Teeth in a Day: How All-on-X Really Works

The visible surgery is the short part. The work that determines the outcome happens in planning software weeks earlier.

It starts with a CBCT scan of the jaws and an iTero digital scan of the existing teeth or dentures. Those two data sets are merged so the surgeon can see bone, nerves, sinuses, and the position of the teeth in one coordinate system. Photographs and a facial analysis are added, because the goal is not just implants in bone — it is teeth positioned correctly relative to your lip, smile line, and midline.

Within that merged model, each implant is positioned virtually: its site, angle, depth, and the length chosen to engage the densest available bone. The rear implants are typically tilted forward to avoid the sinus above and the nerve below while gaining anchorage. The plan is then checked against the planned tooth positions to make sure the implants come out where the prosthesis can use them.

Finally, that plan is 3D printed as a surgical guide, and a provisional bridge is fabricated in advance from the same digital model.

You arrive having fasted, and IV sedation is started. Most patients have no memory of the appointment.

Remaining non-restorable teeth are removed and the sockets are thoroughly cleaned. The ridge is contoured to create a smooth, even platform for the prosthesis — this step is what allows the final bridge to sit without gaps that trap food.

The surgical guide is seated and implants are placed through it, each landing in the planned position, angle, and depth. Multi-unit abutments are attached to bring the connection points above the tissue and correct for the angulation of the tilted implants.

Photogrammetry is then performed: stereo cameras record markers on each abutment and capture the exact three-dimensional relationship between all of them in a single measurement. This is the step that makes a same-day bridge possible, because a full-arch prosthesis must fit passively — every screw hole aligning without strain. Traditional impressions of multiple implants introduce enough distortion to make that difficult; photogrammetry does not.

The provisional bridge is fitted to that data, adjusted for bite and aesthetics, and screwed onto the abutments. You wake up with teeth.

Patients sometimes assume the provisional is a placeholder to be tolerated. It is better understood as a full-scale working prototype.

It restores function immediately, so you eat, speak, and appear in public normally from the first week. It supports and shapes the healing gum tissue, which determines how natural the final result looks. And it lets you and the restorative team evaluate tooth length, lip support, speech, and bite over months of real-world use — so the definitive prosthesis is designed from evidence rather than guesswork.

It is fixed, not removable. You clean around and beneath it with a water flosser and the aids you are shown. You eat a soft diet for the first weeks and then progress carefully, with a standing instruction to avoid the hardest foods until the final bridge is in place.

Over the following four to six months, bone grows into the microscopic surface texture of each implant — osseointegration. Straumann's surface chemistry is used at Diamond Arch specifically because it shortens and improves the predictability of this phase.

During integration you are seen periodically. The provisional is checked, the bite is adjusted as tissue settles, and radiographs confirm that healing is proceeding as planned.

Once integration is confirmed, the definitive prosthesis is made. This is usually monolithic zirconia — far stronger, more stain-resistant, and more precisely fitted than the provisional. Photogrammetry or a verified digital scan is repeated so the final bridge fits the integrated implants exactly, and the design incorporates every adjustment learned from the provisional.

That bridge is then delivered and torqued into place, and maintenance begins: home cleaning, periodic professional cleaning with the prosthesis removed, and monitoring of the implants themselves.

Good candidates have failing or missing dentition in an arch, enough bone in the anterior region to accept implants with strong initial stability, controlled systemic health, and a willingness to follow the post-operative protocol.

The requirement that governs same-day loading is initial stability. An implant that is firmly locked in bone at placement can carry a provisional immediately; one that is not must be left to heal unloaded. When several implants in an arch lack that stability, delivering a fixed provisional the same day is not safe, and the honest plan is a staged approach.

Heavy smoking, uncontrolled diabetes, untreated bruxism, and some medication histories — particularly certain bone-modifying drugs — change the risk profile and are reviewed carefully. Severe posterior and anterior resorption may point instead to zygomatic implants.

A consultation with a CBCT scan is the only way to get a real answer, and it produces a written plan with the sequence, timeline, and cost laid out before anything begins.