All on x

1. Pre-surgical Waxup

1

Pontic Waxup
Dentate Arch
INTRODUCTION

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Very few medical specialties have such an incredible way to impact the
day to day lives of a patient like we do through restoring the ability of I trust that you will take what you have learned here and use it to impact
someone to smile and allow them to eat solid foods again. A patient can the lives of your patents.
leave with a 3D printed direct to MUA prosthetic on the day of surgery
using the knowledge gained in this book. I want to share this with you Happy Designing,
because at The MOD institute we believe in the power of knowledge to
transform practices.

I started my All on X journey 18 years ago with hours long conversions,

drilling holes in dentures and injecting poly methyl methacrylate to pick
up temp cylinders in the mouth. Those days are long gone and this guide Dr. Wally Renne
represents the way I have trained my team around same day conversions.
Understanding the principles outlined in this guide will unlock new levels
of creativity and allow you will develop your own creative work ows.

Copyright © 2025 The MOD Institute

All rights reserved. All rights reserved. This book or any portion thereof may not be reproduced Published by WRMDSV I LLC, in the United States of America. First Publication March, 2024
or used in any manner whatsoever without the express written permission of the publisher
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Front cover image by Dr. Wally Renne. Supporting images by Dr. Michael DeFee and Dr.
www.themodinstitute.com
Queiroz. Names, places, products and events are the sole opinion of the author.
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Table of Contents
01 Pre-Surgical Waxup: Dentate Single Arch 1
02 Anatomic Waxup Technique 101
03 Pre-Surgical Waxup: Pontic Waxup Day Of 179
04 Surgery Conversion: Edentulous Arch 269
05 Pre-Surgical Waxup: Dual Arch 352
06 Universal Method: Day of Surgery 465
07 Using a Scanned Denture 605
08 Bar Design: Convert to Split File 696
09 iCam Day of Surgery 806
 ALL ON X

Pre-Surgical Waxup
D E N TAT E S I N G L E A RC H

1 | exocad ALL ON X STEP-BY-STEP GUIDE

 1 . Anatomic Pontic Technique-Dentate Arch
My favorite way to wax is
still using anatomic pontic
with gingiva and exporting
the merged part. It is easy
and always works. Some
prefer the pontic waxup
because it allows editing
tissue in the project easier
however I prefer this
anatomic pontic. I will
show you pontic waxup
techniques too in other
chapters.

2 | exocad ALL ON X STEP-BY-STEP GUIDE

 2 . Open Dental DB
I am using exocad 3.2.

3 | exocad ALL ON X STEP-BY-STEP GUIDE

 3 . Click Default Client
Select Here.

4 | exocad ALL ON X STEP-BY-STEP GUIDE

 4 . Click “Default Client”
Select “Default Client” in
the drop down menu.

5 | exocad ALL ON X STEP-BY-STEP GUIDE

 5 . Enter Patient Name
Enter the patient’s name
in the type field.

6 | exocad ALL ON X STEP-BY-STEP GUIDE

 6 . Click Distal-Most Tooth
To start the pre-surgical
wax up we need to set the
case up as anatomic wax
up.

7 | exocad ALL ON X STEP-BY-STEP GUIDE

 7 . Save the Case
Click “Anatomic Pontic”.

8 | exocad ALL ON X STEP-BY-STEP GUIDE

 8 . 3D Print
Select 3D print and virtual
gingiva “yes”. Then click
“OK”.

9 | exocad ALL ON X STEP-BY-STEP GUIDE

 9 . Duplicate Shift-Click
Duplicate and shift-click to
all the teeth in the arch you
want to wax with these
settings.

10 | exocad ALL ON X STEP-BY-STEP GUIDE

10 . Virtual Extraction
For 7-14 I will change the
prescription to virtual
extraction. Even though this
can be accessed in expert
mode any time.

11 | exocad ALL ON X STEP-BY-STEP GUIDE

 11 . Save the Case
Hit “Save”.

12 | exocad ALL ON X STEP-BY-STEP GUIDE

12 . Design
If the design is grayed-out
you have not hit “save” yet.

13 | exocad ALL ON X STEP-BY-STEP GUIDE

13 . Load your Files
You just need the
preoperative scans and the
antagonist.

14 | exocad ALL ON X STEP-BY-STEP GUIDE

14 . Rotate the Jaw Scan
Rotate the arch so that you
are looking down on the
occlusal like this and hit
“next”.

15 | exocad ALL ON X STEP-BY-STEP GUIDE

15 . Start Smile Creator
We are going to use a photo
to design. I have one photo
for this case, which is not a
good one.

16 | exocad ALL ON X STEP-BY-STEP GUIDE

16 . Load Photo
You need a full face photo. I
could onky find a smile
photo. Normally, I have a
retracted photo and smile
photo. I am going to load my
smile photo.

17 | exocad ALL ON X STEP-BY-STEP GUIDE

17 . Load Smile Photo
Select common points. Zoom
into the photo and select
points one on the left and one
on the right.

18 | exocad ALL ON X STEP-BY-STEP GUIDE

18 . Load Smile Photo
Select common points. Zoom
into the photo and select
points one on left and one on
the right. Click the same
exact points on the intraoral
scans. You can click a dot
and drag to refine. If you do
not see dots when you click
zoom out, you accidentally
dropped them somewhere.

19 | exocad ALL ON X STEP-BY-STEP GUIDE

19 . Click “Next”
Click “next” when the dots
are identical.

20 | exocad ALL ON X STEP-BY-STEP GUIDE

20 . Fine-Tune Merge
Right-click to alter the
angulation of the intraoral
scan.

21 | exocad ALL ON X STEP-BY-STEP GUIDE

21 . Fine-Tune Merge
Then, left-click the center of
a dot and move the photo.
Repeat on the other side.

22 | exocad ALL ON X STEP-BY-STEP GUIDE

22 . Fine-Tune Merge
Repeat as many times as
need to get a perfect match.

23 | exocad ALL ON X STEP-BY-STEP GUIDE

23 . Click “Next”
Click “next” to move on.

24 | exocad ALL ON X STEP-BY-STEP GUIDE

24 . Mark the Lip
This should be fast.

25 | exocad ALL ON X STEP-BY-STEP GUIDE

25 . Mark Pupils
This photo has the eyes
closed. This case was
referred to me. The referring
team made the photos. It is
nice to have something to
work with, but ideally the
records process will lead to
better photos.

26 | exocad ALL ON X STEP-BY-STEP GUIDE

26 . Move Smile Arc
Move the smile arc to the
midline.

27 | exocad ALL ON X STEP-BY-STEP GUIDE

27 . Move Smile Arc
Move the proportion gauge.
The horizontal line should be
on the proposed incisal edge
of the centrals. The vertical
bar aligned with the midline.
The cuspid bars on the distal
of cuspids or alar of the
nose. Click “next”.

28 | exocad ALL ON X STEP-BY-STEP GUIDE

28 . Global Movement
In this tab, I only do global
movements. Look at your
midline incisal edge position
and anterior-posterior
position.

29 | exocad ALL ON X STEP-BY-STEP GUIDE

29 . Global Movement
Make sure the box is around
all the teeth as shown. If not
left click and draw a big box
around the arch. This way you
can move all teeth. Click the
center of the box to move the
teeth.

30 | exocad ALL ON X STEP-BY-STEP GUIDE

30 . Global Movement
Fine-tune the position of the
arch and focus on the
anteriors. Click measurement
and click the central to
determine the tooth size. You
want a central 10-11mm long

31 | exocad ALL ON X STEP-BY-STEP GUIDE

31 . Central Size
Fine-tune the position of the
arch and focus on the
anteriors. Click measurement
and click the central to
determine the tooth size. You
want the central to be
10-11mm long.

32 | exocad ALL ON X STEP-BY-STEP GUIDE

32 . Central Size
Click the blue dot on top of
the box in the facial image
and drag to increase or
decrease the length of the
centrals.

33 | exocad ALL ON X STEP-BY-STEP GUIDE

33 . Next
Hit “next” when happy. I do
not move individual teeth in
this module, only the entire
arch.

34 | exocad ALL ON X STEP-BY-STEP GUIDE

34 . Skip
Just click “next” to skip this
step. We do not need it.

35 | exocad ALL ON X STEP-BY-STEP GUIDE

35 . Done
Hit “done”.

36 | exocad ALL ON X STEP-BY-STEP GUIDE

36 . Virtual Extraction
Follow the wizard for virtual
extractions if you set this up
in dental DB it will be a
wizard step. I not you can
find this in expert mode by
entering expert mode, right
click model and hit extract.

37 | exocad ALL ON X STEP-BY-STEP GUIDE

37 . Virtual Extraction
Follow the wizard for virtual
extractions if you set this up
in dental DB it will be a
wizard step. If not, you can
find this in expert mode by
entering the expert mode,
right-click the model, and hit
“extract”.

38 | exocad ALL ON X STEP-BY-STEP GUIDE

38 . Virtual Extraction
I told exocad to see the
extracted tooth as a preop.
Extraction socket 2mmm is
good. The arrow is for socket
angle but it does not matter
because we will do bone
reduction here.

39 | exocad ALL ON X STEP-BY-STEP GUIDE

39 . Extract Each Tooth
Proceed with each tooth. It
doe not matter of they are not
perfect we will edit the mesh.

40 | exocad ALL ON X STEP-BY-STEP GUIDE

40 . Extract Each Tooth
Once done with extractions
hit “Next” or “OK”.

41 | exocad ALL ON X STEP-BY-STEP GUIDE

41 . Expert Mode
We need to jump into expert
mode to refine the model and
do bone reduction.

42 | exocad ALL ON X STEP-BY-STEP GUIDE

42 . Expert Mode
Right-click the model to edit
the mesh.

43 | exocad ALL ON X STEP-BY-STEP GUIDE

43 . Reduce Ridge
Hold shift on keyboard and
click a line across the ridge.

44 | exocad ALL ON X STEP-BY-STEP GUIDE

44 . Reduce Ridge
Do not close the circle, leave
it open.

45 | exocad ALL ON X STEP-BY-STEP GUIDE

45 . Reduce Ridge
Now hit “delete” to start the
bone reduction.

46 | exocad ALL ON X STEP-BY-STEP GUIDE

46 . Close Hole
We now need to seal the
hole.

47 | exocad ALL ON X STEP-BY-STEP GUIDE

47 . Close Hole
Draw a big circle around the
hole make sure to close the
circle and orange around the
entire hole.

48 | exocad ALL ON X STEP-BY-STEP GUIDE

48 . Close Hole
Hit “close hole” and “OK”.

49 | exocad ALL ON X STEP-BY-STEP GUIDE

49 . Free Form
Still in expert mode. Click the
arch and on the bottom m
venue hit freeform scan data.

50 | exocad ALL ON X STEP-BY-STEP GUIDE

50 . Flatten and Remove
Use flatten and remove tools
to reduce and smooth the
ridge. These tools are
activated by holding shift on
the keyboard and clicking in
the add/remove or smooth/
flatten tool. When done hit
“OK”.

51 | exocad ALL ON X STEP-BY-STEP GUIDE

51 . To Wizard
Jump back to wizard.

52 | exocad ALL ON X STEP-BY-STEP GUIDE

52 . Chain Mode
Jump into chain mode in the
tooth placement step.

53 | exocad ALL ON X STEP-BY-STEP GUIDE

53 . Lock the Centrals
Click the green balls on the
centrals to lock them in
location.

54 | exocad ALL ON X STEP-BY-STEP GUIDE

54 . Unlock Molars
Click the red balls to green in
the molar area to unlock
them. If you can’t find the red
balls look form the intaglio.

55 | exocad ALL ON X STEP-BY-STEP GUIDE

55 . Set Molar Position
Now, click the molars or
distal-most tooth and drag
them to a location on both
sides of the arch. This will set
the arch length.

56 | exocad ALL ON X STEP-BY-STEP GUIDE

56 . Set Molar Position
Turn on preoperative teeth if
this helps you with your
molar position.

57 | exocad ALL ON X STEP-BY-STEP GUIDE

57 . Advanced
Now click advanced to exit
chain mode.

58 | exocad ALL ON X STEP-BY-STEP GUIDE

58 . Advanced
Click the eye icon and the
instant anatomic morph icon
and the apply to all icon.

59 | exocad ALL ON X STEP-BY-STEP GUIDE

59 . Fine-Tune Individual Teeth
Now, we can fine-tune tooth
position. Click a tooth to
move it. Control left click to
rotate. Control and shift left
click to stretch. Shift left click
to scale.

60 | exocad ALL ON X STEP-BY-STEP GUIDE

60 . Fine-Tune Individual Teeth
Now, we can fine-tune tooth
position. Click a tooth to
move it. Control left click to
rotate. Control and shift left
click to stretch. Shift left click
to scale.

61 | exocad ALL ON X STEP-BY-STEP GUIDE

61 . Next
All of your teeth should have
good occlusion (but not
perfect) before hitting next.
They should all be touching
with no spaces or diastema.

62 | exocad ALL ON X STEP-BY-STEP GUIDE

62 . Adjust Static Occlusion
In freeform, the only thing
that you need to do is refine
contacts. Notice how I have
dynamic occlusion marks but
never used the articulator. In
my settings, I have selected
to use auto articulator (this is
in settings - add on modules-
auto articulation) this way I
do not have to mount this.

63 | exocad ALL ON X STEP-BY-STEP GUIDE

63 . Turn Off Dynamic
Focus on static fist so turn off
dynamic.

64 | exocad ALL ON X STEP-BY-STEP GUIDE

64 . Add/Remove
Use add remove to make sure
each tooth has a static
occlusion mark.

65 | exocad ALL ON X STEP-BY-STEP GUIDE

65 . Adapt
Click adapt.

66 | exocad ALL ON X STEP-BY-STEP GUIDE

66 . Adapt
Adapt proximal, Basal and
Static by clicking each one.
Do not hit cut all.

67 | exocad ALL ON X STEP-BY-STEP GUIDE

67 . Dynamic
We now need to adjust
dynamic occlusion. Click the
little chevron on the dynamic
button.

68 | exocad ALL ON X STEP-BY-STEP GUIDE

68 . Protect the Incisal Edge
Click exclude select parts
and paint the very tips of the
incisal edges of the anteriors.

69 | exocad ALL ON X STEP-BY-STEP GUIDE

69 . Adapt Dynamic
Now click the dynamic button
to cut the dynamic .

70 | exocad ALL ON X STEP-BY-STEP GUIDE

70 . Fine-Tune
We have cut our dynamic and
now we need to fine-tune.

71 | exocad ALL ON X STEP-BY-STEP GUIDE

71 . Group Function
Click the articulator button,
choose lower if it has an
option, and slide the scale.
Make sure that the dynamic is
off on the color map.

72 | exocad ALL ON X STEP-BY-STEP GUIDE

72 . Protrusion
Use add remove to adjust the
protrusion.

73 | exocad ALL ON X STEP-BY-STEP GUIDE

73 . Right Lateral Movements
The more you slide the bar,
the more you will see lateral
movements. Use add remove
to get group function in right
movements.

74 | exocad ALL ON X STEP-BY-STEP GUIDE

74 . Left Lateral Movements
The more you slide the bar,
the more you will see lateral
movements. Use add remove
to get group function in left
movements.

75 | exocad ALL ON X STEP-BY-STEP GUIDE

75 . Click Next
We need to hit “next”.

76 | exocad ALL ON X STEP-BY-STEP GUIDE

76 . Skip
Skip this step and hit “next”.
We do not want to adapt to a
preop and usually never do.

77 | exocad ALL ON X STEP-BY-STEP GUIDE

77 . Set from View
Rotate the arch to the path of
insertion, usually occlusal
view and hit “set from view”.

78 | exocad ALL ON X STEP-BY-STEP GUIDE

78 . Next
Hit “next”.

79 | exocad ALL ON X STEP-BY-STEP GUIDE

79 . Draw Tissue
Click and draw a horseshoe
shape around the arch for
your tissue. Remember go
wider than you think.

80 | exocad ALL ON X STEP-BY-STEP GUIDE

80 . Draw Tissue
Keep drawing.

81 | exocad ALL ON X STEP-BY-STEP GUIDE

81 . Draw Tissue
Keep drawing.

82 | exocad ALL ON X STEP-BY-STEP GUIDE

82 . Draw Tissue
Double click first dot to
render.

83 | exocad ALL ON X STEP-BY-STEP GUIDE

83 . Change Thickness
Change thickness to 2mm.
Edit the margin if needed by
dragging the balls. Hit
“Apply” to render changes.

84 | exocad ALL ON X STEP-BY-STEP GUIDE

84 . Next
Hit “Next”.

85 | exocad ALL ON X STEP-BY-STEP GUIDE

85 . Free Form Tissue
Use a small region to pull
down the papillas from this
view.

86 | exocad ALL ON X STEP-BY-STEP GUIDE

86 . Free Form Tissue
Use add remove and mouth
flatten to smooth the tissue.
We do not need to festoon.

87 | exocad ALL ON X STEP-BY-STEP GUIDE

87 . Done!
You are done. Now you need
to export a few files to save
for day of surgery.

88 | exocad ALL ON X STEP-BY-STEP GUIDE

88 . Export Merged Part
Make sure noting else is
visible. Right-click the screen
and hit “save scene as”.

89 | exocad ALL ON X STEP-BY-STEP GUIDE

89 . Export Merged Part
You should export to Plain
STL.

90 | exocad ALL ON X STEP-BY-STEP GUIDE

90 . Export Merged Part
Visible objects only.

91 | exocad ALL ON X STEP-BY-STEP GUIDE

91 . Export Merged Part
Default orientation.

92 | exocad ALL ON X STEP-BY-STEP GUIDE

92 . Export Pre-Op
Turn on your preoperative
with the teeth and the tissue
as shown. Nothing else
should be on.

93 | exocad ALL ON X STEP-BY-STEP GUIDE

93 . Export Pre-Op
Right-click “Save Scene As”.

94 | exocad ALL ON X STEP-BY-STEP GUIDE

94 . Export Pre-Op
Export as plain STL.

95 | exocad ALL ON X STEP-BY-STEP GUIDE

95 . Export Pre-Op
Visible only.

96 | exocad ALL ON X STEP-BY-STEP GUIDE

96 . Export Pre-Op
Default coordinate system.

97 | exocad ALL ON X STEP-BY-STEP GUIDE

97 . Export Antagonist
This is optional as I usually
don’t use it on day of surgery
same thing. Right click-plain
stl-visible only-default.

98 | exocad ALL ON X STEP-BY-STEP GUIDE

98 . Save the Case
Close the case. Remember
where you saved those files
for day of surgery.

99 | exocad ALL ON X STEP-BY-STEP GUIDE

99. Save the Case
Close the case. Remember
the name you set the case up
because on the day of surgery
you need to be able to locate
this case and open it. If using
the anatomic waxup workflow
you can take this case to the
final merged part.

100 | exocad ALL ON X STEP-BY-STEP GUIDE

 ALL ON X

Anatomic Waxup Technique

101 | exocad ALL ON X STEP-BY-STEP GUIDE

 1 . Anatomic Waxup Technique: Surgery Day
We need to load the files on
day of surgery and convert
this waxup to an all on x
prosthetic.

102 | exocad ALL ON X STEP-BY-STEP GUIDE

 2 . Open Dental DB
Begin, day of surgery, by
opening Dental DB.

103 | exocad ALL ON X STEP-BY-STEP GUIDE

 3 . Click “Default Client”
Select default client from the
drop down menu here.

104 | exocad ALL ON X STEP-BY-STEP GUIDE

 4 . Enter Patient Name
Enter the patient’s name in
the type field.

105 | exocad ALL ON X STEP-BY-STEP GUIDE

 5 . Click a Tooth that has an Implant
To start the conversion, we
need to click one of the teeth
that has an implant.

106 | exocad ALL ON X STEP-BY-STEP GUIDE

 6 . Click Here
Select “Anatomic Waxup”.

107 | exocad ALL ON X STEP-BY-STEP GUIDE

 7 . Screw Retained
Select “3D Print” as the
material and “Screw
Retained”, then hit “OK”.

108 | exocad ALL ON X STEP-BY-STEP GUIDE

 8 . Click OK
Click “OK” to save.

