Workflow Guide:
3D printing Provisional Restoration for All-on-X

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The future of full mouth provisional restoration is here! All-on-X is the preferred treatment for those who lost all their teeth in one or both arches. With everyday dental implant improvements nowadays, All-on-X is easier than ever and can be practiced by most dentists. To make it more accessible and available to most surgeons, SprintRay offers the workflow to 3D print two key components in this process: the Surgical Guide and Provisional Restoration.

Today, it is very easy to digitally plan implant placement by using a CT scan and intraoral scan of the jaws, designing a Surgical Guide in a dental implant CAD software, and fabricating the surgical guide using a biocompatible resin in a SprintRay 3D printer. After implants are placed, the clinician takes a final scan using scan bodies, which would then be sent to a lab for live restoration design. The design will then be 3D printed and characterized while the patient is recovering from sedation. Before the patient leaves the office, the Provisional Restoration would be ready for insertion.

Here, we show and walk you through every step involved in the workflow of fabricating a Surgical Guide and Provisional Restoration in your office.

Step-by-Step Guide for Provisional Restoration

The workflow is divided into 4 phases:
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1. Digital Impression and CBCT data

Time required: Elapsed/Labor Time: 5-10 min
What you need: Intraoral or desktop 3D scanner, and CBCT data

SprintRay Dashboard
2. Treatment Planning
Time required, if done in-office: Elapsed/Labor Time: 12-20 min.
What you need: Access to the internet. Designing is done on Splint CAD software by SprintRay Cloud Design Services.
Surgical Guide
3. Surgical Guide Fabrication

Time required: Elapsed Time: About 80-110 minutes, including Labor of about 15-30 min.
What you need: SprintRay Pro printer, ProWash, ProCure, SprintRay Surgical Guide 2, RayWare software, IPA, Flush cutter, Lab pearl-shape carbide bur, Scotch BriteTM/FuzziesTM fine polishing wheel, Surgical Guide Sleeve, Muslin, Pumice, Nitrile gloves, Protective eyewear.

provisional restoration design
5. Provisional Restoration Design

Time required: Elapsed Time: About 80-110 minutes, including Labor of about 15-30 min.
What you need: SprintRay Pro printer, ProWash, ProCure, SprintRay Surgical Guide 2, RayWare software, IPA, Flush cutter, Lab pearl-shape carbide bur, Scotch BriteTM/FuzziesTM fine polishing wheel, Surgical Guide Sleeve, Muslin, Pumice, Nitrile gloves, Protective eyewear.

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6. Provisional Restoration Fabrication

Time Required: Elapsed Time: About 67-94 minutes, including Labor of about 8-15 min. 
What you need: SprintRay Pro printer, ProWash, ProCure, SprintRay Nano Ceramic Hybrid OnX Resin, Gloves, (IPA) Isopropyl Alcohol 91% or higher, Shop towels, Protective eyewear, Flush cutter, Round diamond disc, Lab carbide bur, Pink composite, OptiGlazeTM kit, Implant metal coping.

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7. Provisional Restoration Delivery

Time Required: Elapsed/Labor Time: 5-10 min
What you need: Abutment screws, abutment screwdriver


1. Digital Impression and CBCT data

The first step in this workflow is to obtain CBCT data and digitally record the patient’s dentition/arches information using an intraoral scanner. We can either take a direct or indirect digital impression.

1.1.  
Use an intraoral scanner to take direct digital impressions, then export the STL files. Common compatible scanners include, but are not limited to: Primescan (DentsplySirona), iTero (Align Tech), Trios (3Shape), Omnicam (DentsplySirona), Emerald (Planmeca), Medit (Medit), CS3700 (Carestream).

Scanners

1.2.
Indirect digital impressions are done by using a desktop scanner to convert a VPS impression or a model into a digital impression. Once the maxillary, mandibular, and bite scan files (digital impressions) are ready, export and save them in the highest resolution (if you have the option of choosing resolution) on your computer in STL format.

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Pro Tips:

• Primescan does not allow exporting bite-scan as a separate file. By default, Primescan users can only export 2 files: upper and lower. In case you need to export bite-scan as a separate file, you need to follow the steps from this link: Link to “How to export separate bite-scan file from Primescan
• To avoid rescanning and delays to the workflow, make sure all critical and required areas are scanned and captured. This will mitigate any delays in the treatment and discomfort to the patient. Here are some examples of problematic scans:

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Occlusion is unclear and scan has bubbles.
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Scan has scraps.
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Scan is coincident and contains distortion.
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Scan is incomplete, missing images.

2. Treatment Planning

Treatment Planning is the second step in this workflow and mainly consists of 2 parts: (1) Planning the implants and designing a Surgical Guide (2) Designing a wax-up (Smile Design). Designing can be done either by using an outside provider, or it may be done in-house by a dentist.

