GuidedSMILE Revisions

What is GuidedSMILE™ Revisions?

GuidedSMILE Revisions is a protocol for patients who already have implants and may need more. These are the cases that walk in the door with a failing hybrid, a worn prosthesis, bone loss, implants placed too small or in the wrong position, or simply a case that has reached the end of its service life. They may need additional implants, additional componentry, and a new prosthesis, placed into whatever real estate is left.

These are the cases most doctors pass on. Not for lack of skill, but because there was no protocol for them.

Historically these cases were freehanded, and referring the patient out was the responsible call. A Revision case is typically one of the following:

Removable to fixed - an existing overdenture patient transitioning to a fixed prosthesis
Fixed to fixed - a failing hybrid replaced with additional implants and a new prosthesis
Combination arches - a revision on one arch, a first-time full arch on the other
Partial Revision - adding implants after a single implant failure, or to increase AP spread
Prosthetic Space Failure - salvageable, but only with bone reduction or a change in vertical dimension

GuidedSMILE Revisions brings the same prosthetically driven, stackable workflow ROE built for untouched full-arch cases to patients who have already been treated once.

1. Patient Records

2. Plan the case

3. ROE designs & fabricates guides

4. Seat the final

Capture records to the checklist

Every case follows a consistent digital workflow. Required records include:

CBCT scan
Upper and lower intraoral scans with bite registration
360° scan of the prosthesis outside the mouth
Checklist-based clinical photographs
Scan bodies or photogrammetry

Before a case is moved into the planning stage, every record is reviewed against our submission checklist to ensure the information is complete and ready for the next step.

Plan the case live with ROE

Meet online with ROE's full-arch planning team for a collaborative case review in RealGUIDE™. Every plan is driven by the restorative outcome and carefully developed with attention to:

Implant positioning
Pterygoid implant trajectories
Fixation points
Bone levels
Symmetry and AP spread
Reinforcement for parafunctional patients

ROE engineers and fabricates

Your screw-retained surgical guide is designed around the existing prosthesis after it has been removed, providing the access needed for predictable revision surgery.

Choose the complete stackable GuidedSMILE workflow with surgery-ready prosthetics, or a streamlined CombiGuide™ for bone reduction and implant placement.

Screw down and place

Seat the guide on the abutments with balanced left-to-right engagement. Place the anterior implants first to establish the trajectory, then complete the posterior implants (including pterygoids) with fully guided surgery.

Finish by seating the stackable provisional, allowing your patient to leave with fixed teeth the same day.

1. Two failing arches, captured completely

Jim came in with old, deteriorating prosthetics on both arches, some existing bone loss, and a bigger problem underneath it all: not enough prosthetic space. He needed more room, more implants, and new teeth top and bottom, placed in whatever bone he had left.

The records did the heavy lifting early. Micron Mapper photogrammetry captured the componentry positions on both arches, and an intraoral scan taken with the scan bodies still seated tied his tissue to those positions. His prosthetics were scanned in the mouth as upper, lower, and bite, then removed and scanned all the way around so the lab could stack everything and confirm exactly where the tissue sits. Good photographs finished the set. The first submission arrived missing one item, the 360 prosthesis scan. Intake flagged it, the office captured it, and planning started with nothing left to guess about.

2. A plan built from the face down

The patient had spent years in prosthetics that had stopped fitting his face. So before any tooth positions were locked in, his overjet and lip support were checked against the photographs. The new arches had to hold up his lips and profile, not just fill the space behind them.

From there, each arch got its own plan. The upper kept his existing implants, added pterygoids for posterior anchorage, and picked up one more implant in the back. The patient was glad to hear that most of what he'd already paid for would keep working. The lower went the other way entirely: a full redo, because that arch needed more space, more AP spread, and more implant.

3. Clear the field, then screw it down

The old prosthetics came out before surgery. There was no room to bring the instrumentation in on the planned trajectories. The handpiece would have hit the posterior teeth. And one new implant was headed directly underneath where the prosthesis sat.

A tissue-supported guide wasn't considered for any of this. Pterygoid trajectories need real stability, so does threading implants between existing ones, and the patient had worn dental work long enough to notice slop. Both guides screwed straight down to his abutments: the engagement was checked left and right, torqued, and hand-tightened. The upper, with only three implants planned, used a simple, inexpensive guide priced closer to a traditional one.