109 | exocad ALL ON X STEP-BY-STEP GUIDE

 9 . Copy to Other Implant Teeth
Copy this prescription to all
teeth that have an implant.
Use control to copy or click
and drag . Click Save.

110 | exocad ALL ON X STEP-BY-STEP GUIDE

10 . Click “Design”
If you can not click “design”,
it means that you did not hit
“save”.

111 | exocad ALL ON X STEP-BY-STEP GUIDE

 11 . Load Scans
What Files are needed?

You need all the files from

hour last design that you
exported. The preop you will
bring in as the arch, the
waxup you bring in as the
waxup. The antagonist as the
antagonist. You also need a
unified scan body scan. This
is made on the day of surgery.

You also need a pre surgical

marker scan and a surgical
tissue cap scan.

112 | exocad ALL ON X STEP-BY-STEP GUIDE

12 . Load Your Scans
You need to load the
appropriate scans.

113 | exocad ALL ON X STEP-BY-STEP GUIDE

13 . Immediately go to Expert Mode
It is a good idea to predesign
the gingiva incase you need to
use the anatomic waxup
method taught later on in this
series.

114 | exocad ALL ON X STEP-BY-STEP GUIDE

14 . Tools: Add / Remove Mesh
We need to load some
surgical scans to help with
scanbody location.

115 | exocad ALL ON X STEP-BY-STEP GUIDE

15 . Generic Mesh
Select generic visualization
mesh as mesh type and hit
“load”.

116 | exocad ALL ON X STEP-BY-STEP GUIDE

16 . Load Pre-Surgical Marker Scan
We need to merge the pre-
surgical marker scan, hit “no”
here.

117 | exocad ALL ON X STEP-BY-STEP GUIDE

17 . Orientation Marker Scan
Left-click the marker scan
and drag it to the side.
Control left click to rotate it.
Get it to be next to and in the
same orientation as the other
scans.

118 | exocad ALL ON X STEP-BY-STEP GUIDE

18 . Align Meshes
Turn off everything except the
preoperative scan and the
pre-surgical marker scan. Hit
“Align Meshes”.

119 | exocad ALL ON X STEP-BY-STEP GUIDE

19 . Pick Common Points
Always start on the marker
scan and go to the
preoperative scan and click
the same exact spot. Notice
the direction of the arrows.

120 | exocad ALL ON X STEP-BY-STEP GUIDE

20 . Perform Alignment
Click “Perform Alignment”.

121 | exocad ALL ON X STEP-BY-STEP GUIDE

21 . Best Fit Match
Click “Best fit Match”.

122 | exocad ALL ON X STEP-BY-STEP GUIDE

22 . Evaluate Merge
You should see an accurate
merge of common areas.

123 | exocad ALL ON X STEP-BY-STEP GUIDE

23 . OK
Click “OK” on the small
window but stay in add
remove mesh.

124 | exocad ALL ON X STEP-BY-STEP GUIDE

24 . Replace Jaw Scan
Now that the marker scan is
aligned to the preop. We
need to replace the jaw scan
with the surgical tissue cap
scan. We are still in expert
mode add remove mesh
module. Hit extra jaw scan
and hit “load”.

125 | exocad ALL ON X STEP-BY-STEP GUIDE

25 . Replace Jaw Scan
Hit “no” and it will not
come in aligned.

126 | exocad ALL ON X STEP-BY-STEP GUIDE

26 . Click “OK”
Click “OK” here.

127 | exocad ALL ON X STEP-BY-STEP GUIDE

27 . Tools-Align Mesh
We need to align the new jaw
scan.

128 | exocad ALL ON X STEP-BY-STEP GUIDE

28 . Manually
Use manual mode first. Be
careful not to click any other
model or move any other
model.

129 | exocad ALL ON X STEP-BY-STEP GUIDE

29 . Automatically
Select “Automatically”.

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30 . Click Common Spots
Notice the direction of the
arrows. Focus mostly on the
markers. At least 5 spots.

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31 . Exclude Elect Spots
Hit matching exclude selected
spots and then paint the
common areas.

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32 . Invert
Click invert to change the
selection as shown

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33 . Perform Alignment
Click “perform alignment”.

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34 . Best Fit Match
Now hit “best fit”. Exocad will
only look at the Data that is
not blue.

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35 . Evaluate
Turn off the matching exclude
selected parts and turn on
show distances. The markers
should be accurate.

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36 . OK
Click “OK”.

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37 . Back to Align Meshes
Now we can merge the unified
scanbody scan to the surgical
tissue cap scan.

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38 . Manually
Go to manually and move and
rotate the unified scanbody
scan to make them off to the
side but in the same location
as the surgical tissue cap
scan.

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39 . Automatically
Now click “automatically”.

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40 . Common Spots
Always start on the unified
scanbody scan. One spot per
scanbody. Notice direction of
the arrows.

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41 . Perform Alignment
Click “Perform Alignment”.

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42 . Best Fit Match
It is ok to have some errors.
The weak link is the tissue
scan.

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43 . OK
We are now done merging.

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44 . Wizard
Jump back to wizard mode.
We are at step 1. Rotate the
arch looking straight down
the arch from occlusal. Hit
“next”.

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45 . Skip
Skip this merge step do not
click the models just hit next.
We already aligned them in a
better way.

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46 . Replace
Click replace the whole scan.

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47 . Merge Standby
Find the implant library that
matches the surgical caps you
scanned with and allows
direct to MUA. Click the tooth
number as indicated in the
wizard in the spot as shown
on the rendered scan cap
where the red dot is.

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48 . Merge Standby
You can turn off the tissue
scan if it distracts you.

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49 . Perfect Merge
If it is not all blue you may
have picked the wrong
library, if you do not see
colors hold control when
clicking the scanbody.

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50 . Follow Wizard and Merge
Hit “next” and on to the next
one. Make sure to check the
tooth is correct.

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51 . Follow Wizard and Merge
Hit “next” and on to the next
one. Make sure to check the
tooth is correct.

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52 . Follow Wizard and Merge
Hit “next” and on to the next
one. Make sure to check the
tooth is correct.

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53 . Follow Wizard and Merge
This is the last one.

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54 . Follow Wizard and Merge
This is the last one.

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55 . Click “Next”
All done.

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56 . MUA
You should now see virtual
MUA abutments. If your
tissue cap scan does not have
holes in it, it is because a bad
exocad library. You can cut
them out manually by expert
mode, edit mesh.

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57 . Define Emergence Profile
Keep hitting “next” we do not
do anything here.

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58 . Abutment Bottoms
Keep hitting “next” for this as
well. We do not do anything
here.

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59 . Free Form Step
Add remove and smooth
flatten to bulk and smooth
areas.

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60 . Tissue
I underestimated the bone
reduction when I did my
original waxup. See the space
here. Easy fix.

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61 . Anatomic Paint Pull
Go to anatomic paint pull.

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62 . Paint Pull
Paint the tissue of the waxup.

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63 . Paint Pull
Pull it.

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64 . Paint Pull
Pull it to tissue.

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65 . Flatten
Use Flatten.

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66 . Flatten
Use Flatten.

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67 . Check Tissue Pressure
Change the color scale to
distance to scan data. Make
sure to hit nearest point
distance.

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68 . Check Tissue Pressure
Change the color scale to
0.01-1mm.

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69 . Cut Tissue
Go to adapt -basal. Drag to
-350 microns. And hit the
basal button.

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70 . Cut Tissue
Go to adapt-basal. Drag to
-350 microns, then hit basal
button.

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71 . Cut Tissue
Go to adapt -basal. Drag to
-350 microns. And hit the
basal button.

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72 . Flatten
After the cut just flatten the
tissue surface, it should be
smooth, convex, or flat, and
cleanable.

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73 . Festoon
Do some festooning.

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74 . Festoon
Do some festooning.

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75 . Next
Hit “Next”.

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76 . Next Again
Hit “next” again.

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77 . All Done
You are now done and ready
to print.

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 ALL ON X

Pre-Surgical Waxup
PONTIC WAXUP
EDENTULOUS ARCH

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 1 . Pontic Waxup Edentulous Arch
Typically you will have a
scan of an old denture. This
denture ideally is relined
and fits well. Then you have
a photograph or 3D face
scan off the old denture in
place. You will then use that
information to wax the arch
and have it ready for surgery
day. The patient does not
like the esthetics of this
denture so we will need to
wax the arch just using the
old tenure as a guideline to
align the scans to the face.

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 2 . Open Dental DB
AI features are only
available in some regions
and on exocad 3.2-9 or
later.

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 3 . Click “Default Client”
Select Here.

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 4 . Click “Default Client”
Select “Default Client” in
the drop down menu.

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 5 . Enter Patient Name
Enter the patient’s name
in the type field.

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 6 . Click Distal Most Tooth
To start the pre-surgical
wax up, we need to set the
case up as pontic wax up.

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 7 . Click Here
Select pontic wax up.

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 8 . Click “3D Print”
Select “3D print” as the
material.

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 9 . Click Virtual Gingival and Pre-Op
It is a good idea to
predesign the gingiva
incase you need to use the
anatomic waxup method
taught later on in this
series. Also select Preop
so you can bring in the old
denture scan.

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10 . Click “Yes, Design Digitally”
This means you do not have a
scanned wax up and you are
designing yourself

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 11 . Click “OK”
Click the “OK” button to
continue.

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12 . Click “Contralateral Tooth”
Select the distal-most
contralateral tooth while
holding shift on the keyboard.
This will copy the
prescription.

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13 . Click “Save”
You have to hit save so you
can design.

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14 . Click “Design”
We will need to load the files
next.

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15 . Load Proper Files
You will need to load

1) tissue scan

2) denture scan

3) opposing

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16 . Orientate Scan Date
Rotate the tissue scan looking
top down like this.

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17 . Click “Next”
Click next. If your scans are
not aligned you need to align
them by going to expert mode
tools, align meshes. Mine are
already all aligned form the
scanner software. If you do
not know how to do this with
your scanner I think you need
training on scanning.

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18 . Smile Creator
We will start smile creator. If
you do not have photos to
work with, you should. I
would never do any of this
without at least photos and
preferentially face scans. You
would skip this whole step by
hitting next.

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19 . Load Retracted Photo
Click “load retracted photo”.

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20 . Navigate to Retracted Photo
If this cloud feature menu
pops up just hit “confirm”.
We will not be using the AI
features as this is not
available everywhere.

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21 . Use Manual Alignment
Exocad does have AI cloud
alignment but it rewires
segmentation. Segmentation
is still buggy.

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22 . Click “Contralateral Tooth”
Select the distal most
contralateral tooth while
holding shift on the keyboard.
This will copy the
prescription.

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23 . Click “Common Spots”
Left-click the patient's right
cuspid CEJ and then left
cupid cusp tip.

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24 . Click “Common Spots”
Left click the patient right
cuspid CEJ and then left
cupid cusp tip.

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25 . Repeat Dots on Scan of Denture
Select the same dots in the
same order on the denture
scan.

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26 . Repeat Dots on Scan of Denture
Select the same dots in the
same order on the denture
scan. Then hit “next”. It helps
if the denture scan is rotated
in the same orientation as the
denture in the photo before
hitting next.

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27 . Fine Tune Match
I typically first right-click the
midline and drag the mouse
to rotate the detour scan and
split the difference in error
between right and left sides. I
then left click the center of
the dot and drag the balls
slightly so the silhouette is
better in alignment to the
photo. I repeat this a few
times until perfect. For more
information on smile design
check out our smile design
exocad manual.

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28 . Fine Tune Match
First right click midline and
drag to rotate the denture.

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29 . Fine Tune Match
Then left click the center of a
dot and move the dot slightly
to help the alignment.

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30 . Repeat
Repeat until you have a
perfect match all the way to
the molar region. Pay
attention to midline and
incisal embrasures.

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31 . Click “Next”
Click next when satisfied with
alignment. At first this takes
a while but an experienced
designer this is a 60 second
step.

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32 . Click “Load Smile Image”
We now will load a smile
image. The smile image
should be made after the
retracted image and from the
same angle. If the camera or
the patient moved between
the retracted image and smile
image the images will be
worthless. Use a tripod and
make sure to coach the
patient to keep the head still
when removing the retractors.

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33 . Automatic Alignment
If you did the photos
correctly the images will
automatically align. My
images always automatically
align perfectly. My team has
the shot protocol dialed. If
you do not take the photos
correctly, they will never
align. You can try all you
want and might get a few
teeth to align but you really
can’t trust the data.

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34 . Lips
Mark the lip line. Click the
line to get more control
points. Hit “next” when done

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35 . Pupils
Drag the pupil dots to be
perfectly in the center of the
pupils. Hit “next” when done.

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36 . Midline
First focus on facial midline.
Drag the midline dot left or
right to the desired facial
midline. Exact puts midline
equal distance between
pupils. It often needs
refinement as people are very
asymmetrical.

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37 . Gingival Zenith Line
Drag the gingival zenith line
to the new midline position. If
you do not have this line
check your settings and
exocad version. You can
manually add the line using
add lines and curves.

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38 . Smile Arc Line
Drag the smile line to the new
midline position. If you do not
have this line, check your
settings and exocad version.
You can manually add the line
using add lines and curves.

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39 . Proportion Gauge
I change from the golden
ration to the 100-65-60
ration and then move the
vertical bar to midline, then
the horizontal bar to the
desired location of 8 and 9
incisal edge. Then you set the
cuspid bar any clicking here
and moving the cuspid line to
the distal of the cuspid or
alar region of the nose.

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40 . Smile Creator Modeling
I do not spend a lot of time
here. I mainly dial in my front
4 teeth. I only do global
movements where I move all
the teeth at the same time.
Make sure the bounding box
is around all the teeth. If you
do not see a box click and
draw a square around all the
teeth. Here we are making a
massive change to midline
compared to the old denture.

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41 . Roate Proclination
Step one for me is to always
rotate the proclamation of the
arch. Usually, I have to rotate
the teeth more palatal.

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42 . Establish Incisal Edge Location
Left-click the center of the
box in the silhouette and drag
the entire arch to where the
incisal edge is on the
horizontal line of the
proportion gauge. Make sure
the midline is also in line with
the proportion gauge.

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43 . Establish Tooth Length
Click measurements then
click the central then click 3
the blue dot to lengthen or
shorten the teeth. Ideally
your central is 10-11mm
2
long.
1

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44 . Establish Overjet
Focus on the center row on
the left column. Click the
center of the square and
move the arch anterior or
posterior looking at the
overjet.

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45 . Check Your Values
Check midline, incisal edge
location, tooth size and
overjet. Hit Next when done.
Please not we have a smile
design handout that goes into
much more details on smile
deign.

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46 . Hit “Next”
I do not use this tool so hit
“next”.

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47 . Click “Done”
I do not use this PDF so hit
“done”.

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48 . Tooth Placement-Chain
Most of the design happens in
tooth placement. Click chain
mode.

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49 . Lock the Centrals
Lock the centrals by clicking
the green balls and turning
them red. This will keep our
tooth size and midline where
we had created it from the
facial photos.

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50 . Unlock the Molars
Unlock the molars by clicking
the red dot to green. If you
can’t find the red dot check
the intaglio surface.

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51 . Move Molars
Set the arch size by drawing
the molars. You click them
and move them. You can use
the preoperative denture as a
guide. In this case, the old
denture was very bad so I am
only using it as a loose
guideline.

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52 . Advanced
I tend to get out of chain
mode quick. I only lock the
centrals unlock the molars
and move the molars. Then I
head to advanced.

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53 . Click on the Eye Icon
Select the eye icon and
instant atomic morphing and
apply to all.

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54 . Move Individual Teeth
Each tooth can be refined
now individually. The
occlusion will be equilibrated
as you move the tooth. Click
to move, control left click to
rotate, control and shift and
left click to stretch (my
favorite). Work your way
around the arch refining the
teeth.

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55 . Refine Tooth Positions
Work your way around the
arch and refine tooth
locations.

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56 . Check Occlusion
The teeth should have
occlusion and it should be
mostly blue color of you have
show contact areas as your
selected color range. It is ok
if they are not perfect as we
will refine them in the
freeform stage. All the teeth
should be touching with no
unintentional diastema. Hit
“next” when happy with tooth
location and basic tooth
contacts.

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57 . Free Form
Select add/remove and add to
areas that need occlusal
contact and remove areas
that you do not want to have
contact.

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58 . Free Form
Select add/remove and add to
areas that need occlusal
contact and remove areas
that you do not want to have
contact.

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59 . Free Form
Select add/remove and add to
areas that need occlusal
contact and remove areas
that you do not want to have
contact.

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60 . Adapt
Click adapt and static
occlusion to further refine
contact strength. Ideally true
blue is the color when show
contact areas is the color
scale of exocad. Be careful
some versions of exocad
default to show interference
contacts in which case blue is
too hard of a contact. You
can change the color map in
the top color scale menu bar
in the show distances tab or
in settings.

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61 . Adapt
Now we have good static
occlusion. What about
dynamic occlusion?

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62 . Expert Mode
We can jump into expert
mode and mount this on the
virtual articulator.

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63 . Tools: Articulator
Navigate to tools and then
find the articulator icon.

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64 . Automatic Alignment
One thing that is nice about
exocad 3.2 is automatic
alignment in the skull articulator
and the ability for mandibular or
maxillary movement. If you don’t
have this feature, you can drag
the model into the articulator
using control to rotate. Or you
can click automatically and select
the 3 points indicated. Once
happy with the position of the
teeth in the articulator, hit ok on
the small box. A merged face
scan helps with mounting. Check
our face scan chapter in our
exocad handouts to learn more.

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65 . Leave the Gap
Exocad will detect a gap
between the tissue scan and
the antagonist. Leave the
gap.

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66 . Start Movements
Click start articulator
movements.

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67 . Click “OK”
Click ok to save the
movements.

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68 . Click “Wizard”
Enter back into wizard to go
back to the freeform tab.
Except now we will have
dynamic occlusion.

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69 . Adapt Dynamic
You should see new colors
now and have a dynamic
option in the free-adapt tab.

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70 . Exclude Selected Parts
Click the small box on
exclude selected parts.

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71 . Paint Incisal Edges
Paint the incisal edges of the
anterior teeth and then hit the
dynamic button. What his
does is it prevents the
software from slicing away
the incisal due to lateral and
protrusive movements but it
will adapt the dynamic
occlusion everywhere else.

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72 . Use Slider to Fine Tune
First turn off dynamic
contacts. Then drag the slider
in protrusive and
laterotrusion left and right.
Use the add remove tool to
refine.

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73 . Group Function
We want group function
where when the patient slides
into laterotrusion left al the
teeth cuspid back hit at the
same time and with the same
pressure. Then we want to
eliminate not working side
contacts.

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74 . Group Function
We want group function
where when the patient slides
into laterotrusion left al the
teeth cuspid back hit at the
same time and with the same
pressure. Then we want to
eliminate non working side
contacts.

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75 . Anterior Guidance
When the patient goes into
protrusive movements you
want equal pressure through
the first 4 mm of protrusive
motions which usually covers
the most physiological range
of movement in most people.
It is worth noting Modjaw for
other jaw motion data can
easily be imported for more
accurate movements.

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76 . Proximal Contacts and Basal
We need to adapt basal
contacts which will slice the
pontics from the tissue.

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77 . Click “Next”
Click “next” to move on.

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78 . Adapt to Pre-Op Scan
The software will ask if you
want to adapt your new tech
to match the preop denture.
This is a hard NO. we do not
want to copy that old thing.
Just hit “next”.

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79 . Virtual Waxup Bottom
Rotate the model form the
occlusal view with a slight
facial bias and hit set from
view then hit next.

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80 . Virtual Waxup Bottom
Rotate the model form the
occlusal view with a slight
facial bias and hit set from
view then hit next. We will
update this on the day of
surgery with our new surgical
scan but it save a few
seconds on day of surgery to
do it once now.

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81 . Next
Hit “next”.

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82 . Draw Your Tissue
Draw your tissue margin.
Remember we are making a
conversion out of this. We do
not really know exactly where
the implants will be so make
it a little bigger than you
think.

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83 . Render Tissue
Double click on first dot to
render the tissue.

