Full-arch restorations, verified in your operatory.
For All-on-X cases, we bring the Aoralscan Elite intraoral photogrammetry system and a technician to your surgery — capturing implant positions to sub-20-micron accuracy at the chair, the moment they’re placed. Tampa Bay’s family-owned dental laboratory since 1984.
Does your lab have a face? Ours does — and we’ve been here for over forty years. Expect to see us. Expect to know us.
A full-arch prosthesis lives or dies on passive fit.
And passive fit is decided long before the bridge is designed — at the single hardest step in the entire workflow: capturing exactly where the implants are.
An implant-supported full-arch bridge has to seat passively — dropping into place with no rocking, no gaps, no forcing the screws. Miss it and the consequences accumulate over time: screw loosening, framework fracture, and biological complications around the implants.
The accepted clinical tolerance for passive fit is under 150 microns across the arch. Every stage introduces potential error — impression, model, design, milling — but the first stage is the most decisive. If the implant positions are captured wrong, nothing downstream can fix it.
This is exactly where conventional methods struggle. A splinted open-tray impression is slow and uncomfortable. A standard intraoral scan accumulates stitching error across an edentulous arch with few landmarks. Both are capturing the hardest possible geometry in the least forgiving way.
Representative in-vitro comparison (J. Clinical Prosthodontics & Implantology, 2025). Photogrammetry also recorded the fastest acquisition — under 2 minutes vs. ~4 (IOS) and ~15 (conventional).
Industrial metrology, brought to the mouth.
Photogrammetry was borrowed from industrial measurement, where capturing precise 3D position from images is a solved problem. Coded scan bodies on each implant act as control points — the system reads their position and angle directly, instead of stitching a surface together.
Position, not surface
Rather than reconstructing geometry from thousands of overlapping frames, photogrammetry reads the encoded markers on each scan body as fixed reference points — sidestepping the cumulative stitching error that grows across an edentulous arch.
Validated for full-arch
The full-arch implant application is exactly where photogrammetry has been most studied — and where it most consistently outperforms intraoral scanning, comfortably inside the 150-micron passive-fit requirement.
Faster, on the patient
A full IPG capture typically completes in 20–30 seconds when the field is clean — fast enough to perform at the chair, the moment the implants are placed, without extending surgical time.
The broader literature isn’t unanimous — across all digital-vs-conventional studies, results are mixed, and method, operator, and conditions all matter. What’s consistent is the narrower, relevant finding: for full-arch implant capture specifically, photogrammetry is reliably accurate enough for passive fit. We’d rather tell you that precisely than oversell it — because on a full-arch case, the details are the whole game.
We don’t wait for the case. We come to the surgery.
For All-on-X cases in Tampa Bay, we bring the Aoralscan Elite scanner, the coded scan-body kit matched to your implant system, and a trained technician directly to your operatory. The implant positions are captured chairside — the moment they’re placed — by the same lab that designs and builds the bridge.
No shipping impressions into a queue and hoping they’re close enough. The photogrammetry capture happens in your operatory, under your control, verified before the patient is discharged.
A Natural Esthetics technician sets up adjacent to the operatory, runs the capture, converts the implant library on-site, and is reachable at try-in to diagnose fit in real time. Not a call center — a person you know.
The team that captures the implant positions is the team that designs the bridge in exocad and finishes it by hand. Nothing is lost in a handoff between strangers, because there is no handoff.
The bigger a lab gets, the more your case becomes someone else’s quota. We’ve stayed the size where it’s still personal — on purpose.Does your lab have a face? Ours does. — Natural Esthetics, since 1984
The All-on-X workflow, step by step.
Seventeen steps across four phases, each tagged by responsibility. Surgical planning stays with the doctor’s planning resource; Natural Esthetics owns the prosthetic side and brings the scanner on surgical day. Tap any step to expand.
Pre-Surgical · Planning & Preparation
Capturing every record needed to plan implant positions and design the provisional — before the patient sits down for surgery.
01Initial consultation & records collectionDoctorJoint
The case begins before surgery is on the calendar.
Clinical exam & medical history
Chief complaint, current dental status, medical history (bisphosphonates, diabetes, smoking, anticoagulants). Photograph smile, lips at rest, full face, and intraoral views.
Diagnostic scans of existing condition
Scan or impress both arches and the existing bite. If a current denture is esthetically acceptable, scan it separately — it becomes a reference for the wax-up.
