Case Submission Form
Case Type
*
Choose Case Type
Full Arch Zirconia
Zirconia with Titanium Bar
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Design Approval
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* Do you want to review design prior to fabrication of final prosthesis?
Please allow up to 14 business days for final case delivery once the design has been approved.
Proceed without design approval
Design approval requested
Acknowledgement
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* Fabrication of any final zirconia will take 12 business days in the lab, plus an additional 2 business days for shipping.
If design approval was requested, fabrication will not begin until approved. Designs requiring approval will be sent to you for review on Slack and customer portal within 3 business days.
Please ensure the return date you request is at least 14 business days from today.
Understood
RUSH (additional cost may be incurred)
Implant Brand
*
* What implant system are you placing?
Requested Return Date
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* When do you need this case back in office? If RUSH was requested, you must call the lab after Rx submission for date approval.
+91-234567890
Tooth Shade
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* Minor changes needed to deliver final hybrid
Tissue Shade
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FP1 No tissue color needed
G00 Lightest Pink
G1 Standard Pink
G3 Medium
G5 Darkest Pink
Tissue Pressure
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0.0mm
0.5mm
1mm
Other
Screw Type
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Follow prototype - no change
SIN - PRH30
Rosen
Dess 19.018 (0.050 driver)
Dess 15.007 (ti base)
Dess 19.069 angled screw
Dess 15.098 (straumann ti base)
Dess 19.096 (unigrip driver)
La-Vis Vortex
Badger
Powerball
Nightguard
*
* Would you like a nightguard made for the final?
Yes
No
Upper
Lower
Final Prosthesis
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Zirconia Hybrid
Zirconia with Ti-bar
PMMA with Ti-bar
Thimble Bar
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