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84 . Change Thickness and Refine
Change thickness to 2mm.
Click any green balls on the
tissue and drag them as
needed to adjust the tissue
borders. Hit apply to see the
changes rendered.

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85 . Change Thickness and Refine
Change thickness to 2mm.
Click any green balls on the
tissue and drag them as
needed to adjust the tissue
borders. Hit apply to see the
changes rendered.

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86 . Next
Hit “Next”.

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87 . Sculpt Tissue
Use the small region tool
under anatomic to drag
papilla down into the gingival
embrasures.

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88 . Free-Form
Use the Free- add/remove
tool to bulk the tissue then
use the smooth tool to
smooth it. You should not
festoon at this point.

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89 . Save and Exit
Go ahead and save and exit.
We are done with the pre
surgical design. Remember
what you called this case so
on the day of surgery you can
bring it back up.

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 ALL ON X

Day of Surgery Conversion

EDENTULOUS ARCH

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 1 . Day of Surgery Conversion
Day of surgery conversion
is a game of aligning
meshes. This is very easy
to do when experienced. It
can be frustrating when
not experienced. Ultra-
aggressive bone reduction
and lack of tissue markers
can make it very difficult.
CBCT alignment may help
in these scenarios.

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 2 . Open Dental DB
Open dental DB.

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 3 . Load Pre-Surgical Wax Up
We need to load the pre-
surgical wax up.

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 4 . Find the Pre-Surgical Design
Search for the pre-surgical
design.

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 5 . Click Load
Hit “load”.

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 6 . Click “Design”
Click Design to reopen the
design file where you left
off.

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 7 . Click Load Scene
Load the scene.

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 8 . Enter Expert Mode
Immediately enter expert
mode.

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 9 . Click Tools
Hit Tool- Add Remove
Mesh. We need to add the
pre-surgical marker scan.
This scan is often done at
the beginning of surgery to
help with the alignment of
the post surgical scan to
the preoperative scan.

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10 . Generic Visualization
Select generic
visualization mesh.

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 11 . Click “Load”
Click load and search for
the newly made day of
surgery intermediate
marker scan. This scan is
critical for accurate
alignment.

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12 . Click “No”
It does not matter what
you select here.

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13 . Rotate, Then Pin
Click the newly imported
scan and drag it. Hold
control and left-click the
center of the new scan to
rotate it. To rotate the
entire scene left-click the
blank screen. You want to
get the new scan next to
and in the same
orientation as the
preoperative scan.

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14 . Align Meshes
Once the models are next
to each other at similar
orientations click the
“Align Meshes” box.

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15 . Find Common Data
First, click a spot on the
newly imported day of
surgery marker scan.
Then, click the same spot
on the original
preoperative scan. Repeat
at least 5 times. Notice
the arrows point from the
new scan to the old scan.
Letting you know the
direction the scan is
moving. This is important
as the old scan has the
waxup aligned to it.

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16 . Exclude Selected Spots
Due to local infiltration
the day of surgery marker
scan will have differences
compared to the pre-
operative scan. Check this
box to exclude selected
parts.

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17 . Paint Common Data
Paint common data blue.
Avoid movable tissues.

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18 . Invert
Click invert. This will
make the all other areas
blue except where you
painted. Exocad will not
take blue areas into
consideration when doing
the best fit match.

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19 . Perform Alignment
Click perform aliment to
bring the two scans
together based exclusively
on the points you
selected.

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20 . Evaluate
Unclick matching exclude
selected parts and then
click the show distances
to see the color map of
alignment. The distances
are indicated in the color
map bar below the check
box. Stay in the add
remove mesh module.

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21 . Click “OK”
Click ok on the small
window, but stay in this
add-remove mesh module.
Now, you wait for the
surgical tissue cap scan
and the unified scan body
export. These are two
different files. First,
merge the surgical tissue
cap scan to this
intermediate visualization
mesh that you just
merged.

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22 . Load Surgical Tissue Cap Scan
Click extra jaw scan.

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23 . Load Surgical Tissue Cap Scan
Click load and navigate to
the new surgical tissue cap
scan.

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24 . Click “No”
It does not matter what
you select here.

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25 . Click “OK”
The tissue cap scan will
not be aligned to the other
scans. That is ok. We will
do that alignment in a
different module. Just
click ok to save.

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26 . Click Tools-Align Meshes
We will now enter the
align meshes tool to merge
the surgical tissue cap
scan to the intermediate
marker scan.

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27 . Move and Rotate
Only move the surgical
tissue cap scan. Be careful
not to move the other two
scans. Left click on the
tissue cap scan and drag it
off to the side. Then
control and left-click the
middle of the tissue cap
scan to rotate it. Get it to
be side by side and at the
same orientation as the
other scans.

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28 . Click Automatically
You can now click
automatically. Turn off the
preoperative scan and
only show the
intermediary marker scan.

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29 . Click Common Points
Focusing on the marker
and non-movable tissues
find common spots.
Always first click the
surgical tissue cap scan
then, click the
intermediary marker scan
in the exact spot.

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30 . Repeat 5 times
Repeat at least 5 times,
but the more spots the
better.

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31 . Exclude Elected Parts
Click the “exclude
selected parts” box.

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32 . Paint Common Areas
Paint common data
between the scans.

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33 . Invert Selection
Flip the colors by clicking
invert. Exocad will not use
the blue data for the
alignment.

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34 . Perform Alignment
Click perform alignment.
This moves the sriuagical
cap scan to the
intermediary marker scan
using only your dots
selected.

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35 . Click “Best Fit Match”
Click best fit match and
now all the data that is
painted will be considered
for the matching. Millions
of points will be analyzed.

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36 . Evaluate Merge
To see the color uncheck
exclude selected parts box
and check show distance.

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37 . Click “OK”
Click OK to save the
merging.

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38 . Tools: Add/Remove Mesh
We need to bring the
unified scanbody scan in.

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39 . Select Scan Marker Scan
Select scan marker scan
and hit load. Find the
unified scan body scan
that was exported from
your Grammetry,
photogrammetry or IPG
device. Make sure it was
the same export as the
tissue caps you used.

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40 . Click “No”
Click no or yes it does not
matter.

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41 . Move the Scan Marker Scan
Click and drag the scan
marker scan. Hold control
and left click to rotate
them. Make sure you click
them to rotate and not the
scene.

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42 . Get Them in Position
You want the scan markers
in the same orientation
and facing the same way
as they are on the surgical
tissues cap scan.

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43 . Align Meshes
Click the align meshes
button.

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44 . Click Common Spots
Click one spot on each
scanbody tissue cap.
Always start on the newly
imported unified
scanbody scan and then
pick the same point on the
surgical tissue cap scan.
Notice the direction of the
arrows. They go from the
unified scanbody scan to
the surgical tissue cap
scan.

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45 . Perform Alignment
Click here.

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46 . Best Fit Match
Use best fit match to
refine alignment.

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47 . Evaluate
It is normal to have
discrepancy here. The
weakest link is the surgical
tissue cap scan. The
unified scanbody scan is
much more accurate. It is
important to understand
this concept. The surgical
tissue cap scan has noting
to do with implant to
implant position and only
aids in aligning the unified
scan to the waxup and soft
tissue.

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48 . Click “OK”
Click OK to save.

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49 . Click Wizard
Click back to the wizard

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50 . Click “Next”
Do NOT align the models
here. We already aligned
them using more
sophisticated alignment
tools. Just ignore this and
hit “next”.

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51 . Click Replace the Whole Scan Data
Click replace scan data,
this will remove the old
pre surgical scan that the
waxup was made on and
replace it with the surgical
tissue cap scan.

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52 . Back to Expert Mode
Before the waxup
calculates head to expert
mode.

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53 . Select Implant Teeth
In expert mode, click a
tooth that is where your
implant is, and then on the
bottom menu hit select
implant type.

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54 . Click “Screw Retained”
Click screw retained then
“OK”.

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55 . Repeat for Every Implant Tooth
Repeat the steps for each
implant, changing the
tooth to the screw-
retained. However many
implants are placed are
how many teeth should be
changed.

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56 . Back to Wizard
Head back to wizard for
scanbody alignment

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57 . Find Proper Library
You need to find the
exocad library for the
screw you want to use and
that is the same geometry
as the tissue cap you
scanned with and the
tissue cap you imposed as
a unified scanbody.

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58 . Merge Scanbody
If you want to hide your
jaw so you only see the
sandy hit “S” on the
keyboard. Now click the
spot on the scanbody the
is indicated by the red dot
in the preview window.
Make sure you are working
tooth number the tooth
prompted in the wizard.

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59 . Evaluate Mesh
It should have one true
blue, which indicates a
perfect match. If you do
not see colors hold control
and clock the dot again.
Any other color means you
have the wrong library.

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60 . Click “Next”
Click next to move onto
the next tooth.

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61 . Repeat
Just repeat for each
tooth.

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62 . Repeat
The last tooth is being
merged now. Next we will
evaluate the substation of
the tissue caps. Hit Next

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63 . Evaluate Tissue Cap Delete
The tissue caps should
one deleted from the
surgical cap scan and you
should now be able to see
the digital MUA.

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64 . Expert Mode
Almost always you see
areas remaining of the
surgical caps. We can
delete this and also
regenerate virtual waxup
bottom in expert mode.

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65 . Edit Mesh
In expert mode right click
the tissue scan and hit edit
mesh.

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66 . Select
Select the area around the
remains tissue cap scan.

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67 . Delete
Hit delete to remove then
hit OK.

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68 . Click Virtual Wax Up Bottom
Click the model than go to
virtual wax up bottom

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69 . Click Update
Click update.

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70 . Click “OK”
Next click ok and save.

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71 . Back to Wizard
We need to go back to
wizard.

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72 . Define Emergence Profile
We do not need to do
anything here except hit
next for each implant.

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73 . Abutment Bottoms
We do not need to do
anything here except hit
next for each implant.

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74 . Virtual Wax Up
A virtual wax up scan will
be generated.

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75 . Free-Form
Most of the freeform is
spent smoothing tissue
surfaces. At first, the
design will be concave and
uinclensable. Use the
free- smooth flatten tool
to smooth the fitting
surface and shrink the
distal extensions.

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76 . Free-Form
Most of the freeform is
spent smoothing tissue
surfaces. At first the
design will be concave
and uinclensable. Use the
free- smooth flatten tool
to smooth the fitting
surface and shrink the
distal extensions.

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77 . Check Tissue Pressure
Click distance to scan
data. Nearest point
distance checked. Change
the scale not 0.1-1mm

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78 . Adjust Tissue Pressure
A color coded map of
tissue pressure can be
seen now. You can go to
adapt tool and hit BASAL
or you can smooth it here.
I tend to like bout 300-500
microns of pressure.
Depending in the ridge.
Make sure no concavities,
creases or uinclensable
areas exist. Please note a
printed provisional will be
more thick compared to
the final

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79 . Adjust Tissue Pressure
A color coded map of
tissue pressure can be
seen now. You can go to
adapt tool and hit BASAL
to get you to a target
number then you can
smooth it from there.

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80 . Click “Next”
Click next to add screw
channels.

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81 . Click “Next”
Nothing to do here except
next.

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82 . All Done
You are all done with the
design and now can print.
Any issue with merging is
most likely a library issue
or your waxup had errors.

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 ALL ON X

Pre-Surgical Waxup
DUAL ARCH

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 1 . Pontic Waxup Technique: Denate Arch
This technique is favored
by a lot of people
especially where a lot of
bone reduction is done.
This technique allows for
fast and easy tissue
surface modifications on
day of surgery. However
this technique is more time
consuming and if less than
2mm of bone reduction is
done this technique is not
as good as the “easy”
technique.

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 2 . Open Dental DB
AI features are only
available in some regions
and on exocad 3.2-9 or
later.

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 3 . Click “Default Client”
Select “Default Client” in
the drop down menu.

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 4 . Enter Patient Name
Enter the patient’s name
in the type field.

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 5 . Click the Distal-Most Tooth
To start the pre surgical
waxup we need to set the
case up as pontic waxup.

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 6 . Click Here
Select pontic waxup.

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 7 . Click “3D Print”
Select 3D print as the
material.

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 8 . Click “Virtual Gingiva”
It is a good idea to
predesign the gingiva
incase you need to use the
anatomic waxup method
taught later on in this
series.

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 9 . Click “Yes, Design Digitally”
This means you do not have a
scanned waxup and you are
designing yourself.

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10 . Click “OK”

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 11 . Click “Contralateral Tooth”
Select the distal most
contralateral tooth while
holding shift on the keyboard.
This will copy the
prescription.

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12 . Select “Opposing Arch Tooth ”
Click and hold the mouse
button down and drag one of
the prescription teeth from
the upper arch to the distal
most tooth in the lower arch
assuming you are waxing both
arches.

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13 . Click Contralateral Tooth
Hold shift and click the distal
most contra later tooth to
copy the prescription across
the lower arch.

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 14 . Click “Save”
Click save or you can’t
proceed to design.

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 15 . Click “Design”
Now hit “Design”.

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16 . Load Files
In a dual arch case, exocad
will ask for upper first then
lower. Any OBJ, STL, or PLY
works. The scans will come
into the scene with the same
occasion that you scanned
them in with your IOS.
Therefore if wanting to open
the vertical it is easies to do
that with a deprogrammer or
Lucia jig, leaf gauge, or other
method and scan at the
desired vertical. Alternatively,
you can open on the virtual
articulator

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 17 . Adjust Orientation
Rotate the models so you are
looking down the occlusal of
the lower arch like shown
here. Hit next when ready.

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18 . Click Load Retracted
If you do not have
photographs you really need
to ask yourself why. I would
never design a case without
photos.

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19 . Find Retracted Photo
Navigate to a retracted photo.

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20 . Click First Point
I usually like to click the CEJ
of tooth 6 and the cusp tip of
tooth 11 starting on the photo
then, moving to the Intraoral
scan (IOS)and repeating the
same spots. If you can see a
dot when you click, you must
have already placed it
somewhere. Zoom out and
search for it.

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 21 . Click Second Point
My second point is usually
the cusp tip of 11. It is
unwise to cross the arch and
go to the mandible as you
can’t be sure the patient is in
proper occlusion and the
occlusion is the same as the
IOS.

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22 . Click First Point IOS
Click CEJ of 6 on the IOS. It
helps if the IOS is in the same
angle and orientation as the
photo.

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23 . Click Second Point IOS
Click cusp tip of 11 in the
IOS.

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24 . Click “Next”
Click the “Next” button.

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25 . Rotate First
At the midline and right click
and drag the mouse to rotate.
We have to align the IOS to
the photo. Small movements
are best. Split the difference
in the error on both sides
equally rather than trying to
match one side perfectly at
the expense of the other.

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26 . Refine Dots
Click the center of the dot
using the left lick and move
the ball slightly to refine the
match. Repeat on the
contralateral dot.

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27 . Click “Next”
When the match is perfect
including both the anterior
and posterior teeth you can
hit next. You may have to
repeat the previous two steps
several times to get a perfect
match.

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28 . Load Smile
Navigate to your smile photo.
It is important that the smile
and retracted photos are
taken at the same head
position and that a tripod for
your camera is used. If done
correctly, exocad will
automatically align the smile
and the retracted.

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29 . Evaluate Merge
You can tell a good smile
merge with the retracted
photo by zooming in on the
teeth. The front 6 teeth
should be clear with no
ghosting or blur. If they are
not perfect, you can tweak
the dots by clicking the
center of the dot and moving
them. If you have bad photos
no amount of adjustments
here will create a better
alignment. Hit “Next” when
happy.

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30 . Mark the Lip
Click the line to add more
control points as needed to
move the lip outline. Click
“next” when happy.

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 31 . Mark the Pupils
AI will auto detect the eyes
and add a dot near the
middle of the pupil. Click the
dot and move it to refine the
location. Hit next when done.

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32 . Refine Smile Helper Lines
Typically I move the facial
midline to be more inline with
the nose and maxilla. I then
move my gingival zenith and
smile arc lines to match. I
then move my proportion
gauge to the midline and place
the horizontal bar where I
want my incisal edges of the
centrals to be. Then I contract
the proportion gauge so the
last line is matching to the
distal of the cusp or nares of
the nose. The width of the
central should be 8-9mm.

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33 . Hit “Next”
When happy with helper lines
hit “next”.

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34 . Adjust Proclination
The bottom right corner box I
usually click the chevron and
rotate the arch to adjust
proclination. Usually I have to
move the incisal edges
towards the palatal.

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35 . Reposition Smile
Click the center of the central
and move the entire arch up
to where the incisal edge of
the central is on the
horizontal line of the
proportion gauge. Make sure
you are moving all teeth here.
You should have a box around
all the teeth. If not, click and
drag a big square around all
the teeth in any of the left
windows.

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36 . Measure Central
Click measurement and then
click the central incisor.

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37 . Adjust Tooth Length
Click the blue dot above the
central indoor around the box
that is encompassing your
smile silhouette. Drag the
blue dot to shrink or lengthen
the teeth. Most people will
have a central on the
10-11mm range.

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38 . Adjust Anterior-Posterior Position
This is ultra critical. Click
the middle box on the right of
the screen and move the
entire arch anterior or
posterior to the desired
location. Before hitting next
check your silhouette to make
sure it is correct and you did
not accidentally move the
midline while position the
arch.

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39 . Click “Next”
There is a lot more you can
do in this step, but I prefer to
finalize my tooth positions in
the Tooth Placement tab due
to chain mode and instant
anatomic morphing. Hit
“next”.

391 | exocad ALL ON X STEP-BY-STEP GUIDE

40 . Click “Continue Without”
Here we will not use AI
photorealistic preview.

392 | exocad ALL ON X STEP-BY-STEP GUIDE

41 . Click “Next”
Click “Next” as I do not use
this step or show the patient
this.

393 | exocad ALL ON X STEP-BY-STEP GUIDE

42 . Click “Done”
I also do not use the PDF
report so I click “done”.

394 | exocad ALL ON X STEP-BY-STEP GUIDE

43 . Tooth Placement
Click Chain mode and lock
the front 4 teeth and unlock
the back teeth.

395 | exocad ALL ON X STEP-BY-STEP GUIDE

44 . Lock the Incisors
Click the green balls to turn
them red on the incisors.

396 | exocad ALL ON X STEP-BY-STEP GUIDE

45 . Unlock the Molars
Click the red balls to green on
the molar region. If you can’t
find them, look underneath
the model.

397 | exocad ALL ON X STEP-BY-STEP GUIDE

46 . Move Molars
Set the arch length by moving
the molars to the proper
location. Lock the molars and
then move the premolars and
cupids using small
movements.

398 | exocad ALL ON X STEP-BY-STEP GUIDE

47 . Hit “Next”
Once the upper arch is set
appropriately, hit “next”. If
you need to move individual
teeth, we will do that once we
set the lower arch.

399 | exocad ALL ON X STEP-BY-STEP GUIDE

48 . Expert Mode
Before creating the virtual
waxup bottom we need to
extract the teeth. Hit expert
mode. Then right-click the
upper arch. Click “Extract
Tooth” in the menu.

400 | exocad ALL ON X STEP-BY-STEP GUIDE

49 . Extract Teeth
Using the extraction tool, all
you do is click virtual preop
as the option and then click
the center of a tooth. The
software will extract the tooth
and then keep a copy as a
preop so you can always refer
back to it.

401 | exocad ALL ON X STEP-BY-STEP GUIDE

50 . Identify The Tooth
Identify the tooth that you
extracted.

402 | exocad ALL ON X STEP-BY-STEP GUIDE

 51 . Keep Extracting
Click extract another tooth.

403 | exocad ALL ON X STEP-BY-STEP GUIDE

52 . Keep Extracting
Click the center of the next
tooth you want to extract.

404 | exocad ALL ON X STEP-BY-STEP GUIDE

53 . Keep Extracting
Repeat this across the entire
arch.

405 | exocad ALL ON X STEP-BY-STEP GUIDE

54 . Keep Extracting
Work your way to the distal
most tooth in the arch.

406 | exocad ALL ON X STEP-BY-STEP GUIDE

55 . Click “OK”
Click “OK” to save your
extractions.

407 | exocad ALL ON X STEP-BY-STEP GUIDE

56 . Smooth Model
We now need to right-click
the upper model and hit
freeform scan date.

