The Dental Lab’s Crucial Role in All-on-X Success

All-on-X is a fixed prosthetic solution that can restore the function and aesthetics of an entire dental arch in a single procedure. The restored bite force can reach 80% of natural teeth, and it can reshape facial contours, making it highly favored by patients. However, All-on-X is a complex procedure. Failure can cause trauma to the patient’s alveolar bone or lead to chronic peri-implantitis, presenting significant challenges for both clinicians and patients. In fact, there is another critically important player in the doctor-patient relationship—the dental laboratory! This article explores its role in All-on-X success.

I. Laboratory Support for Preoperative Planning

1.1 Preoperative Design

Step 1:

The laboratory requests the dentist to provide intraoral scan data or traditional impression-cast model data, CT scans, and photographs of the patient’s front, side, and smile views. Using 3Shape or Exocad software, the intraoral data is fused with CT scans to create a digital virtual patient.

Step 2:

Technicians design the optimal dental bridge for the virtual patient in Exocad—the ideal prosthetic—and perform a virtual try-in.

Step 3:

After confirming the ideal tooth positions, they reverse-engineer the implant locations and depths, ultimately using software to determine the optimal implant pathways.

1.2 Surgical Guide Design and Fabrication

Following the virtual planning in Exocad, the technician proceeds to design the surgical guide. This involves considering implant position, angle, and gingival adaptation. The software generates a guide template, which is then printed or milled. Implants can be precisely placed using this guide.

1.3 Mock-up

The laboratory prints the pre-designed ideal dental bridge and fits it into the patient’s mouth. This allows the patient to preview the post-operative tooth shape, smile, and facial support effects.

1.4 For Special Cases

For patients with periodontal disease, the clinician organizes a pre-operative meeting with the periodontist and technician. Each professional contributes their expertise to discuss and optimize the treatment plan collaboratively.

II. The Dental Laboratory: Chief Engineer of the Restoration Process

For All-on-X prosthesis design, dentists must consider the patient’s budget, occlusal relationship, and aesthetic requirements to provide appropriate recommendations. The final plan—such as titanium bars with acrylic denture bases, titanium bars with zirconia bridges, or abutments with PFM crowns—is communicated to dental technicians. Production begins based on patient needs.

2.1 First, dental technicians use CAD/CAM to design titanium components precisely matching implant positions. Key design considerations focus on occlusal reconstruction: technicians optimize stable occlusal points and correct cusp inclination to enhance chewing efficiency.

2.2 If you opt for a titanium post + zirconia bridge, the zirconia bridge can be designed simultaneously. Select the most suitable zirconia block shade, then use a milling machine to cut the designed bridge. Apply porcelain, mill porcelain, and glaze it. Through these processes, the tooth shape is made to closely resemble a natural tooth, enriching the crown’s color gradation and achieving a realistic gum line.

Thus, it’s evident within the treatment team that the dentist responsible for implant placement functions like an architect laying the foundation, while the laboratory acts as the chief engineer designing and constructing the building—overseeing the entire restoration’s design and production.

III. Consequences of Laboratory Oversights

The All-on-X technique demands exceptional team coordination. Any shortfall in any step can trigger severe consequences affecting both patients and practitioners.

3.1 Impact on Patients

3.1.1 The most significant impact is poor occlusal surface design, directly causing inefficient chewing. Additionally, improper palatal thickness and tooth arrangement can restrict tongue movement, lead to slurred speech, or even result in an ill-fitting bridge. Furthermore, inadequate gingival contour design may cause food debris accumulation under the bridge, making cleaning difficult and triggering gum inflammation, swelling, and bleeding.

3.1.2 Tooth color, size, and the presence of a smile line significantly affect the patient’s overall aesthetics.

3.1.3 The prosthesis size is critical. Laboratories must determine the optimal size and tooth shape based on virtual patient fittings; otherwise, patients will experience a pronounced foreign body sensation.

3.2 Impact on Dentists

3.2.1 First is wasted time. Typically, it takes about 15 days to receive the finished prosthesis from the lab. If the fit or aesthetics are unsatisfactory, another two weeks or more is required for remakes or adjustments.

3.2.2 The most significant impact for clinicians is reputational damage! Imagine spending two hours continuously adjusting and modifying a restoration only to find it still doesn’t fit the patient. Wouldn’t that be embarrassing? Furthermore, if the restoration fails to deliver satisfactory results, will the patient remain patient? This could even lead to medical disputes. If such incidents occur repeatedly, they will directly impact the clinic’s business.

3.3 Impact on Laboratories

3.3.1 Direct financial loss: Poor occlusal surface design necessitates remakes. All materials used—including implant components and full zirconia bridges—are high-quality and costly. Major remakes eliminate profit margins entirely.

3.3.2 Indirect losses are more severe. You risk losing the clinician’s trust. Repeated occurrences inevitably become known within the industry, making it difficult to secure high-quality client orders in the future.

Résumé :

A successful All-on-X restoration is the result of collaboration between the dentist and the dental laboratory. Relying solely on the dental team is insufficient, and depending solely on the lab is equally inadequate.

Dental labs bridge the gap between the dentist’s clinical expertise and the patient’s needs, crafting restorations that blend mechanical strength with aesthetic beauty. Dentists take the spotlight, while labs handle the complex work behind the scenes—they are the unsung heroes. To ensure patients enjoy comfortable chewing, clear speech, and confident smiles, every dentist must prioritize communication and collaboration with the dental lab before production begins.