Lab consultation call
Confirm implant system, arch(es) treated, surgical date, immediate- vs delayed-load, and lab availability for on-site scanning. Lab confirms HACS kit compatibility.
Confirming implant-system compatibility early prevents a surgical-day surprise. We maintain HACS kits for major brands; uncommon systems need lead time to source.
02CBCT & diagnostic workupDoctorLab
The CBCT is the single most important diagnostic for an All-on-X case.
Capture CBCT of operative arch(es)
Full-arch field of view capturing sinuses (upper), IAN canal and mental foramina (lower), and ≥10mm of bone beyond the most distal planned site. Save as DICOM.
Facial scan / photographic series
Face at rest and smiling (MetiSmile or standardized photos) to guide tooth position relative to lip line and midline.
Receive prosthetic records
Lab logs the case and receives intraoral scans, denture scan, facial scan/photos, shade, and esthetic preferences. The CBCT and surgical planning files stay with the doctor’s planning resource — the lab does not use them.
03Case planning & treatment designDoctor
Implant positions are designed prosthetically — the bridge is designed first, then implants are placed to support it.
Surgical planning
The surgeon completes implant planning through their own resource. Natural Esthetics does not perform surgical planning and does not advise on implant positions, angulations, or bone management. The lab receives the finalized plan for restorative preparation.
Implants per arch · system & sizes · planned MUA selections (straight/angled, collar heights) · bone reduction? · immediate- vs delayed-load · surgical date & duration. The lab does not need the CBCT or guide file unless lab-side guide modification is required.
Send finalized plan to the lab
This is the lab’s trigger to design the wax-up, source the correct HACS coded scan-body kit, and schedule scanner and technician for surgical day.
04Digital wax-up & prosthetic preparationLabDoctor
The wax-up is the lab’s prosthetic deliverable — the visual target for the bridge.
Design digital wax-up
Lab designs the planned final prosthesis in exocad from the records and implant plan — the reference for tooth positions against the facial scan / smile line.
Surgical guide fabrication
The guide is produced through the doctor’s planning resource — the lab is not involved in guide design or printing. Confirm the guide is in hand and sterilized before surgical day.
Print wax-up try-in shell (optional)
For immediate-load cases, the lab pre-prints a shell that can be modified chairside into the provisional, saving design time on surgical day. Material: printable PMMA or biocompatible try-in resin.
05Pre-surgical try-in & verificationDoctorJoint
Wax-up try-in appointment (when indicated)
For complex esthetic cases, the printed wax-up is tried in to verify tooth position, midline, lip support, and vertical dimension. Patient sees the planned outcome before surgery. Photograph with try-in in place.
Final pre-surgery confirmation call
Confirm date, time, expected duration, HACS kit on hand, scanner availability, technician scheduling, and production capacity. Delivery timeline established case-by-case.
If the implant system changes between planning and surgery day, the lab must be notified as early as possible to source the correct HACS kit. Do not assume substitution is possible.
Surgical Day · Scan & Convert
Natural Esthetics is on-site. The implant positions are captured the moment they’re placed — this is the phase that determines passive fit.
06Operatory setup & lab arrivalLabDoctor
We arrive with the Aoralscan Elite, IPG tip, the matched coded scan-body kit, cap scan bodies for contingency, and a calibrated laptop.
Arrive 60 minutes before surgery start
Set up workstation · connect scanner & launch IntraoralScan · run calibration · pre-warm and confirm sterilized IPG tip · verify correct HACS library loaded · create patient order set to “Intraoral Photogrammetry” with MUA positions pre-selected per plan.
Patient prep & anesthesia
Standard surgical prep. Lab technician confirmed in the building before incision.
07Extractions, implant placement & MUA installationDoctor
Extractions & bone management
Remove remaining teeth, perform alveoloplasty / bone reduction per plan, curette sockets, irrigate.
Implant placement using surgical guide
Place implants per planned sequence. Document primary stability (≥35 N·cm typical for immediate load). If an implant fails adequate stability, decide immediately whether to bury it and proceed, or convert to delayed load.
Communicate any change in implant count to the lab technician immediately — it affects how many coded scan bodies are placed and how the bridge is designed.
Install multi-unit abutments
Select MUA collar height per tissue depth, install per plan, torque to manufacturer spec, verify seating with periapical radiographs.
Suture & hemostasis
Close around the MUAs. Achieve hemostasis before scanning — bleeding fields significantly increase scan difficulty. If uncontrolled, plan to use cap scan bodies (step 09).