408 | exocad ALL ON X STEP-BY-STEP GUIDE

57 . Smooth /Flatten
Click smooth/flatten and
flatten the ridge by holding
shift on the keyboard and
clicking the ridge. You can
also use the remove tool to
simulate bone reduction.

409 | exocad ALL ON X STEP-BY-STEP GUIDE

58 . Refine the Ridge
Use the remove and flatten
tools smoothing the ridge.

410 | exocad ALL ON X STEP-BY-STEP GUIDE

59 . Click “OK”
To save the edits to the scan
data click “ok”.

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60 . Click Wizard
We will now go back to the
wizard.

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61 . Click “Next”
Just hit next to skip adapting
your new waxup to the old
proper teeth form.

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62 . Rotate
Rotate the model to the path
of iteration of the arch and hit
set from view.

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63 . Set from View
This will create the angle of
block-out for the virtual
waxup bottom.

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64 . Next
Click “next” and the virtual
wax up bottom will be
generated.

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65 . Lower Arch
We are now asked to do the
angle of insertion for the
lower, but since we need to
extract teeth, we must go to
expert mode first and remove
the teeth as we did on the
maxilla.

417 | exocad ALL ON X STEP-BY-STEP GUIDE

66 . Expert Mode
Click expert mode.

418 | exocad ALL ON X STEP-BY-STEP GUIDE

67 . Right-Click the Lower Scan
Right-click the lower scan.

419 | exocad ALL ON X STEP-BY-STEP GUIDE

68 . Extract Tooth
Click extract tooth.

420 | exocad ALL ON X STEP-BY-STEP GUIDE

69 . Click a Tooth
Click the center of the
straight facial for anterior
teeth and the central groove
of posterior teeth.

421 | exocad ALL ON X STEP-BY-STEP GUIDE

70 . Identify the Tooth
Identify what tooth you
extracted. Repeat the process
for the remaining teeth.

422 | exocad ALL ON X STEP-BY-STEP GUIDE

 71 . Correct Errors
If the software accidentally
adds two teeth together for
the extraction click the
correction icon. Hold short
and paint the area you want
to remove from the selection
area. Make sure to remove all
the yellow except from the
tooth you want to extract. If
you need to add yellow do
not hold shift while left
clicking.

423 | exocad ALL ON X STEP-BY-STEP GUIDE

72 . Correct Errors
Once the areas have been
corrected, hit apply to see
the changes take effect.

424 | exocad ALL ON X STEP-BY-STEP GUIDE

73 . Click “OK”
Once all the teeth have been
extracted hit OK to save.

425 | exocad ALL ON X STEP-BY-STEP GUIDE

74 . Free-Form
Right click the model and hit
Free-Form scan data.

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75 . Smooth
Smooth the extraction areas
and reduce the ridge like we
did on the maxilla and then
hit ok.

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76 . Back to Wizard
Jump back to the Wizard
mode by clicking the Wizard
icon here. It should take you
to tooth placement for the
lower arch.

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77 . Click Gingiva Area of Left Molar
Here we are going to place
the lower tooth models. Do
not worry they will come in
not so perfect but in the next
tab it is easy to adjust. Click
the tissue area of the distal
most left molar.

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78 . Click Gingiva area of Right molar
Click the tissue area of the
distal most right molar. It
does not really matter if you
select by contact point or
tissue area here.

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79 . Click “Next”
The teeth will look bad. Do
not worry, hit “Next”.

431 | exocad ALL ON X STEP-BY-STEP GUIDE

80 . Tooth Placement
Jump to chain mode.

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 81 . Free All the Lower Teeth
All the lower teeth including
the distal ring should have
green dots. Click the dot to
turn it from red to green.

433 | exocad ALL ON X STEP-BY-STEP GUIDE

82 . Free All Lower Teeth
Make sure to check both
sides for red dots.

434 | exocad ALL ON X STEP-BY-STEP GUIDE

83 . Move Entire Lower
Now the entire lower arch is
movable and scalable
uniformly. Click the arch and
drag it. Hold shift and click-
drag to scale the arch smaller
and bigger. Your goal is to
match the lower anterior as
close as possible to the
preoperative or if there are
not lower teeth in the
preoperative condition you
want anterior overjet with the
lower central occluding on the
lingual incisal 1/3 of the
upper.

435 | exocad ALL ON X STEP-BY-STEP GUIDE

84 . Match Anteriors First
Match the anteriors. You can
hold control to rotate the
entire arch when clicking.
Shift to scale and clic to drag
to translate.

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85 . Lock Anteriors
Now you want to lock your
lower anteriors. Turn the
green balls red. Remember
the maxilla was set to ideal
esthetics so we do not want
to move those too much now
and we are focused on the
mandibular.

437 | exocad ALL ON X STEP-BY-STEP GUIDE

86 . Move Molars
Now, drag your mandibular
first molars to the correct
position on both sides of the
arch by clicking the molar
tooth in the center and
dragging it.

438 | exocad ALL ON X STEP-BY-STEP GUIDE

87 . Move Molars
Make sure to look form all
angles when moving teeth.

439 | exocad ALL ON X STEP-BY-STEP GUIDE

88 . Move Molars
Repeat on the contralateral
side. Click the center of the
molar tooth and drag it where
you want it. Do not worry too
much about perfecting
occlusion yet.

440 | exocad ALL ON X STEP-BY-STEP GUIDE

89 . Advanced Tab
Now we exit chain mode by
clicking the advanced tab.

441 | exocad ALL ON X STEP-BY-STEP GUIDE

90 . Change Settings
You want to have the eye
highlighted orange in the
menu bar and the instant
anatomic Morphing icons on
both upper and lower
highlighted orange as shown.
Make sure the apply to all
text box is highlighted.

442 | exocad ALL ON X STEP-BY-STEP GUIDE

91 . Change Settings
Match these settings.

443 | exocad ALL ON X STEP-BY-STEP GUIDE

92 . Refine Individual Teeth
You can click a single tooth to
move it. You can scale a tooth
by holding shift and click
dragging the mouse. Control
and click dragging the mouse
will rotate the tooth. My
favorite is Control and Shift
at the same time and click
dragging the mouse to morph
the tooth in the direction of
the arrow as shown here.

444 | exocad ALL ON X STEP-BY-STEP GUIDE

93 . Tooth by Tooth
Go tooth by tooth on the
maxilla and mandible. Hiding
teeth can be tricky. Use X
and N on the keyboard. Also
try holding control and
clicking the roller ball button
down on the object you want
to hide. If you want it back
hold Control and Shift and
click the roller ball and the
object will return in the order
it was removed.

445 | exocad ALL ON X STEP-BY-STEP GUIDE

94 . Click “Next”
Click “next” when happy with
the location and contact
areas. Further refinement is
done to occlusion in the next
tab.

446 | exocad ALL ON X STEP-BY-STEP GUIDE

95 . Freeform
Use the add remove tools to
refine contact location. You
do not want a lot to do here.
Too many new designers
spend way too much time
here. This should take 5
minutes or less.

447 | exocad ALL ON X STEP-BY-STEP GUIDE

96 . Smooth Roots
Smooth flatten protruding
roots.

448 | exocad ALL ON X STEP-BY-STEP GUIDE

97 . Cut All Intersections.
Lastly, hit cut all intersections
to ensure contacts are ideal
and pints get cut.

449 | exocad ALL ON X STEP-BY-STEP GUIDE

98 . Next
Click “next” when done with
free forming.

450 | exocad ALL ON X STEP-BY-STEP GUIDE

99. Skip
If asked to adapt to preop hit
next to skip this step.

451 | exocad ALL ON X STEP-BY-STEP GUIDE

100 . Single Gingiva
If asked you want to click
design signal gingiva. If you
do not, get this option you
may have set the case up
wrong and not selected
gingiva. You can design it in
expert mode if that is the
case.

452 | exocad ALL ON X STEP-BY-STEP GUIDE

101 . Draw Tissue
Click the ridge and draw a
margin of tissue a little wider
than you anticipate incase
implants locations are not
ideal. I generally want the
tissue to be 2mm thick.

453 | exocad ALL ON X STEP-BY-STEP GUIDE

102 . Change Base Thickness
Change the base thickness to
2mm and hit apply.

454 | exocad ALL ON X STEP-BY-STEP GUIDE

103 . Evaluate
If you need to move the tissue
line click a greed ball and
drag it and then hit apply
again to make the change.
When done editing hit next.

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104 . Next
Hit “next”. The tissue may not
be perfect but it is not
important.

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105. Mandibular Tissue
If asked, design a single
gingiva.

457 | exocad ALL ON X STEP-BY-STEP GUIDE

106 . Draw Tissue Border
Click to draw your border.
Go all the way around and
double click on the first ball
to close the tissue line.

458 | exocad ALL ON X STEP-BY-STEP GUIDE

107 . Thickness
Change the thickness to the
desired thickness.

459 | exocad ALL ON X STEP-BY-STEP GUIDE

108 . Thickness
Somewhere around 2mm is
sufficient at first.

460 | exocad ALL ON X STEP-BY-STEP GUIDE

109 . Apply
You have to hit apply to have
thickness changes take
effect.

461 | exocad ALL ON X STEP-BY-STEP GUIDE

110 . Hit “Next”
Hit “next” when done.

462 | exocad ALL ON X STEP-BY-STEP GUIDE

111 . Save the Case
This is a good stopping point
to save the case and have it
ready to go for day of
surgery.

463 | exocad ALL ON X STEP-BY-STEP GUIDE

112 . Save the Case
Close the case. Remember
the name you set the case up
as because on the day of
surgery you need to be able
to locate this case and open
it. If using the anatomic
waxup workflow you can take
this case to the final merged
part.

464 | exocad ALL ON X STEP-BY-STEP GUIDE

 ALL ON X

Universal Method: Day of surgery

465 | exocad ALL ON X STEP-BY-STEP GUIDE

 1 . Aligning Scan Data
Really this is a game of aligning scans. A
diagnostic preoperative scan is made. A
waxup is made on this model. Many ways
exist to do this including waxup pontic and
anatomic pontic. The advantage of using
waxup pontics is you can change to an implant
restoration in expert mode. The waxup is
done before the surgery appointment. Then on
day of surgery you need an intermediate pre
surgical marker scan. This will be aligned to
the original preoperative scan. Typically the
scan has surgical markers. Then you need a
post surgery soft tissue scan. This scan has
some type of tissue scan caps. This is
important as the caps determine the expand
library. Not to be confused with scan bodies.
The scanbody scan comes from IO Connect or
similar scanbody, or Shining IPG or Micron
mapper style Photogrammetry. The system
converts the more accurate scan to an
exported unified scanbody scan that is the
same library as the soft tissue caps used
which is linked to the exocad library.

466 | exocad ALL ON X STEP-BY-STEP GUIDE

 2 . Unified Scanbody Scan
The concept of the unified tissue cap export is
genius. It is a system where a more accurate
way of capture is achieved using grammetry,
photogrammetry, or Intraoral
photogrammetry, and a unified scan body
scan is exported as a tissue cap of choice.
This will then get align with the intraoral
surgical tissue cap scan. This allows using
easy workflows in exocad. IO Connect, Micron
Mapper, Shining IPG and many other system
use this workflow. It is important to
understand when you align this unified
scanbody scan to the intraoral tissue scan it is
only for positioning the scan bodies into the
arch and does not impact implant to implant
position therefore ensuring passivity of fit
(assuming manufacturing is accurate). It only
serves to align the scanbody scan to the jaw
and the premade waxup. Furthermore when
using the exocad scanbody alignment wizard
you are not changing implant positions form
the unified scanbody scan. It will be identical.

467 | exocad ALL ON X STEP-BY-STEP GUIDE

 3 . Shining IPG
Really this is a game of aligning scans. A
diagnostic preoperative scan is made. A
waxup is made on this model. Many ways
exist to do this including waxup pontic and
anatomic pontic. The advantage of using
waxup pontics is you can change to an implant
restoration in expert mode. The waxup is
done before the surgery appointment. Then on
day of surgery you need an intermediate pre
surgical marker scan. This will be aligned to
the original preoperative scan. Typically the
scan has surgical markers. Then you need a
post surgery soft tissue scan. This scan has
some type of tissue scan caps. This is
important as the caps determine the expand
library. Not to be confused with scan bodies.
The scanbody scan comes from IO Connect or
similar scanbody, or Shining IPG or Micron
mapper style Photogrammetry. The system
converts the more accurate scan to an
exported unified scanbody scan that is the
same library as the soft tissue caps used
which is linked to the exocad library.

468 | exocad ALL ON X STEP-BY-STEP GUIDE

 4 . TruAbutment IO Connect
IO connect you must do a
scanbody scan and a soft tissue
scan with the IO Connect caps.
The IO connect software will
convert the more accurate
scanbody scan made with their
proprietary diving board style
scanbody into a soft tissue cap
scanbody scan with a unified
position. IO connect has a
library for the Truabutment
direct to MUA screw, Rosen and
Powerball screw. IO Connect is
the best way to scan all on x if
you do not have photogrammetry
and own a Trios.

469 | exocad ALL ON X STEP-BY-STEP GUIDE

 5 . The Screw
I only do direct to MUA
prosthetics. The direct to MUA
screw you want to use is
determined by your exocad
library. You need to have the
proper library to use to align to
the unified tissue cap scan that
was exported from your
Photogrammetry, grammetry or
IPG system. Powerball continue to
be great and has the best exocad
and CAM libraries. It has angle
correction and is tried and true.
Everyone and their mom has a
screw these days. I like to stick
with ones that have been proven.

470 | exocad ALL ON X STEP-BY-STEP GUIDE

 6 . Load Pre-Surgical exocad Design
To start the conversion on the
day of surgery you should
load the previously made
waxup that was made using
the technique I demonstrated
earlier.

471 | exocad ALL ON X STEP-BY-STEP GUIDE

 7 . Load Original exocad Design
Navigate to the pre-surgical wax
up.

472 | exocad ALL ON X STEP-BY-STEP GUIDE

 8 . Load Original exocad Design
Go back into design.

473 | exocad ALL ON X STEP-BY-STEP GUIDE

 9 . Load Original exocad Design
Your waxup will load just as
you left it. Immediately go
into expert mode.

474 | exocad ALL ON X STEP-BY-STEP GUIDE

10 . Expert Mode
Immediately go to expert
mode.

475 | exocad ALL ON X STEP-BY-STEP GUIDE

 11 . Tools
Go back into tools.

476 | exocad ALL ON X STEP-BY-STEP GUIDE

 12 . Add/Remove Mesh
Go back into add remove
mesh. We need to align the
intermediate surgical scan to
the original preoperative
scan. This should be done at
the beginning of the surgical
appointment and be aligned
and ready to go for the
conversion.

477 | exocad ALL ON X STEP-BY-STEP GUIDE

 13 . Select Generic Visualization Mesh
Make sure to select generic
visualization mesh.

478 | exocad ALL ON X STEP-BY-STEP GUIDE

 14 . Click “Load”
We are going to load a mesh
to merge to the original
scans. We are going to load
an intermediate surgical day
scan. This scan is made the
day of surgery with some type
of markers in place and is
made before the extractions,
flap or ridge augmentation.

479 | exocad ALL ON X STEP-BY-STEP GUIDE

 15 . Find Pre-Surgical Marker Scans
Find the pre-surgical marker
scan that is made on the day
of surgery.

480 | exocad ALL ON X STEP-BY-STEP GUIDE

 16 . Click “No”
It does not matter what you
click here.

481 | exocad ALL ON X STEP-BY-STEP GUIDE

 17 . Manual Position Scan
Click the new scan and rotate
it to be in the same
orientation as the arch you
want to merge it to. Control
left click the scan will rotate
the scan. Left-clicking the
scan will move the scan.
Left-clicking the empty
screen will rotate all objects
at the same time.

482 | exocad ALL ON X STEP-BY-STEP GUIDE

 18 . Manual Position
Ideally, you have them
positioned like this where you
have the occlusal surface
facing you. The preop teeth
should be on and the new
marker scan should be off to
the side, but at the same
orientation.

483 | exocad ALL ON X STEP-BY-STEP GUIDE

 19 . Automatic Merging
Click the align meshes
button.

484 | exocad ALL ON X STEP-BY-STEP GUIDE

20 . Select Common Points
Alway start by clicking the
floating mesh. The floating
mesh is the new scan you
want to move to the original
scan. So we click the molar of
the newly imported scan.

485 | exocad ALL ON X STEP-BY-STEP GUIDE

 21 . Select Common Points
Click the second point on the
preoperative original scan
data.

486 | exocad ALL ON X STEP-BY-STEP GUIDE

22 . Notice Arrows
Notice the direction of the
arrows is pointing from the
new marker scan to the old
preoperative scan.

487 | exocad ALL ON X STEP-BY-STEP GUIDE

23 . Repeat at Least 5 Spots
A minimum of 5 spots should
be selected spread
throughout the arch. Make
sure your arrows are all
pointing in the same
direction.

488 | exocad ALL ON X STEP-BY-STEP GUIDE

24 . Perform Alignment
Click perform alignments to
move the arch to the
preoperative model based
exclusively on your points.

489 | exocad ALL ON X STEP-BY-STEP GUIDE

25 . Best Fit Matching
Click best fit matching to
allow exocad to use
mathematical triangle
approximation to better align
the data together.

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26 . Cut View
Evaluate the colors. Any color in
the range is acceptable. Use the
cut tool and drag the slicer to
further evaluate the merge.
Because we did some digital
education of the ridge, the teeth
are the most accurate objects.
If you had a scenario where you
did not have hard tissues to
merge you would not have done
bone reduction on the original
scans for a better merge.
Alternatively, you could load
unedited original scans as a
Preop and use that for this
merging.

491 | exocad ALL ON X STEP-BY-STEP GUIDE

27 . Hit “OK”
If happy with the merge hit
OK on the smaller box as
shown.

492 | exocad ALL ON X STEP-BY-STEP GUIDE

28 . Load Lower Arch
Click Load and find the lower
pre surgical marker scan.

493 | exocad ALL ON X STEP-BY-STEP GUIDE

29 . Select
It does not matter what you
hit here. I usually hit no.

494 | exocad ALL ON X STEP-BY-STEP GUIDE

30 . Manual Position New Scan
Manually position new scan
to be in the same angle as the
preoperative jaw but off to
the side as shown.

495 | exocad ALL ON X STEP-BY-STEP GUIDE

 31 . Select Common Points
Select common points
starting on the newly
imported scan.

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32 . Select Common Points
Find the same exact spot on
the original scan data. Notice
the arrows are pointing from
the new scan to the original
scan.

497 | exocad ALL ON X STEP-BY-STEP GUIDE

33 . Repeat 5 Times
Repeat a minimum of 5 spots
spread throughout the arch.

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34 . Perform Alignment
Click perform alignment to
move the new scan data to
the original based exclusive
on your spots selected.

499 | exocad ALL ON X STEP-BY-STEP GUIDE

35 . Click “Best Fit Matching”
Click best fit match to allow
exocad to refine the
alignment based on millions
of data points.

500 | exocad ALL ON X STEP-BY-STEP GUIDE

36 . Evaluate Match
Use the slicer tool to verify
alignment. Evaluate color
coded accuracy.

501 | exocad ALL ON X STEP-BY-STEP GUIDE

37 . Click “OK”
Click OK on the small
window.

502 | exocad ALL ON X STEP-BY-STEP GUIDE

38 . Load Surgical Tissue Scan
Now we need to load the
surgical tissue cap scan as a
jaw scan. Navigate to extra
jaw scan.

503 | exocad ALL ON X STEP-BY-STEP GUIDE

39 . Load Extra Jaw Scan
Delineate what arch you are
loading.

504 | exocad ALL ON X STEP-BY-STEP GUIDE

40 . Select the Arch
Choose what arch the jaw
scan is for dual arch cases.

505 | exocad ALL ON X STEP-BY-STEP GUIDE

 41 . Load
Navigate to the surgical tissue
scan for the arch selected.

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42 . Click “No”
It does not matter what you
click. The tissue scan will not
be aligned. Please note we do
not align it here. It will be
wrong and come in not
aligned. Don’t panic. It’s ok.
Click No then Click OK.

