All-on-X Rehabilitation: Does AI Guarantee Optimal Passive Fit?

The challenge of passivity in a full digital workflow

Full arch rehabilitation using the All-on-X technique represents one of the most demanding challenges in digital dentistry. While digital workflows have become standard in single-unit prosthetics, transferring implant positions across an entire arch remains vulnerable to cumulative scanning and registration errors. These inaccuracies compromise the passive fit of the framework, a critical factor in preventing biomechanical complications. Artificial Intelligence (AI) is emerging as a potential solution to secure these complex protocols.

This multicentric case study aimed to evaluate the clinical feasibility of a new AI-assisted workflow (SmartX), combined with extended scan bodies (SmartFlag). The primary objective was to validate the accuracy of position transfer in 10 fully edentulous patients, carrying a total of 54 implants. The authors tested the hypothesis that this protocol would achieve a clinically acceptable passive fit, evaluated by the Sheffield test and screw resistance tests, while ensuring the survival of implants and prostheses over a minimum follow-up of 6 months.

AI-assisted SmartX workflow methodology

This multicenter clinical study takes the form of a case series aimed at evaluating the feasibility of a digital protocol for "all-on-X" type rehabilitations. The cohort included 10 fully edentulous patients in whom 54 implants were placed, representing an average of 5.4 implants per arch.

The experimental protocol used extended scan bodies (SmartFlag) and an intraoral scanner to perform the digital impressions. Data processing was carried out via the artificial intelligence-assisted SmartX workflow to ensure the transfer of implant positions.

The clinical success evaluation was based on the passive fit of the framework, qualitatively measured (acceptable or non-acceptable) via three distinct tests:

• A visual and tactile inspection.
• The Sheffield test (one-screw test).
• A screw-in resistance test.

An indirect clinical indicator of seating was observed by noting the angular displacement (approximately 60 degrees) during progressive tightening from 5 to 20 Ncm. Clinical follow-up was maintained for a minimum period of 6 months to document the survival of implants and prostheses, as well as the potential occurrence of technical or biological complications.

Results: Validated clinical precision on the full arch

This multicenter case series evaluated the clinical feasibility of artificial intelligence (AI)-assisted digital workflow in 10 fully edentulous patients. A total of 54 implants were placed and restored, representing an average of 5.4 implants per arch.

Evaluation of passive fit

The primary outcome of the study, namely a clinically acceptable passive fit, was achieved in 100% of cases (10/10). This validation is based on a rigorous triple qualitative assessment:

• Visual and tactile inspection.
• Sheffield test (one-screw test).
• Screw resistance test.

An indirect clinical indicator of seating behavior was observed during the progressive tightening of the screws: an angular displacement of approximately 60 degrees was recorded when moving from a torque of 5 Ncm to 20 Ncm in all treated cases.

Clinical follow-up and complications

Secondary outcomes, measured over a minimum follow-up period of 6 months, confirm the short-term reliability of the SmartX protocol:

Paramètre évalué	Result (n=10 patients / 54 implants)
Survival rate of implants	100 %
Survival rate of prostheses	100 %
Biological complications	None (0)
Technical complications	None (0)

Significance analysis

Although the results show a 10/10 success rate for passive fit, the authors emphasize that the 95% confidence interval remains wide due to the small sample size. As the study is an uncontrolled case series, no p-value is reported to compare this workflow to a conventional method. Qualitative observations suggest, however, that the integration of AI and extended scan bodies (SmartFlag) helps compensate for cumulative intra-oral scanning errors over large spans.

AI at the service of prosthetic passivity: a confirmed feasibility

The results of this multicentric case series suggest that the AI-assisted digital workflow (SmartX), combined with extended scan bodies (SmartFlag), offers a clinically viable solution for "all-on-X" rehabilitations. The systematic success of passive fit (10/10 patients) validated by standard clinical tests — visual inspection, Sheffield test, and screw resistance — indicates that AI could compensate for cumulative scanning errors, a major obstacle in large-span optical impressions.

Notable observation in the practice: the observation of a 60-degree angular displacement during tightening (from 5 to 20 Ncm) served as an indirect indicator of the seating behavior. Although this data is not a quantitative measurement of misfit, it offers a concrete visual reference during the placement of the framework. The absence of biological or technical complications at 6 months across the 54 implants placed reinforces the immediate safety of this protocol.

However, the study's limitations call for nuance. The small sample size (n=10) and the purely qualitative evaluation limit the statistical significance of the 100% success rate. Unlike in vitro studies that measure precision to the nearest micron, this work validates direct clinical feasibility but does not quantify absolute accuracy (trueness). For the practitioner, this workflow appears ready for daily use, simplifying full-arch capture, subject to future confirmation on larger cohorts and over the longer term.

Study summary

This multicenter case series involving 10 patients (54 implants) confirms the clinical feasibility of the AI-assisted SmartX digital workflow. Qualitative assessments, including the Sheffield test, validate acceptable prosthetic passivity in 100% of cases, with no documented technical or biological complications at 6 months.

In concrete terms, for the practitioner:

• Optimize the full arch: The use of AI combined with extended scan bodies secures the transfer of implant position, reducing cumulative scanning errors on All-on-X rehabilitations.
• Maintain your validation protocols: Technological assistance does not replace classic clinical tests; the one-screw test and tactile inspection remain imperative to confirm actual passivity at the chairside.
• Interpret the tightening: An angular displacement of approximately 60° observed between 5 and 20 Ncm during screwing can be used as an indirect clinical indicator of a good prosthetic fit.

Full-arch digital impressions on implants are often criticized for their lack of precision compared to conventional techniques, due to cumulative scanning errors. However, the integration of artificial intelligence (AI) could well change the game. A recently published multicenter case series explores the clinical feasibility of the SmartX system, an AI-assisted workflow combined with specific scan bodies.

---

Information intended for healthcare professionals. This content may contain errors or truncated summaries. We recommend always verifying with the original source article. Delynov disclaims all responsibility regarding the use of this information. This document is not intended for patients or the general public.