Surgical guides / Tissue-supported
Tissue-supported surgical guides
Custom implant planning and guide design for edentulous patients.
A tissue-supported surgical guide, also called a mucosa-supported guide, is a custom surgical template that rests on the soft tissue covering an edentulous ridge. It helps the clinician prepare the implant sites through guided drilling (osteotomy), following an approved digital implant plan.
On this page
At a glance
Case selection
Edentulous patients considering a fixed implant-supported restoration or a locator overdenture.
What we need
A well-fitting denture and two CBCT scans following the dual-scan protocol. Additional records are needed when designing a new smile.
What you receive
Planning documents, a digital model design and surgical guide STL files, with ready-to-print files for Formlabs and SprintRay users.
Who this is for
Tissue-supported guides may be suitable for edentulous patients transitioning from a conventional removable denture to:
- A fixed/hybrid implant-supported restoration.
- A locator overdenture, a removable denture secured to implants for additional retention.
We always recommend fixation pins for additional guide stabilization. We can design around the fixation pins supplied with your guided surgical kit. Please include the kit and pin details with your case submission.
What to submit
Note: Always check the denture’s fit and reline it if needed before capturing any records.
The denture should be well adapted to the supporting tissues. Complete any required reline before the CBCT scans, intraoral scans or clinical photographs are taken.
Dual-scan protocol
Add 6 fiducial markers (CT markers) to the denture: 3 on the buccal flanges and 3 on the palatal or lingual flanges.
- Patient CBCT: Scan the patient wearing the denture with the CT markers in place.
- Denture CBCT: Scan the same denture outside the mouth, with the same CT markers in place.
Keep the markers in the same positions between scans. Submit both complete original DICOM raw datasets.
Download the dual-scan protocol (download to be added)
If a new smile is being designed
In addition to the dual-scan records, please provide:
- Upper, lower and bite intraoral scans with the denture in place.
- A complete 360-degree extraoral scan of the denture, capturing all surfaces, including the intaglio surface.
- A soft-tissue scan showing the full vestibule and, for the upper arch, the complete palate.
- Patient clinical photographs following the patient pictures protocol.
Download the patient pictures protocol (DSD) (download to be added)
Please also include the intended restoration, implant system, guided surgical kit and fixation pin details.
Our workflow
- Submit your case. Send the required records and case information through the client portal.
- QC and Treatment Planning We check the records for completeness and quality, align the datasets and prepare the proposed digital implant plan.
- Review and approve. The treating clinician reviews and approves the plan by email or during a Zoom call before guide design begins.
- Design and Delivery We design the guide around the approved plan and fixation pin strategy, then provide the planning documents and digital files for your case.
Turnaround and deliverables
Turnaround
| Stage | Turnaround | When it begins |
|---|---|---|
| Implant planning | 1 business day | Once all required records and case information have been received |
| Surgical guide design | 2 business days | Once the implant plan has been approved and all design requirements are available |
These times apply to digital planning and guide design. For a manufactured guide, allow 5 business days total from treatment-plan approval to delivery at your office.
What you receive
- Implant Plan Report
- Drilling protocol
- Case presentation
- Digital model design
- Surgical guide design
- Prepared print file for Formlabs or SprintRay users, configured for the confirmed printer and material workflow.
Need a manufactured guide?
We can also manufacture your surgical guide if you do not have a 3D printer. Allow 5 business days from treatment plan approval to delivery at your office. This period includes guide design, manufacturing and delivery.
Frequently asked questions
Do I need to reflect a flap?
Not necessarily. Tissue-supported guides can be used for flapless implant placement when clinically appropriate. The treating clinician determines whether a flap or a tissue punch is needed for the planned procedure.
Does the denture always need a reline?
Always check the fit first. If necessary, reline the denture before capturing any records.
The denture’s tissue-contacting (intaglio) surface provides a reference for guide design. A well-adapted denture helps establish the fit needed for stable guide seating.
Which CBCT scans do I need?
Submit a CBCT of the patient wearing the denture with markers and a CBCT of the same denture outside the mouth. Keep the same CT markers in place for both scans and submit the complete original DICOM raw datasets.
What if the patient wants a new smile?
Please also submit upper, lower and bite intraoral scans with the denture in place, a complete 360-degree extraoral denture scan, a soft-tissue scan and clinical photographs following our photography protocol.
Do you recommend fixation pins?
Yes. We always recommend fixation pins for additional guide stabilization. We can design around the pins supplied with your guided surgical kit; please provide the kit and pin details.
Can I print the guide in my clinic or laboratory?
Yes. We provide STL design files for compatible 3D printing or milling workflows. For Formlabs and SprintRay users, we also provide a prepared print file configured for the confirmed printer and material workflow.
Your case. Our support.
Send us your records, or get in touch before scanning to discuss what your case needs. We are here to support you and your team, from patient consultation to final restoration.
Clinical evidence
In their 2026 clinical comparison of guide-support types, Smojver et al. highlighted the influence of soft-tissue displacement and guide stabilization on implant placement accuracy. These findings reinforce the importance of careful seating, a planned fixation strategy and case-specific clinical assessment when using tissue-supported guides.
Reference
Smojver I, Bjelica R, Vuletić M, Stojić L, Njari Galić V, Gabrić D. Accuracy of Static Computer-Aided Implant Surgery: A Clinical Comparison of Tooth-, Bone-, and Mucosa-Supported Surgical Guides. Journal of Functional Biomaterials. 2026;17(4):194. doi:10.3390/jfb17040194.