2.1. Out of Office Occlusal Guard Design
SprintRay Cloud Design helps and provides accurate Implant Planning and high-quality Surgical Guide Design, as well as a Smile Design (wax-up). Here you upload the patient’s intraoral scan files, CBCT images, and your prescription, and the rest is done on the cloud. Click here for more information on SprintRay Cloud Design services: SprintRay Cloud Design.
Implant Planning is done in 2 steps: first, you would receive a link to a set of validated information regarding implant planning guide design (such as a video summary, STL files, quality control images, and PDF files). Once the implant planning is approved, you will be sent the actual design file for the Surgical Guide. Once you receive the STL file of the designed Surgical Guide from SprintRay Cloud Design, you may go directly to step 3 (Fabricating
Surgical Guide).

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2.2. In-Office Designing Surgical Guide Design:
This is done in a Splint CAD software. SprintRay Software allows you to choose a splint software that best meets your clinical needs. Below is the list showing our recommended options, however, our software accepts any design file formatted in STL, which means you can use whichever software you are most comfortable with:
• 3Shape Splint Studio
• Exocad
• Magics
• D3splint
Once the scans are imported to the design software:

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2.2.1.  
Follow the instructions for SprintRay Surgical Guide material and choose/provide proper settings in the software. Continue to complete the implant planning, followed by designing a Surgical Guide.

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2.2.2. 
Once designing the Surgical Guide is done, the designed appliance should be exported and saved in STL format.


3. Surgical Guide Fabrication

Fabricating the Surgical Guide is the third step in this workflow. Once the design of the appliance is ready, you may start printing it using RayWare software and a SprintRay Pro printer. Below, we will show you the steps involved in fabricating the Surgical Guide.
If you use SprintRay Cloud Design services for designing the Surgical Guide, you may use the direct print option, click on “Print” button, and send the design directly to printer. In this case you may jump to step 3.5, otherwise continue with step 3.1. Click here to learn more about direct print option and workflow on SprintRay Cloud Design services: SprintRay Cloud Design

3.1. Initial Preparation
To prepare the appliance design for printing, import it to RayWare in STL format.

RayWare

3.2. Print Settings and Configuration
The recommended resin for printing Surgical Guide is SprintRay Surgical Guide 2, and the recommended thickness is 100 microns. This thickness provides great accuracy for surgical guide fabrication.

RayWare Settings

3.3. Print Orientation
The print orientation/angulation is an important printing factor. We recommend the following for best results:
• The intaglio surface should be facing up.
• The occlusal plane should be at an angle of 20-30 degrees to the print platform.
• The anterior part of the design should be closer to print platform than the posterior.

SprintRay RayWare Settings

3.4. Adding Supports
Once the orientation is obtained, the supports should be added to the design using the “Supports” button on the left side of the screen. We highly recommend printing the design with full supports to avoid any inaccuracies in the final product. Using supports only in the anterior region may lead to lack of fitment. Make sure there is no support attachment within the drill holes or at the edge of them.

SprintRay RayWare Settings

3.5. Prepare 3D Printer
Set print settings.
3.5.1.

Once the settings are complete, check the resin level in the resin tank. It should stand between the minimum and maximum lines. If there is leftover resin in the tank from the previous print, use the provided resin wiper to stir the resin before printing. This ensures that the resin is properly mixed and clean. Make sure the resin tank is fully secured in place.

SprintRay resin tank

3.5.2. 
Make sure the print platform is clean, dry, securely placed, and locked on the platform-arm.

SprintRay Pro Platform

3.5.3.
In RayWare, click the “Print” button to send the design to the printer for printing or place it in the queue to print later.

SprintRay RayWare Settings

3.6. Cleaning the Surgical Guide: 
Once the printing is done, the Surgical Guide needs to be cleaned from any remaining liquid resin and then dried. ProWash/Dry is designed to provide the best cleaning experience in the shortest time, with the lowest IPA usage.

SprintRay Pro Wash-Dry

3.7. 
Once the 3D printed Surgical Guide is cleaned and dried, remove it from the print platform using the Part-Removal-Tool by pressing it firmly underneath the supports, and gently twisting it from side to side while pushing forward. Before attempting to remove the printed Surgical Guide, make sure the platform is rested on a flat surface (table/countertop).

Surgical guide removal

3.8. Post-Curing the Printed Surgical Guide
The 3D printed Surgical Guide must be properly cured to the manufacturer’s resin specifications before use. This will help obtain complete curing as well as the best mechanical properties and accuracy. Since this is a very important step, ProCure is preset with all the settings according to resin’s specification regarding time and temperature.