507 | exocad ALL ON X STEP-BY-STEP GUIDE

43 . Tools-Align Meshes
Stay in expert mode. Click
tools, align meshes.

508 | exocad ALL ON X STEP-BY-STEP GUIDE

44 . Manual Movement
Click the new tissue scan and
drag it. This is frustrating for
new users. If you left click the
new tissue scan you will move
it. Control left click the new
scan to rotate it. Do not move
the pre surgical marker scan.
If you left click the blank
screen the scene will move
together. That’s ok.

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45 . Side by Side
Manipulate the new scan until
it is side by side with the pre
surgical marker scan.

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46 . Automatic Alignment
Once they are side by side
and similar orientation click
the automatically button.

511 | exocad ALL ON X STEP-BY-STEP GUIDE

47 . Common Points
Click common points first
starting on the new surgical
tissue scan (floating mesh).
Then clicking the same point
on the pre surgical scan.
Repeat a minimum of 7 spots
focusing on the markers and
any non movable tissues. The
blue arrows should point from
the surgical tissue cap scan to
the pre-surgical scan.

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48 . Exclude Selected Parts
Check the box.

513 | exocad ALL ON X STEP-BY-STEP GUIDE

49 . Paint Common Areas
Paint both models blue where
they have similar data like the
markers.

514 | exocad ALL ON X STEP-BY-STEP GUIDE

50 . Invert Selection
Hit invert selection area and
the common data will now not
be blue and everything else
will be blue. Blue means
exocad will not use that data
for the matching.

515 | exocad ALL ON X STEP-BY-STEP GUIDE

 51 . Change Settings
Max influence distance
around 4mm and matching
parts ratio around 10%. Play
with values to see what works
for you.

516 | exocad ALL ON X STEP-BY-STEP GUIDE

52 . Perform Alignment
This will move the tissue cap
scan to the pre-surgical scan
using only your selected
points.

517 | exocad ALL ON X STEP-BY-STEP GUIDE

53 . Best Fit Match
This will use millions of data
points and find a better
match.

518 | exocad ALL ON X STEP-BY-STEP GUIDE

54 . Evaluate
Uncheck the exclude selected
parts box and check the show
distances. Now you can see
color map of alignment
accuracy. Blue and green are
nearly perfect. Due to
swelling and bone reduction
and sutures many areas may
not align. This is why marker
scans are so important. CBCT
data can also be used for
alignment.

519 | exocad ALL ON X STEP-BY-STEP GUIDE

55 . Click “OK”
Click OK to save the
alignment.

520 | exocad ALL ON X STEP-BY-STEP GUIDE

56 . Repeat for Lower
Now we have to repeat for the
lower arch . Go to tools- add
remove mesh- extra jaw scan
and find the lower surgical
tissue scan. Then click Ok to
save the loaded scan. It will
not be aligned.

521 | exocad ALL ON X STEP-BY-STEP GUIDE

57 . Tools-Align Meshes-Manual
Once the lower is loaded go
to tools- align meshes and
select manual. Rotate and
drag the lower surgical scan
to be next to and at the same
orientation as the pre surgical
marker scan.

522 | exocad ALL ON X STEP-BY-STEP GUIDE

58 . Switch to “Automatically”
Now we will go into automatic
alignment.

523 | exocad ALL ON X STEP-BY-STEP GUIDE

59 . Common Points
Start with the tissue markers.
Click first on the newly
imported surgical tissue cap
scan. Then click the same
exact spot on the pre-surgical
marker scan.

524 | exocad ALL ON X STEP-BY-STEP GUIDE

60 . Common Spots
Find the same exact spot on
the pre-surgical scan.

525 | exocad ALL ON X STEP-BY-STEP GUIDE

 61 . Common Spots
Keep finding common spots.
Always first click the surgical
cap scan then the pre surgical
scan. Focus on areas that
would not have changed
between the scans. This is
why markers are so
important.

526 | exocad ALL ON X STEP-BY-STEP GUIDE

62 . Exclude Selected Parts
Check the box, Matching
excuse selected parts.

527 | exocad ALL ON X STEP-BY-STEP GUIDE

63 . Paint Common Data
Pin the markers and any
areas you see in common that
have not moved.

528 | exocad ALL ON X STEP-BY-STEP GUIDE

64 . Invert
Invert the markings.

529 | exocad ALL ON X STEP-BY-STEP GUIDE

65 . Change Ratios
Alter settings to your liking.
10% and 4mm are a good
start.

530 | exocad ALL ON X STEP-BY-STEP GUIDE

66 . Perform Alignment
Click perform alignment.

531 | exocad ALL ON X STEP-BY-STEP GUIDE

67 . Best Fit Match
Best fit match will fine tune
the alignment. It will ignore
all the blue data.

532 | exocad ALL ON X STEP-BY-STEP GUIDE

68 . Evaluate
Look for high accuracy on the
markers. A midline marker on
the mandible is very helpful.
A strategically kept tooth is
also very helpful.

533 | exocad ALL ON X STEP-BY-STEP GUIDE

69 . Click “OK”
Click “Ok” when done.

534 | exocad ALL ON X STEP-BY-STEP GUIDE

70 . Load Scanbody Scans
Exocad will detect that you
brought new jaw scans.

535 | exocad ALL ON X STEP-BY-STEP GUIDE

 71 . Tools
Go to tools- add remove
mesh.

536 | exocad ALL ON X STEP-BY-STEP GUIDE

72 . Add/Remove Mesh
Go to mesh type.

537 | exocad ALL ON X STEP-BY-STEP GUIDE

73 . Scanbody Scan
Navigate to scan marker scan
in the menu.

538 | exocad ALL ON X STEP-BY-STEP GUIDE

74 . Choose Jaw
Choose the jaw and then hit
load.

539 | exocad ALL ON X STEP-BY-STEP GUIDE

75 . Hit “No”
It does not matter what you
select.

540 | exocad ALL ON X STEP-BY-STEP GUIDE

76 . Move the Scan Bodies
This is a unified scanbody
scan meaning all the scabies
are in a locked orientation.
Click and move them off to
the side and in the same
orientation as the surgical
scan.

541 | exocad ALL ON X STEP-BY-STEP GUIDE

77 . Align Meshes
Click align meshes once the
scanbody scan is orientated.

542 | exocad ALL ON X STEP-BY-STEP GUIDE

78 . Find Common Points
Select common spots first
click the scanbody scans then
click the same spot on the
surgical tissue cap scan. You
need at least one for each
scanbody.

543 | exocad ALL ON X STEP-BY-STEP GUIDE

79 . Find Common Points
It is important to understand
the only reason to align the
scanbody scan to the tissue is
for soft tissue alignment and
this has noting to do with
implant locations in space as
those are fixed by the unified
scanbody scan and will not be
changed.

544 | exocad ALL ON X STEP-BY-STEP GUIDE

80 . Perform Alignment
Click perform alignment.

545 | exocad ALL ON X STEP-BY-STEP GUIDE

 81 . Best Fit Match
Hit best fit match for
automatic alignment.

546 | exocad ALL ON X STEP-BY-STEP GUIDE

82 . Evaluate
It is not uncommon to have
small discrepancies in
location from the unified
scanbody scan and the
surgical tissue scan. This is
because tissue scan is not as
accurate.

547 | exocad ALL ON X STEP-BY-STEP GUIDE

83 . Repeat for Lower
Change to lower jaw.

548 | exocad ALL ON X STEP-BY-STEP GUIDE

84 . Load Lower Unified Scan Body Scan
Find the lower unified
scanbody scan. Click and
drag them to be next to the
surgical tissue scan. Control
and clock them to rotate
them. They should be in the
same orientation like shown.

549 | exocad ALL ON X STEP-BY-STEP GUIDE

85 . Align Meshes
Click align meshes for
common point match.

550 | exocad ALL ON X STEP-BY-STEP GUIDE

86 . Common Points
First select a spot on the
unified scanbody scan then
find the same spot on the
surgical tissue scan. Repeat
for each scanbody.

551 | exocad ALL ON X STEP-BY-STEP GUIDE

87 . Perform Alignment
Click perform alignment.

552 | exocad ALL ON X STEP-BY-STEP GUIDE

88 . Best Fit Match
Next click best fit match.

553 | exocad ALL ON X STEP-BY-STEP GUIDE

89 . Evaluate
It is normal to have
discrepancies as the weakest
link is the soft tissue scan.

554 | exocad ALL ON X STEP-BY-STEP GUIDE

90 . Click “OK”
Click “ok” to save.

555 | exocad ALL ON X STEP-BY-STEP GUIDE

 91 . Select Implant Teeth
Still in expert mode. Click a
tooth that is where one of the
implants is located.

556 | exocad ALL ON X STEP-BY-STEP GUIDE

92 . Select Implant Type
In the lower menu bar that
will pop up when you select a
tooth you will see select
implant type. Click it. This
will not pop up if you select
multiple teeth. Only 1 at a
time.

557 | exocad ALL ON X STEP-BY-STEP GUIDE

93 . Select Implant Type
Change to screw retained.

558 | exocad ALL ON X STEP-BY-STEP GUIDE

94 . Select Screw Retained
Select screw retained.

559 | exocad ALL ON X STEP-BY-STEP GUIDE

95 . Click “OK”
Click ok to save.

560 | exocad ALL ON X STEP-BY-STEP GUIDE

96 . Repeat for Each Implant Tooth
Repeat for each implant tooth
on the maxilla and mandible.
Only click the tooth
immediately over the implant.
Do not select all the teeth.
The amount of teeth selected
should be identical to the
number of implants in each
arch.

561 | exocad ALL ON X STEP-BY-STEP GUIDE

97 . Wizard Mode
Jump back to wizard once
you have selected and
changed to screw retained the
appropriate amount of teeth.

562 | exocad ALL ON X STEP-BY-STEP GUIDE

98 . Wizard Mode
When jumping back to wizard
mode if asked to align the jaw
scans in the wizard skip the
step and just hit next. We
already aligned using a more
sophisticated and accurate
alignment method. To
preserve our alignment SKIP
this by hitting next.

563 | exocad ALL ON X STEP-BY-STEP GUIDE

99. Wizard Mode
Click replace entire jaw scan
to now have exocad recognize
the surgical tissue cap scan
as the jaw scan. This way
when we are using the adapt
feature it will adapt the
prosthetic to this scan with
the bone reduction and not
the old pre-surgical scan.

564 | exocad ALL ON X STEP-BY-STEP GUIDE

100 . Wizard Mode
Repeat same for lower jaw. If
it asks you to align in the
wizard just hit next.
Remember we already aligned
these using a more powerful
tool in expert mode.

565 | exocad ALL ON X STEP-BY-STEP GUIDE

101 . Wizard Mode
Replace the whole scan data.

566 | exocad ALL ON X STEP-BY-STEP GUIDE

102 . Pick Library
Exocad will now want you to
pick the exocad library.
Remember you need a direct
to MUA library that can align
to the tissue cap you
scanned with and that has the
screw you want to use.

567 | exocad ALL ON X STEP-BY-STEP GUIDE

103 . Align Library
Click the scanbody where the
red dot is on the virtual
scanbody image. Make sure
you are selecting the correct
tooth number as the wizard
wants.

568 | exocad ALL ON X STEP-BY-STEP GUIDE

104 . Check Alignment
Remember you are actually
signing to the unified
scanbody scan not the tissue
scan. The cap aliment should
be all blue indicating perfect
alignment. If not you
probably have the wrong
library. If you can’t see
alignment colors hit control
on your keyboard and click
again. Once satisfied hit next
to move onto the next
implant.

569 | exocad ALL ON X STEP-BY-STEP GUIDE

105 . Repeat for all Implants
Keep following the wizard for
each implant for both upper
and lower jaws.

570 | exocad ALL ON X STEP-BY-STEP GUIDE

106 . Continue on to Lower
Keep matching and remember
to check what tooth the
wizard is on.

571 | exocad ALL ON X STEP-BY-STEP GUIDE

107 . Define Emergence
When you get to the define
emergence step. Stop and go
to expert mode.

572 | exocad ALL ON X STEP-BY-STEP GUIDE

108 . Check Tissue Cap Removal
Depending on the library you
may or may not have your
tissue caps removed from the
scan and holes in the scan.
Even if it did cut the caps out
you may have little parts
remaining, we need to clean
this up. If this did not
happen automatically and
you are having to do this
manually like I am it is a bad
library.

573 | exocad ALL ON X STEP-BY-STEP GUIDE

109 . Edit Mesh
Right click the tissue scan
and hit edit mesh in the menu
options.

574 | exocad ALL ON X STEP-BY-STEP GUIDE

110 . Circle the Caps
Circle each cap and hit
delete. If exocad did this for
you then make sure it
removed all the caps.

575 | exocad ALL ON X STEP-BY-STEP GUIDE

111 . Delete the Caps
Circle all the caps making
them orange.

576 | exocad ALL ON X STEP-BY-STEP GUIDE

112 . Delete the Caps
Hit delete.

577 | exocad ALL ON X STEP-BY-STEP GUIDE

113 . Load Original exocad Design
You now have holes and that
is ok. Click OK.

578 | exocad ALL ON X STEP-BY-STEP GUIDE

114 . Repeat for Upper
Right click upper jaw. Edit
mesh. Cycle each cap that
was not automatically
deleted. Then hit delete.

579 | exocad ALL ON X STEP-BY-STEP GUIDE

115 . Hit “OK”
Once deleted hit “OK”.

580 | exocad ALL ON X STEP-BY-STEP GUIDE

116 . Regenerate Virtual Waxup Bottom
Left click the tissue scan. Go
to the menu bar at the
bottom. Hit virtual waxup
bottom.

581 | exocad ALL ON X STEP-BY-STEP GUIDE

117 . Regenerate Virtual Waxup Bottom
Hit Update to regenerate the
virtual waxup bottom for the
new tissue scans.

582 | exocad ALL ON X STEP-BY-STEP GUIDE

118 . Click “OK”
Hot ok to save. If you need to
change the insertion angle hit
set from view then update
then ok.

583 | exocad ALL ON X STEP-BY-STEP GUIDE

119 . Repeat for Upper Arch
Repeat these steps for the
upper arch if doing dual
arches.

584 | exocad ALL ON X STEP-BY-STEP GUIDE

120 . Back to Wizard: Define Emergence
When going back to wizard it
will take you to the define
emergence profile. Just hit
next for each implant.

585 | exocad ALL ON X STEP-BY-STEP GUIDE

121 . Abutment Bottoms
Just hit next for each
abutment bottom step.

586 | exocad ALL ON X STEP-BY-STEP GUIDE

122 . Virtual Wax Up Calculation
Now exocad will take the
previous waxup and make a
virtual waxup calculation.

587 | exocad ALL ON X STEP-BY-STEP GUIDE

123 . Freeform Wax Up
The only free forming you
really need to do is on the
tissue surface and maybe
around the implant areas to
increase strength.

588 | exocad ALL ON X STEP-BY-STEP GUIDE

124 . Focus on Tissue Surface
We need to smooth and make
this cleanable and add the
desired amount of tissue
pressure. I first use the
smooth flatten tool and hold
shift to flatten.

589 | exocad ALL ON X STEP-BY-STEP GUIDE

125 . Smooth/Flatten Tissue Surfaces
Go to free.

590 | exocad ALL ON X STEP-BY-STEP GUIDE

126 . Smooth/flatten
Click on the “Smooth/
Flatten” tool.

591 | exocad ALL ON X STEP-BY-STEP GUIDE

127 . Max Strength and Size
Make size maximum and
strength.

592 | exocad ALL ON X STEP-BY-STEP GUIDE

128 . Smooth Flatten Tissue Surfaces
Spend a lot of time
smoothing. Toggle to add/
remove to add material then
back to smooth.

593 | exocad ALL ON X STEP-BY-STEP GUIDE

129 . Distance to Scan Data
Turn on show distances, hit
the chevron here at the top
color bar.

594 | exocad ALL ON X STEP-BY-STEP GUIDE

130 . Distance to Scan Data
Change to distance to scan
data.

595 | exocad ALL ON X STEP-BY-STEP GUIDE

131 . Change Color Scale
0.01min-1.4mm max. Check
the nearest point distance.

596 | exocad ALL ON X STEP-BY-STEP GUIDE

132 . Auto Cut Using Adapt
Go to adapt and basal.

597 | exocad ALL ON X STEP-BY-STEP GUIDE

133 . Auto Cut Using Adapt
Go to adapt and basal .
Change pressure to positive
350 microns or your desired
pressure.

598 | exocad ALL ON X STEP-BY-STEP GUIDE

134 . Hit Basal
Hit basal to have exocad slice
the tissue surface to the
desired pressure.

599 | exocad ALL ON X STEP-BY-STEP GUIDE

135 . Hit Basal
Hit basal to have exocad slice
the tissue surface to the
desired pressure.

600 | exocad ALL ON X STEP-BY-STEP GUIDE

136 . Smooth Flatten Tissue Surfaces
Remove any folds concavities
creases or plaque traps.
Surface should be flat or
convex. Smooth distal
extension to minimize them.
Remember this is a printed
prototype and will be more
bulky compared to the final
design. Hit NEXT when done.

601 | exocad ALL ON X STEP-BY-STEP GUIDE

137 . Screw Channel
Just hit next here.

602 | exocad ALL ON X STEP-BY-STEP GUIDE

138 . Done
Your final prosthetic is done.
If you need to smooth an area
you can freeform merged.
Otherwise you are all set.

603 | exocad ALL ON X STEP-BY-STEP GUIDE

139 . Merge Issues
If you have issues where your
screw channels are sealed
and not cut or your MUA is
deformed or sealed it can be
from two common problems.
Most likely it is a library
issues. Otherwise your digital
waxup could have issues such
as inverted triangles, creases,
floater meshes. This comes
with experience on how to
deal with these.

604 | exocad ALL ON X STEP-BY-STEP GUIDE

 ALL ON X

Using a Scanned Denture

DAY O F S U R G E R Y C O N V E R S I O N
ENDENTULOUS ARCH

605 | exocad ALL ON X STEP-BY-STEP GUIDE

 1 . Using a Scanned Denture
You will laugh but I do this all
the time. Patient has an old
denture. I reline it and scan it.
This technique always works.
Just like we did in the 90’s
when we drilled holes on a
denture, cut the palate out and
picked it up on temp cylinders,
but all digitally. This works
great. It can be a scan or STL
of anything such as a denture,
new or old waxup, old dentate
arch. Just make sure it is a
solid model that you import in
as the “waxup” when doing
this technique.

606 | exocad ALL ON X STEP-BY-STEP GUIDE

 2 . Scans Needed
1 2 3 4 5

350 denture scan Preoperative tissue Pre-surgical post-surgical Unified scanbodyu

as the “waxup” scan. The denture marker scan. This tissue cap scan scan as “scan
should be aligned will be aligned to This will be marker” scan. This
to this scan scan 2. aligned to scan3. will be aligned to
already. scan 4.

You can optionally have an antagonist although it is not mandatory.

607 | exocad ALL ON X STEP-BY-STEP GUIDE

 3 . Open Dental DB
Open dental DB.

608 | exocad ALL ON X STEP-BY-STEP GUIDE

 4 . Client and Name
Select client and patent
name.

609 | exocad ALL ON X STEP-BY-STEP GUIDE

 5 . Click Implant Location
Click a tooth that will be
near one of the implants
placed.

610 | exocad ALL ON X STEP-BY-STEP GUIDE

 6 . Click Anatomic Waxup
Anatomic waxup is
selected.

611 | exocad ALL ON X STEP-BY-STEP GUIDE

 7 . 3D Print and Screw-Retained
Click screw retained.

612 | exocad ALL ON X STEP-BY-STEP GUIDE

 8 . Click “OK”
Click “OK” to save.

613 | exocad ALL ON X STEP-BY-STEP GUIDE

 9 . Copy to All Implant Sites
An easy way to copy a
prescription and jump
around the arch is to hold
control on the keyboard
and click the other teeth.

614 | exocad ALL ON X STEP-BY-STEP GUIDE

10 . Click “OK”
Click save to be able to
design.

615 | exocad ALL ON X STEP-BY-STEP GUIDE

 11 . Click “Design”
Click design.