08Soft tissue scanLab
Edentulous tissue scan
Scan the sutured arch with the IPG tip, Edentulous Scan mode on — capturing the tissue surface that defines the bridge intaglio. Toggle AI cleanup off if it removes needed tissue data. Target: under 60 seconds per arch.
Have the team irrigate, suction, and dry. If bleeding can’t be controlled, switch to the cap scan-body workflow: capture implants first with coded bodies, then swap to cap bodies for tissue alignment.
09IPG photogrammetry captureDoctorLabJoint
This is the moment that determines passive fit. Sub-20-micron accuracy is achievable only when the coded scan bodies are placed, oriented, and captured correctly.
Install coded scan bodies on MUAs
Hand-tighten onto each MUA, orient all tail ends the same direction (fan shape). Verify seating with a periapical radiograph before scanning — unseated bodies invalidate the entire capture. Final torque 10–15 N·cm or ≤30 RPM electric.
Every coded scan body must be inspected for blood contamination or surface damage before installation. Compromised bodies will fail recognition.
IPG capture — loop & marker scan
Loop first: from the posterior-most body, sweep the diagonal to the opposite side, capturing the rough loop between all bodies. Markers second: return to the first body, scan each back-and-forth until all markers turn dark green — capturing the 6 dots around each hexagon that carry position and angle data. Typically 20–30 seconds when clean.
Soft tissue alignment
Scan the connection zone where each coded body meets the soft tissue — right side first, then left. Software auto-aligns; manual fallback available.
Cap scan-body fallback (if conditions require)
If tissue is mobile, bleeding uncontrolled, or feature points obscured: capture implant positions with coded bodies first, then install minimum 2 (recommended 3+) cap scan bodies. Lab re-scans tissue with Intraoral + Edentulous modes; software aligns cap bodies to the captured implant positions.
10Bite registration & opposing scanLabJoint
Opposing arch scan
Standard intraoral scan of the opposing arch (or its denture). If the opposing arch is also being treated, follow the full IPG workflow for it as well.
Bite registration
With a stable bite reference, scan in occlusion (intraoral mode). For fully edentulous cases with no vertical reference, the doctor establishes vertical with a bite rim/registration material/block; the lab scans it. Confirm midline and occlusal plane visually with the patient.
11Implant library conversion & data handoffLabDoctor
Convert coded bodies to implant-system library
Select all captured positions and convert to the patient’s actual system (Nobel, Straumann, MegaGen, etc.). Generic coded-body geometry is replaced with the manufacturer-specific MUA library so exocad knows exactly where the screw channels and connections sit.
Place interim coverage & discharge patient
After scanning, place healing caps/temporary cylinders over the MUAs. Verify hemostasis, post-op instructions, soft-diet protocol. Advise against wearing an old denture over the surgical site during healing.
Production timing varies by case, material, and lab schedule. Confirm the delivery window during pre-surgery planning and again at the end of the scan appointment so try-in is scheduled appropriately.
Export & transfer files for design
Export as STL/OBJ/PLY: soft tissue scan · implant positions with library-matched MUAs · bite registration · opposing arch · pre-op temporary teeth (if captured). Files transfer back to the lab for design and fabrication.
Fabrication · Design, Produce, Deliver
Back at the lab — the team that captured the case is the team that builds it.
12Bridge design in exocadLab
Load scan data
Import soft tissue, implant positions, bite, opposing arch, and pre-surgical wax-up. exocad auto-aligns implant positions to the wax-up using soft tissue as the reference surface.
Modify wax-up intaglio to operated tissue
The wax-up was designed against pre-op tissue; now tissue has changed. Modify the intaglio to match actual post-op tissue while maintaining original tooth positions and occlusal scheme.
Cut screw channels & MUA connections
Library-matched positions drive precise screw-access channels. Direct MUA connections — no TiBase intermediaries when using compatible screw systems (e.g., ROSEN) — eliminate a potential cement-gap error source.
Final design review & approval
Review occlusion, emergence profiles, screw-channel angulations (must exit lingual/occlusal, never facial), bridge thickness for strength, and esthetics. Export STL to printer or mill.
13Production · printed or milledLab
We produce by the method that fits the case — printed for typical immediate-load, milled when greater strength or refined esthetics are called for.
