crucial role in the outcome, affecting durability, aesthetics, and patient satisfaction. There are many exotic materials and solutions that Burbank Dental Lab can provide; however, several materials are commonly used, each offering distinct advantages.

  • Acrylic is often used for provisional restorations due to its affordability and ease of adjustment, providing a temporary yet functional solution during the healing phase.
  • Zirconia is a popular choice due to its exceptional strength, biocompatibility, and natural appearance, making it ideal for patients seeking a durable and aesthetically pleasing restoration.
  • Porcelain-fused-to-metal (PFM) restorations combine the strength of a metal framework with the natural look of porcelain, offering a balance between durability and aesthetics.
  • Titanium frameworks with acrylic or composite resin are also commonly used, providing a strong foundation with a lightweight design.
  • Hybrid prostheses, which combine a titanium bar with zirconia, offer a blend of strength and esthetics.

Each material has its own set of benefits, and the choice depends on factors such as the patient’s functional needs, aesthetic preferences, and budget.

The All On X Revolution: Transforming Dental Practices through Collaboration - Burbank Dental Lab - CA

The All On X procedure represents a groundbreaking advancement in dental implantology, offering patients a reliable and aesthetically pleasing solution for full-arch rehabilitation. By understanding the intricacies of the All On X process and adhering to best practices, dentists can significantly enhance patient outcomes.

Collaborate with an Experienced Dental Lab

Collaboration with an experienced dental lab such as Burbank Dental Lab, is crucial for achieving optimal results, as it ensures precise planning, accurate implant placement, and high-quality restorations. Whether through traditional or digital methods, effective communication and coordination between the dentist and dental lab are essential for delivering prostheses that meet the highest standards of fit, function, and aesthetics.

By staying informed and embracing innovative techniques, dentists can provide exceptional care and improve the quality of life for their patients through the All On X procedure.

Call Burbank Dental Lab today or chat with us to get started on your next All On X case.

IMETRIC Digital Scan In-Office Service - LOS ANGELES AREA ONLY

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