616 | exocad ALL ON X STEP-BY-STEP GUIDE

12 . Load Files
You need the following
files.

1) soft tissue scan

2) denture scan (as waxup)

3) scan body scan

4) opposing

617 | exocad ALL ON X STEP-BY-STEP GUIDE

13 . Immediately Enter Expert Mode
Rotate the model so you
are looking down on the
arch then go to expect
mode. Your unified
scanbody scan will not be
aligned to the models.
Your denture may or may
not be aligned to the
preoperative maxillary
soft tissue scan. Mine is
aligned already from the
scan software.

618 | exocad ALL ON X STEP-BY-STEP GUIDE

14 . Tools: Add/Remove Mesh
We need to bring the
intermediate marker scan
into the scene and merge
it with the preoperative
tissue scan.

619 | exocad ALL ON X STEP-BY-STEP GUIDE

15 . Generic Visualization Mesh
Select generic
visualization as the mesh
typo and hit load.

620 | exocad ALL ON X STEP-BY-STEP GUIDE

16 . Find Pre-Surgical Marker Scan
Navigate to the pre
surgical marker scan.

621 | exocad ALL ON X STEP-BY-STEP GUIDE

17 . Find Pre-Surgical Marker Scan
Navigate to the pre
surgical marker scan.

622 | exocad ALL ON X STEP-BY-STEP GUIDE

18 . Click “No”
It does not matter what
you select here.

623 | exocad ALL ON X STEP-BY-STEP GUIDE

19 . Rotate, then Pin
Click the newly imported
scan and drag it. Hold
control and left click the
venter of the new scan to
rotate it. To rotate the
entire scene left click the
blank screen. You want to
get the new scan next to
and in the same
orientation as the
preoperative scan.

624 | exocad ALL ON X STEP-BY-STEP GUIDE

20 . Align Meshes
Once the models are next
to each other at similar
orientations click the align
meshes box.

625 | exocad ALL ON X STEP-BY-STEP GUIDE

21 . Find Common Data
First click a spot on the
newly imported day of
surgery marker scan. Then
click the same spot on the
original preoperative scan.
Repeat at least 5 times.
Notice the arrows point
from the new scan to the
old scan. Letting you know
the direction the scan is
moving. This is important
as the old scan has the
waxup aligned to it.

626 | exocad ALL ON X STEP-BY-STEP GUIDE

22 . Exclude Selected Spots
Due to local infiltration
the day of surgery marker
scan will have differences
compared to the pre-
operative scan. Check
this box to exclude
selected parts.

627 | exocad ALL ON X STEP-BY-STEP GUIDE

23 . Paint Common Data
Paint common data blue.
Avoid movable tissues.

628 | exocad ALL ON X STEP-BY-STEP GUIDE

24 . Invert
Click invert. This will
make the all other areas
blue except where you
painted. Exocad will not
take blue areas into
consideration when doing
the best fit match.

629 | exocad ALL ON X STEP-BY-STEP GUIDE

25 . Perform Alignment
Click perform aliment to
bring the two scans
together based exclusively
on the points you
selected.

630 | exocad ALL ON X STEP-BY-STEP GUIDE

26 . Evaluate
Unclick matching exclude
selected parts and then
click the show distances
to see the color map of
alignment. The distances
are indicated in the color
map bar below the check
box. Stay in the add
remove mesh module.

631 | exocad ALL ON X STEP-BY-STEP GUIDE

27 . Click “OK”
Click ok on the small
window but stay in this
add remove mesh module.
Now you wait for the
surgical tissue cap scan
and the unified scanbody
export. These are two
different files. First merge
the surgical tissue cap
scan to this intermediate
visualization mesh that
you just merged.

632 | exocad ALL ON X STEP-BY-STEP GUIDE

28 . Load Surgical Tissue Cap Scan
Click extra jaw scan.

633 | exocad ALL ON X STEP-BY-STEP GUIDE

29 . Load Surgical Tissue Cap Scan
Click load and navigate to
the new surgical tissue cap
scan.

634 | exocad ALL ON X STEP-BY-STEP GUIDE

30 . Click “No”
It does not matter what
you select here.

635 | exocad ALL ON X STEP-BY-STEP GUIDE

31 . Click “OK”
The tissue cap scan will
not be aligned to the other
scans. That is ok. We will
do that alignment in a
different module. Just
click ok to save.

636 | exocad ALL ON X STEP-BY-STEP GUIDE

32 . Tools: Align Meshes
We will now enter the
align meshes tool to merge
the surgical tissue cap
scan to the intermediate
marker scan.

637 | exocad ALL ON X STEP-BY-STEP GUIDE

33 . Move and Rotate
Only move the surgical
tissue cap scan. Be carful
not to move the other two
scans. Left click on the
tissue cap scan and drag it
off to the side. Then
control and left click the
middle of the tissue cap
scan to rotate it. Get it to
be side by side and at the
same orientation as the
other scans.

638 | exocad ALL ON X STEP-BY-STEP GUIDE

34 . Click “Automatically”
You can now click
automatically. Turn off the
preoperative scan and
only show the
intermediary marker scan.

639 | exocad ALL ON X STEP-BY-STEP GUIDE

35 . Click “Common Points”
Focusing on the marker
and non movable tissues
find common spots.
Always first click the
surgical tissue cap scan
then click the
intermediary marker scan
in the exact spot.

640 | exocad ALL ON X STEP-BY-STEP GUIDE

36 . Repeat 5 Times
Repeat at least 5 times but
the more spots the better.

641 | exocad ALL ON X STEP-BY-STEP GUIDE

37 . Exclude Elected Parts
Click the exclude selected
parts box.

642 | exocad ALL ON X STEP-BY-STEP GUIDE

38 . Paint Common Areas
Paint common data
between the scans.

643 | exocad ALL ON X STEP-BY-STEP GUIDE

39 . Invert Selection
Flip the colors by clicking
invert. Exocad will not use
the blue data for the
alignment.

644 | exocad ALL ON X STEP-BY-STEP GUIDE

40 . Perform Alignment
Click perform alignment.
This moves the sriuagical
cap scan to the
intermediary marker scan
using only your dots
selected.

645 | exocad ALL ON X STEP-BY-STEP GUIDE

41 . Click “Best Fit Match”
Click best fit match and
now all the data that is
painted will be considered
for the matching. Millions
of points will be analyzed.

646 | exocad ALL ON X STEP-BY-STEP GUIDE

42 . Evaluate Merge
To see the color uncheck
exclude selected parts box
and check show distance.

647 | exocad ALL ON X STEP-BY-STEP GUIDE

43 . Click “OK”
Click OK to save the
merging.

648 | exocad ALL ON X STEP-BY-STEP GUIDE

44 . Tools: Align Meshes
We need to merge the
scan marker scan to this
surgical tissue cap scan.

649 | exocad ALL ON X STEP-BY-STEP GUIDE

45 . Click “Manually”
You need to left-click and
drag the scan body scan off
to the side. Then control left-
click the scan body scan to
rotate them. You want them
in the same orientation but
off to the side of the surgical
cap scan. You should be
using a unified scan body
scan from grammetry,
photogrammetry or Shining
IPG.

650 | exocad ALL ON X STEP-BY-STEP GUIDE

46 . Click “Manually”
Please note we are only
moving scan bodies. Don’t
click other things and move
them by accident. If you did
hit undo or cancel and try
again.

651 | exocad ALL ON X STEP-BY-STEP GUIDE

47 . Click “Automatically”
Now we can use automatic
alignment.

652 | exocad ALL ON X STEP-BY-STEP GUIDE

48 . Click Common Spots
Click one spot on each
scanbody tissue cap.
Always start on the newly
imported, unified
scanbody scan and then
pick the same point on the
surgical tissue cap scan.
Notice the direction of the
arrows. They go from the
unified scanbody scan to
the surgical tissue cap
scan.

653 | exocad ALL ON X STEP-BY-STEP GUIDE

49 . Perform Alignment
Click perform alignment.

654 | exocad ALL ON X STEP-BY-STEP GUIDE

50 . Best Fit Match
Use best fit match to
refine alignment.

655 | exocad ALL ON X STEP-BY-STEP GUIDE

51 . Evaluate
It is normal to have
discrepancy here. The
weakest link I the surgical
tissue cap scan. The
unified scanbody scan is
much more accurate. It is
important to understand
this concept. The surgical
tissue cap scan has noting
to do with implant to
implant position and only
aids in aligning the unified
scan to the waxup and soft
tissue.

656 | exocad ALL ON X STEP-BY-STEP GUIDE

52 . Click “OK”
Click OK to save.

657 | exocad ALL ON X STEP-BY-STEP GUIDE

53 . Edit Denture Scan
Your denture should be
merged to the files. If not
it you can do it in align
meshes. Here mine is
aligned already. I am
going to edit the denture
scan by right clicking the
denture and hitting edit
mesh.

658 | exocad ALL ON X STEP-BY-STEP GUIDE

54 . Remove Palate
Look down on the palatial
area. Make sure you have
select through selected
circle the distal extension
and palate. Do not close
the lasso and hit delete.
By not closing the lasso it
will create a smoother cut.

659 | exocad ALL ON X STEP-BY-STEP GUIDE

55 . Close Holes
We have holes in the
denture scan now. Rotate
and you will see open
mesh data.

660 | exocad ALL ON X STEP-BY-STEP GUIDE

56 . Close Holes
We have holes in the
denture scan now. Rotate
and you will see open
mesh data.

661 | exocad ALL ON X STEP-BY-STEP GUIDE

57 . Close Holes
Circle a big circle around
the entire denture and
highlight the denture
surface. Then hit close
holes. You must have the
entire denture selected
otherwise the holes will
not close.

662 | exocad ALL ON X STEP-BY-STEP GUIDE

58 . Close Holes
We can now see the holes
are sealed. Wasn’t that
easier than using a acrylic
bur?

663 | exocad ALL ON X STEP-BY-STEP GUIDE

59 . Cut Flange
Now look from the facial
and circle the flange of the
denture. Do not close the
lasso. Hit delete.

664 | exocad ALL ON X STEP-BY-STEP GUIDE

60 . Cut Flange
Now look from the facial
and circle the flange of the
denture. Do not close the
lasso. Hit delete.

665 | exocad ALL ON X STEP-BY-STEP GUIDE

61 . Close Holes
We cut the flange but now
have additional holes.

666 | exocad ALL ON X STEP-BY-STEP GUIDE

62 . Close Holes
Highlight the entire
denture by drawing a big
circle around it and
closing the circle. Then hit
close holes.

667 | exocad ALL ON X STEP-BY-STEP GUIDE

63 . Click “OK”
Click ok. We have now
prepared the denture
digital for the implant
pickups.

668 | exocad ALL ON X STEP-BY-STEP GUIDE

64 . Back to Wizard
In wizard we will be at the
first step but now with
everything aligned.

669 | exocad ALL ON X STEP-BY-STEP GUIDE

65 . Rotate Models
In the wizard route the
model to the occlusal view
as shown and then hit
next.

670 | exocad ALL ON X STEP-BY-STEP GUIDE

66 . Skip by Hitting “Next”
Step two in wizard will be
skipped. Just hit next. We
do not want to use this
alignment feature as the
one we used was more
powerful.

671 | exocad ALL ON X STEP-BY-STEP GUIDE

67 . Click “Replace the Whole Scan Data”
Click replace scan data,
this will remove the old
pre surgical scan that the
waxup was made on and
replace it with the surgical
tissue cap scan.

672 | exocad ALL ON X STEP-BY-STEP GUIDE

68 . Find Proper Library
You need to find the
exocad library for the
screw you want to use and
that is the same geometry
as the tissue cap you
scanned with and the
tissue cap you imposed as
a unified scanbody.

673 | exocad ALL ON X STEP-BY-STEP GUIDE

69 . Merge Scanbody
If you want to hide your
jaw so you only see the
sandy hit “S” on the
keyboard. Now click the
spot on the scanbody the
is indicated by the red dot
in the preview window.
Make sure you are working
tooth number the tooth
prompted in the wizard.

674 | exocad ALL ON X STEP-BY-STEP GUIDE

70 . Evaluate Match
It should one true blue
which indicated a perfect
match. If you do not see
colors hold control and
clock the dot again. Any
other color means you
have the wrong library.

675 | exocad ALL ON X STEP-BY-STEP GUIDE

71 . Click “Next”
Click next to move onto
the next tooth.

676 | exocad ALL ON X STEP-BY-STEP GUIDE

72 . Repeat
Just repeat for each
tooth.

677 | exocad ALL ON X STEP-BY-STEP GUIDE

73 . Repeat
The last tooth is being
merged now. Next we will
evaluate the substation of
the tissue caps. Hit Next

678 | exocad ALL ON X STEP-BY-STEP GUIDE

74 . Evaluate Tissue Cap Delete
The tissue caps should
one deleted from the
surgical cap scan and you
should now be able to see
the digital MUA.

679 | exocad ALL ON X STEP-BY-STEP GUIDE

75 . Expert Mode
Almost always you see
areas remaining of the
surgical caps. We can
delete this and also
regenerate virtual waxup
bottom in expert mode.

680 | exocad ALL ON X STEP-BY-STEP GUIDE

76 . Edit Mesh
In expert mode right click
the tissue scan and hit edit
mesh.

681 | exocad ALL ON X STEP-BY-STEP GUIDE

77 . Select
Select the area around the
remains tissue cap scan.

682 | exocad ALL ON X STEP-BY-STEP GUIDE

78 . Delete
Hit delete to remove then
hit OK.

683 | exocad ALL ON X STEP-BY-STEP GUIDE

79 . Define Emergence Profile
We do not need to do
anything here except hit
next for each implant.

684 | exocad ALL ON X STEP-BY-STEP GUIDE

80 . Abutment Bottoms
We do not need to do
anything here except hit
next for each implant.

685 | exocad ALL ON X STEP-BY-STEP GUIDE

81 . Virtual Waxup
A virtual waxup scan will
be generated.

686 | exocad ALL ON X STEP-BY-STEP GUIDE

82 . Free-Form
Most of the freeform is
spent smoothing tissue
surfaces. At first the
design will be concave
and uinclensable. Use the
free- smooth flatten tool
to smooth the fitting
surface and shrink the
distal extensions.

687 | exocad ALL ON X STEP-BY-STEP GUIDE

83 . Free-Form
Most of the freeform is
spent smoothing tissue
surfaces. At first the
design will be concave
and uinclensable. Use the
free- smooth flatten tool
to smooth the fitting
surface and shrink the
distal extensions.

688 | exocad ALL ON X STEP-BY-STEP GUIDE

84 . Check Tissue Pressure
Click distance to scan
data. Nearest point
distance checked. Change
the scale not 0.1-1mm.

689 | exocad ALL ON X STEP-BY-STEP GUIDE

85 . Adjust Tissue Pressure
A color coded map of
tissue pressure can be
seen now. You can go to
adapt tool and hit BASAL
or you can smooth it here.
I tend to like bout 300-500
microns of pressure.
Depending in the ridge.
Make sure no concavities,
creases or uinclensable
areas exist. Please note a
printed provisional will be
more thick compared to
the final.

690 | exocad ALL ON X STEP-BY-STEP GUIDE

86 . Adjust Tissue Pressure
A color coded map of
tissue pressure can be
seen now. You can go to
adapt tool and hit BASAL
to get you to a target
number then you can
smooth it from there.

691 | exocad ALL ON X STEP-BY-STEP GUIDE

87 . Click “Next”
Click next to add screw
channels.

692 | exocad ALL ON X STEP-BY-STEP GUIDE

88 . Click “Next”
Nothing to do here except
next.

693 | exocad ALL ON X STEP-BY-STEP GUIDE

89 . All Done
You are all done with the
design and now can print.
Any issue with merging is
most likely a library issue
or your waxup had errors.

694 | exocad ALL ON X STEP-BY-STEP GUIDE

90 . Check Screw Channels and MUA
Everything should be
perfect. If not check your
waxup scan for errors and
your library.

695 | exocad ALL ON X STEP-BY-STEP GUIDE

 ALL ON X

Bar Design
CO N VE R T TO SPLIT FILE BA R DESIGN

696 | exocad ALL ON X STEP-BY-STEP GUIDE

 1 . Convert Your Design to a Bar Design
You can convert your
monolithic direct to MUA
to a bar design fairly easy.
This works best if
anatomic waxup was the
method used to design the
all on x prosthetic but does
also work with waxup
pontic. It takes about 10
minutes to do once you get
the hang of it.

697 | exocad ALL ON X STEP-BY-STEP GUIDE

 2 . Open Dental DB
Find your designed case
that you have a final
merged part. Look at the
previous guides for how to
Crete a monolithic direct
to MUA prosthetic.

698 | exocad ALL ON X STEP-BY-STEP GUIDE

 3 . Load Case
We need to load the case

699 | exocad ALL ON X STEP-BY-STEP GUIDE

 4 . Find the Design
Search for the case that
has the final merged
parts.

700 | exocad ALL ON X STEP-BY-STEP GUIDE

 5 . Click Load Scene
Load the scene

701 | exocad ALL ON X STEP-BY-STEP GUIDE

 6 . Click Load Scene
You should see the final
merged direct to MUA
prosthetic in the scene.
Jump into expert mode.

702 | exocad ALL ON X STEP-BY-STEP GUIDE

 7 . Export Your Part
Turn only your merged
part on and turn
everything else off. Make
sure no other parts are on
such as implant parts.
Right-click the screen and
hit save scene as. Change
to stl, Visible objects only,
default orientation.

703 | exocad ALL ON X STEP-BY-STEP GUIDE

 8 . Export Your Part
Turn only your merged
part on and turn
everything else off. make
sure no other parts are on
such as implant parts.
Right click the screen and
hit save scene as. Change
to stl, Visible objects only,
default orientation.

704 | exocad ALL ON X STEP-BY-STEP GUIDE

 9 . Export Your Part
Turn only your merged
part on and turn
everything else off. make
sure no other parts are on
such as implant parts.
Right click the screen and
hit save scene as. Change
to stl, Visible objects only,
default orientation.

705 | exocad ALL ON X STEP-BY-STEP GUIDE

10 . Export Your Part
Turn only your merged
part on and turn
everything else off. make
sure no other parts are on
such as implant parts.
Right click the screen and
hit save scene as. Change
to stl, Visible objects only,
default orientation.

706 | exocad ALL ON X STEP-BY-STEP GUIDE

 11 . Delete Merged Part
Now we need to get rid of
that merged part. Click
the prosthetic and then on
the bottom menu bar hit
the trash button.

707 | exocad ALL ON X STEP-BY-STEP GUIDE

12 . Delete Merged Part
Click the merged part.

708 | exocad ALL ON X STEP-BY-STEP GUIDE

13 . Load Scene
Click ok to remove it.

709 | exocad ALL ON X STEP-BY-STEP GUIDE

14 . Click “Tools”
Jump point tools.

710 | exocad ALL ON X STEP-BY-STEP GUIDE

15 . Change Reconstruction Type
We need to change the
reconstruction type.

711 | exocad ALL ON X STEP-BY-STEP GUIDE

16 . Click One of the Teeth
Click one of the anatomic
waxup teeth and it will
change to a reduced
waxup.

712 | exocad ALL ON X STEP-BY-STEP GUIDE

17 . Change Reconstruction Type
Click “OK”.

713 | exocad ALL ON X STEP-BY-STEP GUIDE

18 . Reduce Waxup
Right-click your waxup.

714 | exocad ALL ON X STEP-BY-STEP GUIDE

19 . Anatomic Reduction
Because we changed the
reconstruction type to
reduced now we can
reduce the waxup to make
the bar structure.

715 | exocad ALL ON X STEP-BY-STEP GUIDE

20 . 2mm
Change depth to 2mm.

716 | exocad ALL ON X STEP-BY-STEP GUIDE

21 . Exclude Selected Parts
Click exclude selected
parts.

717 | exocad ALL ON X STEP-BY-STEP GUIDE

22 . Click “Mark All”
Click Mark all.

718 | exocad ALL ON X STEP-BY-STEP GUIDE

23 . Brush Size
The waxup will turn blue.
Change brush size to the
middle size.