Pro Cure

3.9. Support Removal
Once the post curing is completed, we need to remove all the supports by using a flush cutter. Try to cut as close as possible to the appliance surface to minimize the smoothening and polishing procedure.

Support Removal

3.10. Smooth the Surgical Guide
Use fine Scotch-BriteTM/ FuzziesTM polishing wheel to grind down the remaining knobs from Support-removal step (3.9) and smooth out the surface of appliance. The polishing wheels are used at a low speed (about 10,000 to 12,000 rpm).

Smooth Surgical Guide

3.11. Polishing
Use a muslin polishing wheel and pumice, with a firm and consistent pressure, to reach all the areas of the appliance. Make sure the wheel and pumice are damp enough and the pumice is flowable.

Surgical Guide Polish

3.12. Cleaning and Disinfecting
Use dish soap and a soft toothbrush to clean the appliance before assembly.

Surgical Guide brush

3.13. Assembling the Surgical Guide sleeve
Surgical Guide sleeve helps avoid any damage to the surgical guide. A Surgical Guide sleeve is fitted into the corresponding surgical guide drill hole. Make sure to select a proper and compatible sleeve at the time of treatment submission.

Surgical Guide Sleeve

3.14. Sterilization
Surgical Guide is then autoclaved at 134o for 5 minutes. You may use a sterilization pouch for sterilization. If disinfection is required, use non-chemical products. If this is not possible, an IPA solution is recommended for 5 minutes to disinfect.

Sterilization
Pro Tips:

• Use protective eyewear and nitrile gloves at all times to avoid eye/skin contact with uncured resin.
• Always keep the printer door closed to avoid premature curing of the resin.
• You may use a lab pearl-shape carbide bur to smooth out the knobs if any of them fall in a depth.
• Always shake the resin bottle well before pouring it into the resin tank.
• Always remove print platform before removing the resin tank to avoid excess resin dripping inside your printer.
• ProCure may need to warm up for a few minutes before the UV lights start to shine.
• Make sure the Surgical Guide is completely dried after sterilization.
• Do not expose the Surgical Guide to excess heat or time during sterilization.
• If soaked in IPA to disinfect, do not exceed more than 10 minutes.
• Visit https://sprintray.com/software/ to download the latest version of RayWare.

4. Surgical Phase (placing implants)

At this step, the surgeon places the implants using the surgical guide. Once all implants are placed and surgery is done, scan bodies are screwed on each implant, followed by taking intraoral scan or performing photogrammetry. Once the data is recorded, the files are exported and saved in STL format.

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Pro Tips:

• To avoid rescanning and delays is the workflow, make sure all critical and required areas are scanned and captured. This will avoid any delays in the treatment and discomfort to the patient.
• Always use the proper and recommended scan bodies for best result.

5. Designing Provisional Restoration

To have a quick and smooth design, an appointment should be scheduled with SprintRay Cloud Design services in advance to have a designer ready for you. Once the intraoral records are saved and ready, sent them to SprintRay Cloud Design services for a Provisional Restoration 3D design. You may provide the Smile Design wax-up as well as which one will be used to copy the same smile design on the Provisional Restoration.

Provisional design
provisional restoration design

6. Provisional Restoration Fabrication

Fabricating the Provisional Restoration is the sixth step in this workflow. Once the design of the Provisional Restoration is ready, you may start printing it using RayWare software and a SprintRay Pro printer. Below, we will show you steps involved in fabricating the Provisional Restoration.
If you use SprintRay Cloud Design services to design the Provisional Restoration, you may use the direct print option. Click on the “Print” button and send the design directly to the printer. In this case, you may jump to step 6.5. Otherwise, continue with step 6.1.
Click here to learn more about direct print option and workflow on SprintRay Cloud Design services: SprintRay Cloud Design.

6.1. Initial Preparation
To prepare the Provisional Restoration design for printing, import it to RayWare in STL format.

RayWare

6.2. Print Settings and Configuration
The recommended resin for printing Provisional Restoration is SprintRay Nano Ceramic Hybrid OnX Resin, and the recommended thickness is 100 microns. This thickness provides great accuracy for Provisional Restoration fabrication.

RayWare Settings

6.3. Print Orientation
Print orientation/angulation is a vital printing factor.
We recommend the following for best results:
• The teeth surface should be facing down.
• The occlusal plane should be parallel to the print platform.

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6.4. Adding Supports
Once the orientation is obtained, the supports should be added to the design using the “Supports” button on the left side of the screen.
We highly recommend printing the design with full supports to avoid any inaccuracies in the final product. Using partial supports may lead a to lack of fitment.
Make sure there is no support attachment within the screw holes or at the edge of them.