Produce the bridge
Printed: definitive provisional or high-ceramic-filled resin, 25–50µm layer height. Milled: PMMA, composite, or hybrid puck for higher strength, refined detail, or extended provisional wear.
Post-process & finish
Printed: wash, UV post-cure, individualize (staining, gingival contouring, occlusal refinement), polish. Milled: hand-finish margins, stain, characterize, polish. Both finish with MUA library inserts for direct screw retention and a test-screw alignment check.
Quality check & delivery
Passive seat verified on lab model, occlusal scheme confirmed, esthetics reviewed. Sterilize, package, and hand-deliver or ship to the practice for try-in.
14Try-in & deliveryDoctorJoint
Remove interim coverage & prepare
Remove healing caps/cylinders, inspect tissue health, clean MUA platforms, irrigate, verify MUAs are still seated.
Initial seating & passive fit check
The bridge should drop into place — no rocking, no gaps, no forcing. If it doesn’t seat passively, do not torque the screws. A lab rep is reachable during this appointment to diagnose discrepancy in real time.
Common causes: a coded scan body shifted during scanning, tissue swelling changed since the scan, or an MUA seating issue. Re-scan with the bridge in place and contact the lab to identify the discrepancy before forcing the bridge or re-designing.
Occlusion check & final torque
Verify with articulating paper, adjust as needed. Torque screws to spec (typically 10–15 N·cm for provisional, varies by system). Seal screw access with PTFE and composite.
Patient discharge instructions
Soft diet 2 weeks, no chewing on the bridge until cleared, chlorhexidine rinses, prescribed meds, swelling expectations. Schedule post-op check (7–14 days) and final design (4–6 months once osseointegration is confirmed).
Post-Delivery · Follow-Up & Final Prosthesis
Through healing and into the definitive restoration — we return to the operatory to re-scan.
15Post-op verification & healing periodDoctor
Post-op check at 7–14 days
Inspect surgical sites, evaluate soft-tissue healing, verify occlusal stability, confirm the provisional is intact. Document with photographs.
Healing period — 3 to 6 months
Patient wears the provisional during osseointegration. Monthly check-ins recommended. At the end, confirm osseointegration with periapical radiographs and ISQ if available.
16Final prosthesis designJointLab
Final restoration planning conversation
Review what worked with the provisional. Decide final material (zirconia full-arch, Ti-zirconia hybrid, PMMA over titanium bar, milled PMMA), shade and morphology refinements, occlusal adjustments to bake in, emergence-profile refinements based on healed tissue.
Re-scan for final prosthesis
A second IPG scan captures post-healing implant positions and matured tissue — positions may have settled and tissue remodeled. The lab returns to the operatory with the Elite scanner for this appointment.
Design & fabricate final prosthesis
Design in exocad from the new data. Mill (zirconia, titanium frame) or print (PMMA, hybrid). Apply final staining, glaze, occlusal refinement — refining against the provisional but driven by healed tissue.
17Final delivery & maintenance protocolJointDoctor
Final try-in & seating
Verify passive fit (same protocol — no rocking, no forced seating), occlusion, esthetics, phonetics, lip support, midline. Patient approves before final torque.
Final torque & seal
Torque to manufacturer spec, seal screw access with PTFE and composite, final photographs for the case record.
Maintenance protocol
Hygiene: water flosser, super floss under the bridge, antimicrobial rinses. Recall: 3-month hygiene first year, then 4–6 months. Annual periapical radiographs for bone levels. Bridge removal and cleaning every 2–3 years.
We know where our work begins.
Surgical planning, implant position, angulation, and bone management belong to the doctor and their planning resource. Natural Esthetics owns the prosthetic side — design, capture, fabrication, and fit. Knowing exactly where that line sits is what makes a true co-procedure work.
Systems, files & turnaround.
- ScannerAoralscan Elite (IPG)
- Designexocad DentalCAD
- IPG capture accuracy<20µm (full arch)
- Coded scan-body libraries100+ implant systems
- File formatsSTL · OBJ · PLY
- ProvisionalPrinted or milled
- FinalZirconia · Ti-hybrid · PMMA
- Implant systemsNobel · Straumann · MegaGen · BioHorizons +
- On-site scanningTampa Bay surgical cases
- SchedulingReserve scanner + technician in advance
Bring us your next All-on-X case.
Tell us the implant system and surgical date, and we’ll reserve the scanner, the technician, and the right HACS kit. The first conversation is with a person — the same one you’ll see in your operatory.