719 | exocad ALL ON X STEP-BY-STEP GUIDE

24 . Shift-Click Paint
Hold shift and paint the
prosthetic everywhere
except the bar tissue
surface.

720 | exocad ALL ON X STEP-BY-STEP GUIDE

25 . Shift-Click Paint
Hold shift and paint the
prosthetic everywhere
except the bar tissue
surface.

721 | exocad ALL ON X STEP-BY-STEP GUIDE

26 . Shift-Click Paint
Hold shift and paint the
prosthetic everywhere
except the bar tissue
surface.

722 | exocad ALL ON X STEP-BY-STEP GUIDE

27 . Shift-Click Paint
Depending on the smile
line you may leave a little
blue on the facial ridge.

723 | exocad ALL ON X STEP-BY-STEP GUIDE

28 . Shift-Click Paint
Work to lingual.

724 | exocad ALL ON X STEP-BY-STEP GUIDE

29 . Shift-Click Paint
Work to lingual.

725 | exocad ALL ON X STEP-BY-STEP GUIDE

30 . Shift-Click Paint
Work to lingual. You can
often leave the lingual
margin a little higher up
for added metal thickness.

726 | exocad ALL ON X STEP-BY-STEP GUIDE

31 . Keep Removing Blue
Make sure to not have any
blue specs or islands
anywhere.

727 | exocad ALL ON X STEP-BY-STEP GUIDE

32 . Keep Removing Blue
Remove from occlusal as
well.

728 | exocad ALL ON X STEP-BY-STEP GUIDE

33 . Check
Now under designed parts
you have a reduced waxup
and waxup. Turn off the
waxup to look at the
reduced waxup. It will
look kind of rough.

729 | exocad ALL ON X STEP-BY-STEP GUIDE

34 . Click “OK”
Click “OK”.

730 | exocad ALL ON X STEP-BY-STEP GUIDE

35 . Smooth/Flatten
You have two options to
edit this mesh. You can
right click edit mesh, cut
the bits off and then close
holes. I find this step is
more difficult. I like to
skip to smooth flatten in
freeform. Click the mesh.

731 | exocad ALL ON X STEP-BY-STEP GUIDE

36 . Free-Form
Click the reduced waxup
and then on the lower
menu bar hit Free Form

732 | exocad ALL ON X STEP-BY-STEP GUIDE

37 . Click “Free”
Go to free.

733 | exocad ALL ON X STEP-BY-STEP GUIDE

38 . Smooth/Flatten
Click “Smooth/Flatten”.
Hold shift and left click to
flatten.

734 | exocad ALL ON X STEP-BY-STEP GUIDE

39 . Flatten and Smooth Reduced Waxup
You want to create a
smooth surface that is
relatively flat. Strength on
brush max. Size is
determined by the case. It
should be big enough to
be powerful but not too
big because we do not
want to distort the
external borders.

735 | exocad ALL ON X STEP-BY-STEP GUIDE

40 . Flatten and Smooth Reduced Waxup
Work your way around the
Bar flattening it.

736 | exocad ALL ON X STEP-BY-STEP GUIDE

41 . Keep Smoothing
Avoid the external border.

737 | exocad ALL ON X STEP-BY-STEP GUIDE

42 . Click “Anatomic”
Click the Anatomic button
once the bar is sufficiently
smooth and flat.

738 | exocad ALL ON X STEP-BY-STEP GUIDE

43 . Click “Paint & Pull”
Click paint pull

739 | exocad ALL ON X STEP-BY-STEP GUIDE

44 . Change Brush Size
Brush size around 1.5 to
2.mm

Elastic area around 1 to

1.5mm

740 | exocad ALL ON X STEP-BY-STEP GUIDE

45 . Paint
Paint the top of the bar
with a continuous line
dead center in the bar.

741 | exocad ALL ON X STEP-BY-STEP GUIDE

46 . Paint
Stay in the center of the
bar.

742 | exocad ALL ON X STEP-BY-STEP GUIDE

47 . Finish Painting
Get to the end of the bar.

743 | exocad ALL ON X STEP-BY-STEP GUIDE

48 . Paint Pull
Click Pull.

744 | exocad ALL ON X STEP-BY-STEP GUIDE

49 . Pull the Area Occlusal
Click the painted area and
drag occlusal.

745 | exocad ALL ON X STEP-BY-STEP GUIDE

50 . Drag Bar
The bar needs to be at
least 3mm tall for proper
retention.

746 | exocad ALL ON X STEP-BY-STEP GUIDE

51 . Drag Facial or Lingual
You can move the segment
facial and lingual too.

747 | exocad ALL ON X STEP-BY-STEP GUIDE

52 . Turn On Waxup to See
Turn waxup to half
transparency to see how
the bar is positioned.

748 | exocad ALL ON X STEP-BY-STEP GUIDE

53 . Edit Bar
Hold control to alter the
angle and tilt off the
painted bar segment.
Make sure the bar is in the
ideal location and allows
the superstructure to have
enough thickness.

749 | exocad ALL ON X STEP-BY-STEP GUIDE

54 . Edit Bar
Look from all angles to
make sure the bar is in the
ideal location in relation to
the waxup.

750 | exocad ALL ON X STEP-BY-STEP GUIDE

55 . Back to Free
Go back to free to smooth
and add.

751 | exocad ALL ON X STEP-BY-STEP GUIDE

56 . Back to Free
Smooth any areas that
need it.

752 | exocad ALL ON X STEP-BY-STEP GUIDE

57 . Add Thickness
Add thickens around
implant min thickness
bubbles. Do not make
undercuts when doing
this.

753 | exocad ALL ON X STEP-BY-STEP GUIDE

58 . Add Thickness
Add and then smooth to
make sure it is a nice
surface.

754 | exocad ALL ON X STEP-BY-STEP GUIDE

59 . Click “OK”
Click OK when done.

755 | exocad ALL ON X STEP-BY-STEP GUIDE

60 . Merge and Save Bar
Right-click the bar.

756 | exocad ALL ON X STEP-BY-STEP GUIDE

61 . Merge and Save
Click merge and save.

757 | exocad ALL ON X STEP-BY-STEP GUIDE

62 . Export Merged Bar
You can save the merged
bar and construction data
if needed for milling. To
save the STL right click
the screen. It is already
saved in the project folder
so you really don’t need to
save it unless you want a
backup copy.

758 | exocad ALL ON X STEP-BY-STEP GUIDE

63 . Save Bar
Make sure nothing else is
on or visible on the screen
except the merged bar.
Right click the screen.
Save scene as-STL-Visible
objects only-default
orientation.

759 | exocad ALL ON X STEP-BY-STEP GUIDE

64 . Save Bar
Make sure to pick
someplace you can find it.
This is the final bar so call
it final bar.

760 | exocad ALL ON X STEP-BY-STEP GUIDE

65 . Save Reduced Waxup
Navigate to your files and
turn on your reduced
waxup. You want to save
the reduced waxup on the
jaw scan.

761 | exocad ALL ON X STEP-BY-STEP GUIDE

66 . Save Reduced Waxup
Save this reduced waxup
like we did the merged
bar. Call it Reduced waxup
or something you will
know what it is.

762 | exocad ALL ON X STEP-BY-STEP GUIDE

67 . Save Reduced Waxup
Plain STL.

763 | exocad ALL ON X STEP-BY-STEP GUIDE

68 . Save Reduced Waxup
Select “Yes” when asked if
you want to save visible
objects only.

764 | exocad ALL ON X STEP-BY-STEP GUIDE

69 . Save Reduced Waxup
Select “Use default
coordinate system”.

765 | exocad ALL ON X STEP-BY-STEP GUIDE

70 . Save Case and Exit
Save the scene.

766 | exocad ALL ON X STEP-BY-STEP GUIDE

 71 . Subtract Bar
We now need to boolean
subtract the bar the most
powerful boolean tool in
exocad is the hard cut
found in mockup module.

767 | exocad ALL ON X STEP-BY-STEP GUIDE

72 . Click New
Hit new. We will start a
new case just to use the
more powerful boolean.
Select default client and
call the case bar subtract.

768 | exocad ALL ON X STEP-BY-STEP GUIDE

73 . Click One Tooth
Click only one tooth.

769 | exocad ALL ON X STEP-BY-STEP GUIDE

74 . Mockup
Call it mockup.

770 | exocad ALL ON X STEP-BY-STEP GUIDE

75 . 3D Print
Print now.

771 | exocad ALL ON X STEP-BY-STEP GUIDE

76 . Click “OK”
Nothing special to do
here.

772 | exocad ALL ON X STEP-BY-STEP GUIDE

77 . Save
Hit “Save”.

773 | exocad ALL ON X STEP-BY-STEP GUIDE

78 . Design
You do not need an
antagonist. Hit design.

774 | exocad ALL ON X STEP-BY-STEP GUIDE

79 . Load Scans
The scan you want to load
as the tissue scan is this
scan the you saved with
the tissue bar merged to
the jaw scan. It looks like
this.

775 | exocad ALL ON X STEP-BY-STEP GUIDE

80 . Follow the Wizard
First orientate the model
so you are looking down
like this image below then
hit next. Note that your
model should not have
screw holes like mine. I
will close these. Click
next.

776 | exocad ALL ON X STEP-BY-STEP GUIDE

81 . Change Fit
Use the bottom properties
to change fit.

777 | exocad ALL ON X STEP-BY-STEP GUIDE

82 . Change Fit
Cement gap of around
70-80 microns is ideal.
Smoothing 5-17%. Default
undercut blockout. Make
sure to rotate the scan
from the ideal path of
insertion of the
superstructure and hit set
insertion from view, then
hit update or apply. Hit
next.

778 | exocad ALL ON X STEP-BY-STEP GUIDE

83 . Free-Form
We can go to freeform
after hitting apply to
remove spacer along the
margin.

779 | exocad ALL ON X STEP-BY-STEP GUIDE

84 . Remove
Use remove tool to remove
spacer along the margin.

780 | exocad ALL ON X STEP-BY-STEP GUIDE

85 . Remove
Use remove tool to remove
spacer along the margin.

781 | exocad ALL ON X STEP-BY-STEP GUIDE

86 . Remove
Hold shift to remove
spacer on the margin. You
will not really be able to
tell it’s doing anything but
you are. Once done hit
OK.

782 | exocad ALL ON X STEP-BY-STEP GUIDE

87 . Tools
Select ‘Tools.’

783 | exocad ALL ON X STEP-BY-STEP GUIDE

88 . Add/Remove Mesh
We need to add the
monolithic direct to MUA
prosthetic.

784 | exocad ALL ON X STEP-BY-STEP GUIDE

89 . Click Load
You have to select waxup
scan.

785 | exocad ALL ON X STEP-BY-STEP GUIDE

90 . Click Load
Find the final merged
monolithic direct to MUA
prosthetic and hit yes.

786 | exocad ALL ON X STEP-BY-STEP GUIDE

91 . Click “OK”
Click ok to save.

787 | exocad ALL ON X STEP-BY-STEP GUIDE

92 . Waxup Calculation
Click the imported waxup.

788 | exocad ALL ON X STEP-BY-STEP GUIDE

93 . Waxup Calculation
Click waxup calculation.

789 | exocad ALL ON X STEP-BY-STEP GUIDE

94 . OK
Click “ok”.

790 | exocad ALL ON X STEP-BY-STEP GUIDE

95 . Click the Waxup
Now click the wax up.

791 | exocad ALL ON X STEP-BY-STEP GUIDE

96 . Free-Form
Stay in expert mode. Click
free form.

792 | exocad ALL ON X STEP-BY-STEP GUIDE

97 . Minimum Thickness
Select your minimum
thickness.

793 | exocad ALL ON X STEP-BY-STEP GUIDE

98 . Minimum Thickness
Smooth and add to areas
that are thin.

794 | exocad ALL ON X STEP-BY-STEP GUIDE

99 . Turn on Virtual Waxup Bottom
To see borders and areas
turn on virtual wax up
bottom.

795 | exocad ALL ON X STEP-BY-STEP GUIDE

100 . Check All Around
You can see the bar
margin and you can
remove flash.

796 | exocad ALL ON X STEP-BY-STEP GUIDE

101 . Adapt
Click adapt button.

797 | exocad ALL ON X STEP-BY-STEP GUIDE

102 . Hard Cut
Now click hard cut. This is
the most powerful boolean
operation in exocad. This
works much better than
trying to subtract using
freeform merged and
attachments.

798 | exocad ALL ON X STEP-BY-STEP GUIDE

103 . Super Structure
You now have a super
structure.

799 | exocad ALL ON X STEP-BY-STEP GUIDE

104 . Super Structure
Check your super
structure.

800 | exocad ALL ON X STEP-BY-STEP GUIDE

105 . You Can Load Bar as Tissue
You can load the bar as a
tissue scan to check fit.
Go to tools.

801 | exocad ALL ON X STEP-BY-STEP GUIDE

106 . Add/Remove Mesh
Now click gingiva. Load
the final bar design you
saved earlier.

802 | exocad ALL ON X STEP-BY-STEP GUIDE

107 . Click “Yes”
Yes if you used default
orientation to export.

803 | exocad ALL ON X STEP-BY-STEP GUIDE

108 . Check Fit
Hit ok and now you can
see your bar and
superstructure and can
check fit using cut tool.

804 | exocad ALL ON X STEP-BY-STEP GUIDE

109 . Cut Tool
You can check your fit.

805 | exocad ALL ON X STEP-BY-STEP GUIDE

 All On X

iCAM Day of Surgery

806 | exocad ALL ON X STEP-BY-STEP GUIDE

110 . Save Super Structure
You can now saves your
superstructure design.

807 | exocad ALL ON X STEP-BY-STEP GUIDE

 1 . Load Original exocad Design
Find the original waxup case
by opening dental DB and
finding the pre surgical waxup
case.

808 | exocad ALL ON X STEP-BY-STEP GUIDE

 2 . Find the Original Design
Find the original pre-surgical
design.

809 | exocad ALL ON X STEP-BY-STEP GUIDE

 3 . Click Design
Click Design.

810 | exocad ALL ON X STEP-BY-STEP GUIDE

 4 . Load Scene File
This should load the scene.

811 | exocad ALL ON X STEP-BY-STEP GUIDE

 5 . Expert Mode
Immediately go into expert
mode: Tools: Add/Remove
Mesh: Generic visualization
mesh.

812 | exocad ALL ON X STEP-BY-STEP GUIDE

 6 . Select “Generic Visualization Mesh”
Make sure to select generic
visualization mesh.

813 | exocad ALL ON X STEP-BY-STEP GUIDE

 7 . Click “Load”
We are going to load a mesh
to merge with the original
scans. We are going to load
an intermediate surgical day
scan. This scan is made on
the day of surgery with some
type of markers in place and
is made before the
extractions, flap, or ridge
augmentation.

814 | exocad ALL ON X STEP-BY-STEP GUIDE

 8 . Find Pre-Surgical Marker Scans
Find the pre surgical marker
scan that is made on day of
surgery.

815 | exocad ALL ON X STEP-BY-STEP GUIDE

 9 . Click “No”
It does not matter what you
click here.

816 | exocad ALL ON X STEP-BY-STEP GUIDE

 10 . Manual Position Scan
Click the new scan and rotate
it to be in the same
orientation as the arch you
want to merge it to. Control
left click the scan will rotate
the scan. Left-clicking the
scan will move the scan.
Left-clicking the empty
screen will rotate all objects
at the same time.

817 | exocad ALL ON X STEP-BY-STEP GUIDE

 11 . Manual Position
Ideally you have them
positioned like this where you
have the occlusal surface
facing you, the preop teeth on
and the new marker scan off
to the side but at the same
orientation.

818 | exocad ALL ON X STEP-BY-STEP GUIDE

 12 . Automatic Merging
Click the align meshes
button.

819 | exocad ALL ON X STEP-BY-STEP GUIDE

 13 . Select Common Points
Alway start by clicking the
floating mesh. The floating
mesh is the new scan you
want to move to the original
scan. So we click the molar of
the newly imported scan.

820 | exocad ALL ON X STEP-BY-STEP GUIDE

 14 . Select Common Points
Click the second point on the
preoperative original scan
data.

821 | exocad ALL ON X STEP-BY-STEP GUIDE

 15 . Notice Arrows
Notice the direction of the
arrows is pointing from the
new marker scan to the old
preoperative scan.

822 | exocad ALL ON X STEP-BY-STEP GUIDE

 16 . Repeat at Least 5 spots
A minimum of 5 spots should
be selected spread
throughout the arch. Make
sure your arrows are all
pointing in the same
direction.

823 | exocad ALL ON X STEP-BY-STEP GUIDE

 17 . Perform Alignment
Click preform alignments to
move the arch to the
preoperative model based
exclusively on your points.

824 | exocad ALL ON X STEP-BY-STEP GUIDE

 18 . Best Fit Matching
Click best fit matching to
allow exocad to use
mathematical triangle
approximation to better align
the data together.

825 | exocad ALL ON X STEP-BY-STEP GUIDE

 19 . Cut View
Evaluate the colors. Any color in
the range is acceptable. Use the
cut tool and drag the slicer to
further evaluate the merge.
Because we did some digital
education of the ridge the teeth
are the most accurate objects.
If you had a scenario where you
did not have hard tissues to
merge you would not have done
bone reduction on the original
scans for a better merge.
Alternatively, you could load
unedited original scans as a
Preop and use that for this
merging.

826 | exocad ALL ON X STEP-BY-STEP GUIDE

20 . Hit “OK”
If happy with the merge hit
OK on the smaller box as
shown.

827 | exocad ALL ON X STEP-BY-STEP GUIDE

 21 . Load Lower Arch
Click Load and find the lower
pre surgical marker scan.

828 | exocad ALL ON X STEP-BY-STEP GUIDE

 22 . Select
It does not matter what you
hit here. I usually hit no.

829 | exocad ALL ON X STEP-BY-STEP GUIDE

 23 . Manual Position New Scan
Manually position new scan
to be in the same angle as the
preoperative jaw but off to
the side as shown.

830 | exocad ALL ON X STEP-BY-STEP GUIDE

 24 . Select Common Points
Select common points
starting on the newly
imported scan.

831 | exocad ALL ON X STEP-BY-STEP GUIDE

 25 . Select Common Points
Find the same exact spot on
the original scan data. Notice
the arrows are pointing from
the new scan to the original
scan.

832 | exocad ALL ON X STEP-BY-STEP GUIDE

26 . Repeat Five Times
Repeat a minimum of 5 spots
spread throughout the arch.

833 | exocad ALL ON X STEP-BY-STEP GUIDE

 27 . Perform Alignment
Click preform alignment to
move the new scan data to
the original based exclusive
on your spots selected.

834 | exocad ALL ON X STEP-BY-STEP GUIDE

28 . Click Best Fit
Click best fit match to allow
exocad to refine the
alignment based on millions
of data points.

835 | exocad ALL ON X STEP-BY-STEP GUIDE

29 . Evaluate Match
Use the slicer tool to verify
alignment. Evaluate color
coded accuracy.

836 | exocad ALL ON X STEP-BY-STEP GUIDE

30 . Click “OK”
Click “OK” twice first on the
small window, then on the
larger window.

837 | exocad ALL ON X STEP-BY-STEP GUIDE

 31 . Save Files in Project Folder
We need to save the newly
aligned marker scans as
preop models for our surgical
conversion. Turn off all other
models except a single arch
of the newly aligned marker
scans. Make sure no other
models are on. You can see
the markers as shown here.

838 | exocad ALL ON X STEP-BY-STEP GUIDE

 32 . Save Scene
Right click the empty screen
area and hit save scene as.

839 | exocad ALL ON X STEP-BY-STEP GUIDE

33 . Plain OBJ
Change type to OBJ or STL.

840 | exocad ALL ON X STEP-BY-STEP GUIDE

34 . Location
Do not change the location.
Keep it in the project folder.

841 | exocad ALL ON X STEP-BY-STEP GUIDE

 35 . Naming
The file naming is very
important. You must add a -
after the project number. No
space. And then add
lowerjaw-situ or upperjaw-
situ

No spacing no capitals.