All on x

6.5. Prepare 3D Printer
Set print settings.
6.5.1.

Once settings are complete, check the resin level in the resin tank. It should stand between the minimum and maximum lines. If there is leftover resin in the tank from the previous print, use the provided resin wiper to stir the resin before printing. This ensures that the resin is properly mixed and clean. Make sure the resin tank is fully secured in place.

Resin level

6.5.2. 
Make sure the print platform is clean, dry, securely placed, and locked on the platform-arm.

SprintRay Pro Platform

6.5.3.
In RayWare, click the “Print” button to send the design to the printer for printing, or place it in the queue to print later.

All on X

6.6. 
Once the 3D printed Provisional Restoration is printed, remove it from the print platform using the Part-Removal-Tool by pressing it firmly underneath the supports and gently twisting it from side to side while pushing forward. Before removing the printed Provisional Restoration, make sure the platform rests on a flat surface (table/countertop).

print removal

6.7. Support Removal
Next, remove all the supports by using a flush cutter. Try to cut as close as possible to the appliance surface to minimize the smoothening and polishing procedure.

Restoration support removal

6.8. Cleaning the Provisional Restoration
Once the print is cleaned from all support structures, it needs to be cleaned from any remaining uncured resin residue, and then dried. Unlike other resins, this resin should NOT be washed/immersed in Isopropyl Alcohol (IPA); otherwise, the polishing process will be tedious.
Follow these steps to clean the resin residue before post-curing: Remove the parts from the Print Platform.
• Use a shop towel to wipe off and remove excess material.
• Use a spray bottle with >91% IPA to lightly spray the Provisional Restoration.
• Immediately blast with compressed air after spraying to dislodge as much resin as possible.
• Repeat, giving extra attention to screw holes to be sure all liquid is
removed.

Make sure IPA does not stand more than 1 minute on the printed Provisional Restoration.
If any residue remains, you may repeat the cleaning cycle. Ensure that your prints are completely dry before the next step; if not, use compressed air to dry your parts rapidly.
Remember: IPA is highly flammable! Please keep it away from heat sources, sparks, and flames.

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6.9. Post-Curing the Printed Provisional Restoration
The 3D printed Provisional Restoration must be properly cured to the manufacturer’s resin specifications before use. This will help obtain the complete curing, as well as the best mechanical properties and accuracy. Since this is a very crucial step, ProCure is highly recommended, which is preset with all the settings according to resin’s specification regarding time and temperature.

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6.10. Smoothening the Provisional Restoration 
Use a fine lab carbide bur to grind down the remaining knobs from the Support- removal step (6.7) and smooth out the support attachments.

Smoothening the Provisional Restoration:

6.11. Characterization
The printed Provisional Restoration is mono color. Characterization helps give the Provisional Restoration a better and more natural look by staining and glazing it, which allows to change shades, shift value, characterize, create effects and glaze to achieve a more beautiful and esthetic restoration. You may use the OptiGlazeTM kit by GC for a better cosmetic effect. Light cure the OptiGlaze colors and stains on the Provisional Restoration. You may combine multiple colors to make the desired color. Use clear glaze to give the restoration a final glaze.

• Use pink composite to cover the gingival area and provide a more natural texture and look.
• Use a fine brush and stain gingiva with pink stain to obtain more depth and character to the gingiva.
• Lightly use a blue stain at the incisal edges to create a translucent effect.
• You may use other stains (such as brown or orange) to create more characterization and a natural look.
• Paint the entire surface of the Provisional Restoration with a thin layer of clear glaze to give a final effect and a mirror finish.

Placing any metal coping should be done before characterization.

Characterization: Image
Pro Tips:

• Use protective eyewear and nitrile gloves at all times to avoid eye/skin contact with uncured resin.
• Always keep the printer door closed to avoid premature curing of the resin.
• Always shake the resin bottle well before pouring in resin tank.
• Always remove print platform before removing the resin tank to avoid excess resin dripping inside your printer.
• ProCure may need to warm up for a few minutes before the UV lights start to shine.
• Do not expose the provisional Restoration to excess heat or time during sterilization.
• Do NOT soak the Provisional Restoration in IPA to disinfect.
• Visit https://sprintray.com/software/ to download the latest version of RayWare.

7. Delivery of Provisional Restoration

The last step in this workflow is done when you deliver the Provisional Restoration to the patient. At this step, we want to make sure the restoration is seating completely on the implants, with the titanium screws being completely in place. Make any occlusal adjustments if necessary.

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Pro Tips:

• You may print patient model in advance to make initial occlusal adjustments in vitro and before patient delivery. This step should be done prior to characterization.
• Set up follow up meetings to check on the Provisional Restoration and soft tissue healing process.

For further information or any questions, please contact our Customer Support team from Monday through Friday, 7AM - 5PM PST at (800) 914 8004, or visit www.support.sprintray.com.