Encompass Case Submission

Encompass Case Submission
Required Items

DICOM of patient wearing denture with radiographic markers

Complete scan of denture, with radiographic markers, including intaglio surface

Opposing and bite

Patient photos - High and Low smile
Doctor *

First Name Last Name
License # *
Patient Identification Code (PIC) *
Required for case communication to maintain HIPPA compliance. Please enter existing PIC (already used within your office). Or Create a 5-7 digit code (alpha & numerical) Example: Pt. John Doe = D13578
Patient Name

First Name Last Name
Care Coordinator

First Name Last Name
Email *
example@example.com
Secondary Email
example@example.com
Phone Number *

Area Code Phone Number
Practice Branch
Zest Rep

First Name Last Name
- We cannot start processing your case without necessary records.
- You will receive an email confirming reciept of patient records within 24 hours.
- We will be ready to schedule a review within 4 days after receiving all necessary patient records.
- We guarantee shipment of a Encompass Denture-in-a-Box case 10 business days after case review and approval is received from surgeon.
Do you feel the fit and design of the patient's current denture is satisfactory enough to serve as the foundation of a new design? *

Yes - Send me an Encompass Denture-In-A-Box No - We will contact you within 24 hours to discuss options - see protocols below
Arches *

Maxillary Mandibular Dual Arch Uploading supplemental material
Implants *

Maxillary, 6 implant Maxillary, 4 implant Mandible, 4 implant Mandible, 2 implant
STL Upper Denture Scan - Including intaglio *

Browse Files
Scan the denture with radiographic markers attached Cancel of
STL Lower Denture Scan - Including intaglio *

Browse Files
Scan the denture with radiographic markers attached Cancel of
Opposing *

Browse Files

Cancel of
Bite Scan

Browse Files
A bite scan is not required if the scans are already in the correct bite Cancel of
Please do not submit CBCT scans of dentures - only digital models will be accepted
STL Denture Scan - Including intaglio

Browse Files
With PVS wash impression Cancel of
STL Denture Scan - Including intaglio

Browse Files
With PVS wash impression Cancel of
Upper Full-Arch Scan

Browse Files
(For bite-rim fabrication) Cancel of
Lower Full-Arch Scan

Browse Files
(For bite-rim fabrication) Cancel of
DICOM Upload (Out of Occlusion) *

Browse Files
Scan the patient wearing the denture with radiographic markers. Please upload a zipped folder of raw .DCM slices. Cancel of
Photographs - High and Low Smile *

Upload Files

Cancel of
Tissue Shade *
Tooth Shade *
If you are a new customer please select yes and fill in the following
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Agree to terms and conditions of order *

I have read, understand and agree to the terms and conditions of ordering products using this form.
Notes
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