842 | exocad ALL ON X STEP-BY-STEP GUIDE

36 . Naming
The file naming is very
important. You must add a -
after the project number. No
space. And then add
lowerjaw-situ or upperjaw-
situ

No spacing no capitals. So it
will be exactly this for my
project

2025-03-06_00001-002-
lowerjaw-situ

843 | exocad ALL ON X STEP-BY-STEP GUIDE

 37 . Orientation
Click yes to visible objects
only if prompted. Orientation
is very important. When
saving within exocad projects
select original.

844 | exocad ALL ON X STEP-BY-STEP GUIDE

38 . Repeat for Upper Arch
Make sure no other models
are visible.

845 | exocad ALL ON X STEP-BY-STEP GUIDE

39 . Save Scene As
Right click the black area of
the screen.

846 | exocad ALL ON X STEP-BY-STEP GUIDE

40 . Save Scene As
STL or OBJ as the file type.
Same location make sure you
do not change location.

847 | exocad ALL ON X STEP-BY-STEP GUIDE

 41 . Rename
Rename to the project name-
upperjaw-situ no spacing no
capitals. xyz-xyz-xyzzzz-
upperjaw-situ

848 | exocad ALL ON X STEP-BY-STEP GUIDE

 42 . Save
Click save.

849 | exocad ALL ON X STEP-BY-STEP GUIDE

43 . Visible Only
Visible objects only.

850 | exocad ALL ON X STEP-BY-STEP GUIDE

44 . Original Orientation
Whenever saving in the
project folder use original.

851 | exocad ALL ON X STEP-BY-STEP GUIDE

45 . Close and Save the Scene
Close the case and go back to
dental DB, You should now
see the new scans in the
preview window.

852 | exocad ALL ON X STEP-BY-STEP GUIDE

46 . Duplicate the Case
In dental DB hit duplicate.

853 | exocad ALL ON X STEP-BY-STEP GUIDE

 47 . Scan Data and Design
Select both scan data and
designed files.

854 | exocad ALL ON X STEP-BY-STEP GUIDE

48 . OK
Click Ok, Now the case is
duplicated and you are now
able to change the
prescription.

855 | exocad ALL ON X STEP-BY-STEP GUIDE

49 . Click Implant Sites
Visible select the implant
sites and change the
prescription. Make sure you
select the same teeth that you
entered in the iCAM capture
software.

856 | exocad ALL ON X STEP-BY-STEP GUIDE

50 . Change Prescription
Change the prescription to
anatomic waxup only for the
implant sites.

857 | exocad ALL ON X STEP-BY-STEP GUIDE

 51 . Screw Retained
Select screw retrained.

858 | exocad ALL ON X STEP-BY-STEP GUIDE

 52 . Scanbody Main Scan
Change to scanbody is main
scan.

859 | exocad ALL ON X STEP-BY-STEP GUIDE

 53 . Click “Pre-Op”
Click Preop so the previously
loaded situ scans will
populate.

860 | exocad ALL ON X STEP-BY-STEP GUIDE

54 . Click “OK”
Save changes by hitting ok.

861 | exocad ALL ON X STEP-BY-STEP GUIDE

 55 . Duplicate to All Other Implants
Left click the newly changed
tooth and hold the mouse
button and drag to additional
tooth sites that have the
implants to replicate the
prescription. You can drag to
the mandible arch as well to
clone the prescription.

862 | exocad ALL ON X STEP-BY-STEP GUIDE

56 . Duplicate to All Other Sites
Make sure the new
prescription matches what
you entered in iCAM.

863 | exocad ALL ON X STEP-BY-STEP GUIDE

 57 . Load iCAM Data
Click open in explorer.

864 | exocad ALL ON X STEP-BY-STEP GUIDE

58 . Navigate to iCAM exocad Data
Find the scam exocad implant
position data and jaw scan.

865 | exocad ALL ON X STEP-BY-STEP GUIDE

59 . Copy Data
Select all the icam exocad
data and load it into the
project folder.

866 | exocad ALL ON X STEP-BY-STEP GUIDE

60 . Rename iCAM Data if Needed
If your iCAM data is not
properly named you have to
rename it to the project name
but keep the implant site
which will be in universal
nomenclature. One tiny error
in naming such as a space or
mistranslated number will
mean the implant locations
will not come into the scene.

867 | exocad ALL ON X STEP-BY-STEP GUIDE

 61 . Rename iCAM Data if Needed
Rename your iCAM Data as
shown here:

868 | exocad ALL ON X STEP-BY-STEP GUIDE

 62 . Click “Use Anyway”
Use anyway for the iCAM
implant library. It is
important to have the icam
implant library installed in
your exocad already before
starting this project.

869 | exocad ALL ON X STEP-BY-STEP GUIDE

63 . Load Previous Images
You can optionally load
previous images just
understand this is a little
buggy with case duplication.

870 | exocad ALL ON X STEP-BY-STEP GUIDE

64 . Expert Mode
Most of the design will be
done in expert mode. Click
into expert mode. Hide any
photos or scans that are
distracting you on your
screen. We need to merged
the icam files to the marker
scan.

871 | exocad ALL ON X STEP-BY-STEP GUIDE

65 . Tools
Go to tools and click “Align
Meshes”.

872 | exocad ALL ON X STEP-BY-STEP GUIDE

66 . Hide All Lower Data
Hide all lower data including
implant parts. Make sure all
upper data is visible including
all implant parts. In the
objects browser you should
see the ability to turn all
objects on and off in the
arch.

873 | exocad ALL ON X STEP-BY-STEP GUIDE

 67 . Click Manual
Click Manual. We now need
to make sure we tell exocad
few want to move not only the
surgical scan but also all the
icam data and implant
locations.

874 | exocad ALL ON X STEP-BY-STEP GUIDE

68 . Select Additional Floating Parts
Click the box. We are about
to get into very sophisticated
alignment of 3D meshes. This
is for advanced users only.

875 | exocad ALL ON X STEP-BY-STEP GUIDE

69 . All Visible Objects
Make sure all your lower data
is off and all your upper data
is visible. Including all the
implant information. Then hit
“All Visible”. This means all
visible object will move with
the mesh you select.

876 | exocad ALL ON X STEP-BY-STEP GUIDE

70 . Rotate and Translate
Now rotate and translate the
surgical scan to be in a
similar position as the Pre-
surgical or mid surgical
marker scan. Holding control
and left clicking the model
will rotate it. If you left click
the blank screen the entire
scene moves. Make sure not
to rotate or move the pre
surgical marker scan as this is
perfectly aligned to the
waxup.

877 | exocad ALL ON X STEP-BY-STEP GUIDE

 71 . Automatic Alignment
Now that the surgical scan is
next to the pre surgical scan
and in the same orientation
we can do automatic
alignment.

878 | exocad ALL ON X STEP-BY-STEP GUIDE

 72 . Select Additional Floating Meshes
We have to again tell exocad
that we want all the implant
locations and data to move
along with the surgical scan.

879 | exocad ALL ON X STEP-BY-STEP GUIDE

 73 . All Visible
Like before we hit all visible.

880 | exocad ALL ON X STEP-BY-STEP GUIDE

 74 . Select Common Points
First click a common point on
the surgical scan. Next click
the same common point on
the pre surgical marker scan.
Repeat for at least 5 common
points always starting on the
surgical scan then moving to
the pre-surgical scan. Notice
the blue arrows are pointing
from the surgical scan to the
pre surgical scan.

881 | exocad ALL ON X STEP-BY-STEP GUIDE

 75 . Exclude Selected Parts
Click matching exclude
selected parts.

882 | exocad ALL ON X STEP-BY-STEP GUIDE

 76 . Paint Areas
Paint areas you are certain
did not move or change
between the pre or mid
surgical scan to the post
surgical scan. Areas like the
hard palate, any markers
placed, any teeth that may
have been strategically left in
place.

883 | exocad ALL ON X STEP-BY-STEP GUIDE

 77 . Invert Marking
The blue area is areas that
exocad will not take into
consideration when aligning
the meshes. We need in
invert the markings so exocad
only considers the areas we
painted. The rest of the
model becomes blue and now
the areas painted will not be
blue.

884 | exocad ALL ON X STEP-BY-STEP GUIDE

 78 . Perform Alignment
Now pick preform alignment
to move the surgical model
and all implant data to the
pre surgical model which has
the waxup aligned to it.

885 | exocad ALL ON X STEP-BY-STEP GUIDE

 79 . Change Distance Calculations
Around 10% and 4mm always
seems to be the best for me.

886 | exocad ALL ON X STEP-BY-STEP GUIDE

80 . Best Fit Match
After you hit perform
alignment hit best fit match
so exocad will use
mathematical closest point
algorithms to refine the
alignment.

887 | exocad ALL ON X STEP-BY-STEP GUIDE

 81 . Evaluate Colors
Now to see the color you turn
of the match exclude selected
parts check box.

888 | exocad ALL ON X STEP-BY-STEP GUIDE

 82 . Show Distance
Turn on show distances.

889 | exocad ALL ON X STEP-BY-STEP GUIDE

83 . Evaluate Colors
Evaluate the merge. Andy
color other than pink is
acceptable. Blue and green
are very good. Ideally your
markers should be all blue.

890 | exocad ALL ON X STEP-BY-STEP GUIDE

84 . Hit “OK”
Hit ok to save your merge.

891 | exocad ALL ON X STEP-BY-STEP GUIDE

 85 . Repeat for the Lower
We need to repeat for the
lower. Go to tools-align
meshes.

892 | exocad ALL ON X STEP-BY-STEP GUIDE

86 . Hide All Upper Arch Data
Turn everything off except the
lower arch data. You want all
the lower arch data on
including implant parts.

893 | exocad ALL ON X STEP-BY-STEP GUIDE

 87 . Hide All Upper Arch Data
You only want to look at the
lower arch data. We are
about to do some very
advanced file merging. This
can be frustrating and you
want to make sure you are not
doing this for the first time on
the day of surgery.

894 | exocad ALL ON X STEP-BY-STEP GUIDE

88 . Manual Mode
Make sure you are on manual
mode. Click additional
floating part.

895 | exocad ALL ON X STEP-BY-STEP GUIDE

89 . All Visible
Make sure you select all
visible on the window so that
all the implant data moves
along with the surgical scan.

896 | exocad ALL ON X STEP-BY-STEP GUIDE

90 . Rotate the Surgical Scan
Rotate the surgical scan and
portion it next to the pre-
surgical marker scan. Control
left clicking the surgical scan
should move the surgical scan
and all the implant data. Left
clicking the screen will move
rotate the scene. Make sure
not to move the pre surgical
marker scan by accident.

897 | exocad ALL ON X STEP-BY-STEP GUIDE

 91 . Automatic Alignment
We now can add common
points and focus on the
markers. Make sure to select
additional floating meshes
and all visible.

898 | exocad ALL ON X STEP-BY-STEP GUIDE

 92 . Click a Spot on Markers
Start with a spot on the
marker that is the surgical
scan.

899 | exocad ALL ON X STEP-BY-STEP GUIDE

93 . Keep Clicking Common Spots
Click the same spot on the
pre surgical marker scan.

900 | exocad ALL ON X STEP-BY-STEP GUIDE

94 . Click More Spots
This case is difficult because
we only have markers in the
retromolar pad area and did
not place one in the midline
area. Making a merge more
difficult especially after bone
reduction. Always try to have
3 markers.

901 | exocad ALL ON X STEP-BY-STEP GUIDE

95 . Matching Exclude Parts
Click matching excluding
selected parts and paint the
markers blue and any other
small areas that may have not
changed between the surgery
and pre surgery scan.

902 | exocad ALL ON X STEP-BY-STEP GUIDE

96 . Matching Exclude Parts
Paint all the common areas on
both arches blue.

903 | exocad ALL ON X STEP-BY-STEP GUIDE

 97 . Invert Markings
Click invert to convert all
areas. The blue means
exocad will not look at the
data for the merge. We need
to invert that.

904 | exocad ALL ON X STEP-BY-STEP GUIDE

98 . Perform Alignment
Click Perform alignment.

905 | exocad ALL ON X STEP-BY-STEP GUIDE

99 . Best Fit Match
To see the colors make sure
to uncheck the exclude
selected parts icon and select
show distance. If you need to
fine tune the merge change
the settings to matching parts
ratio 10% and max distance
to 3mm.

906 | exocad ALL ON X STEP-BY-STEP GUIDE

100 . Click “OK”
Once happy with the merge
hit OK.

907 | exocad ALL ON X STEP-BY-STEP GUIDE

101 . Back to Wizard
Head back to the wizard for a
little bit. We will be bouncing
in and out of expert mode
and wizard.

908 | exocad ALL ON X STEP-BY-STEP GUIDE

102 . Next
Do not move any meshes
here. Hit next.

909 | exocad ALL ON X STEP-BY-STEP GUIDE

103 . Next
We do not need to use smile
creator. We already did this
in the original waxup.

910 | exocad ALL ON X STEP-BY-STEP GUIDE

104 . Define Emergence
Hit next for each implant to
skip this step. We do not
need to define emergence.

911 | exocad ALL ON X STEP-BY-STEP GUIDE

105 . Define Emergence
We keep hitting next for each
implant in the mandible as
well.

912 | exocad ALL ON X STEP-BY-STEP GUIDE

106 . Tooth Placement
When you get to the tooth
placement tab go to expert
mode for the rest of the
design. You should see your
waxup perfectly on your
surgical arch with all your
implant data. If not then you
screwed up the alignment
steps.

913 | exocad ALL ON X STEP-BY-STEP GUIDE

107 . Virtual Wax Up Bottom
In expert mode click the arch
and go to virtual waxup
bottom on the bottom popup
screen.

914 | exocad ALL ON X STEP-BY-STEP GUIDE

108 . Set Insertion Direction
Rotate the model looking
down the occlusal surface
straight on the ridge and hit
set from view.

915 | exocad ALL ON X STEP-BY-STEP GUIDE

109 . Click “OK”
Click ok to save the new
virtual waxup bottom.

916 | exocad ALL ON X STEP-BY-STEP GUIDE

110 . Design Gingiva
Now pick the arch again and
go to design gingiva.

917 | exocad ALL ON X STEP-BY-STEP GUIDE

 111 . Draw Tissue
Click to start drawing your
tissue area.

918 | exocad ALL ON X STEP-BY-STEP GUIDE

112 . Draw Tissue
Keep drawing all the way
around the Prosthetic. For a
temporary that is printed
keep it thick for strength.

919 | exocad ALL ON X STEP-BY-STEP GUIDE

113 . Draw Tissue
Avoid too much ridge-lap on
the facial.

920 | exocad ALL ON X STEP-BY-STEP GUIDE

114 . Draw Tissue
Double click the start point to
start the tissue render.

921 | exocad ALL ON X STEP-BY-STEP GUIDE

115 . Modify
Change thickness to 2mm for
tissue. Move any green tissue
dots you want to modify.
Click apply for changes to
take effect. When done hit
OK.

922 | exocad ALL ON X STEP-BY-STEP GUIDE

116 . Set From View
Rotate the arch so ridges are
facing you and you are
looking down on the arch
from an occlusal view. Hit set
from view.

923 | exocad ALL ON X STEP-BY-STEP GUIDE

117 . OK
Hit “OK” to save.

924 | exocad ALL ON X STEP-BY-STEP GUIDE

118 . Gingival Base Design
Next select gingival base
design from the lower menu
bar.

925 | exocad ALL ON X STEP-BY-STEP GUIDE

119 . Draw Gingiva
Draw your gingival design.
Remember to keep it thicker
for temp prosthetics. 2mm
thick minimum and draw
margins wider.

926 | exocad ALL ON X STEP-BY-STEP GUIDE

120 . Draw Gingiva
Keep drawing your gingival
margins.

927 | exocad ALL ON X STEP-BY-STEP GUIDE

121 . Render Gingiva
Double click on first dot to
render the tissue.

928 | exocad ALL ON X STEP-BY-STEP GUIDE

122 . Change Thickness
Change thickness to 2mm.
Move any green gingival dots
you want to edit the line and
hit apply for changes to take
effect. Then hit OK to save.

929 | exocad ALL ON X STEP-BY-STEP GUIDE

123 . Free-Form Teeth
Shift click all the teeth in the
design. Turn off trusmile so
you can see what teeth you
are selecting. Make sure to
select all of them. They will
turn blue or some color
different than the teeth.

930 | exocad ALL ON X STEP-BY-STEP GUIDE

124 . Free-Form Teeth
Now click Freeform down
below.

931 | exocad ALL ON X STEP-BY-STEP GUIDE

125 . Cut All Intersections
In the freeform tab hit cut all
intersections.

932 | exocad ALL ON X STEP-BY-STEP GUIDE

126 . Click “OK”
Click Ok to save the changes.
I did this one arch at a time
but you can select all the
teeth and do it all at once.

933 | exocad ALL ON X STEP-BY-STEP GUIDE

127 . Free-Form Gingiva
Select one or both arches and
hit freeform gingiva design.

934 | exocad ALL ON X STEP-BY-STEP GUIDE

128 . Add/Smooth
Got to Free- add and add
thickness to the design. Next
smooth the tissue.

935 | exocad ALL ON X STEP-BY-STEP GUIDE

129 . Big Movements
Go to anatomic small region
to drag papilla and move
areas of tissue. Go to large
region if need to move big
areas.

936 | exocad ALL ON X STEP-BY-STEP GUIDE

130 . Click “OK”
Click OK to save the tissue
changes.

937 | exocad ALL ON X STEP-BY-STEP GUIDE

131 . Wizard
Back to wizard to finish
design.

938 | exocad ALL ON X STEP-BY-STEP GUIDE

132 . Next
Click next to skip this step.
We do not want to adapt to a
preop.

939 | exocad ALL ON X STEP-BY-STEP GUIDE

133 . Click “Next”
Click next after the waxup is
generated.

940 | exocad ALL ON X STEP-BY-STEP GUIDE

134 . Sculpt Tissue Surfaces
Sculpt and smooth the fitting
surfaces to add tissue
pressure and remove
concavities.

941 | exocad ALL ON X STEP-BY-STEP GUIDE

135 . Sculpt Tissue Surfaces
Spend most of your time with
smooth/ flatten and add /
remove to make the tissue
surfaces flat, cleanable and
not concave.

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136 . Eliminate Cantelivers
Remove any large cantilevers
by using the smooth flatten
and remove tools.

943 | exocad ALL ON X STEP-BY-STEP GUIDE

137 . Evaluate Tissue Pressure
You can look at tissue
pressure. You can go to
distance to scan data and
evaluate in more detail with a
color heat map or look and
estimate. This is the time to
sculpt tissue, not later after
healing.

944 | exocad ALL ON X STEP-BY-STEP GUIDE

138 . Next
Hit next.

945 | exocad ALL ON X STEP-BY-STEP GUIDE

139 . Thickness Recovery
Click OK if get a minimum
thickness recovery.

946 | exocad ALL ON X STEP-BY-STEP GUIDE

140 . Screw Channels
Hit next.

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141 . Done
You are all done. Evaluate
MUA and screw channel
surfaces. Library issues are
the most common cause of
errors in the hole forming.
Also crease and folds in the
waxup sometimes will cause
errors.

948 | exocad ALL ON X STEP-BY-STEP GUIDE

142 . Evaluate
Screw channel should be
clean and clear.

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143 . Evaluate
MUA surface should be clean
and crisp with no errors.

950 | exocad ALL ON X STEP-BY-STEP GUIDE

144 . Free-Form Merged
Freeform merged if any areas
need to be modified. If you
have errors in your MUA
surface or screw channels
check your library from the
manufacture. Also you can
check your waxup for any
inverted triangles and issues.
You can delete the merged
parts and try to smooth areas
in the waxup and regenerate
the merged parts.

951 | exocad ALL ON X STEP-BY-STEP GUIDE

 Designed with
Monday in Mind
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learning and guidance from world-class instructors that combines
modern technology with evidence-backed workflows and practices. It's
the antithesis of an 8 hour lecture. From intraoral scanning to 3D
printing and digital smile design, you'll enjoy a practical approach and
experience exceptional technology, materials and equipment applied in
practical, real-world scenarios..

THE MOD INSTITUTE

320 BROAD ST. #210

CHARLESTON, SC 29401

WWW.THEMODINSTITUTE.COM

952 | exocad ALL ON X STEP-BY-STEP GUIDE