Zest Denture-In-A-Box

Zest Denture-In-A-Box

Zest LODI Implant System
Required Items

DICOM of patient wearing denture with radiographic markers

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

Patient photos - High and Low smile

Completed RX Form
Doctor *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com
Patient Name *

First Name Last Name
Practice Location *
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 48 hours after receiving all necessary patient records.
- We guarantee shipment of a Denture in a Box case 5 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 a Denture-In-A-Box No - We will contact you within 24 hours to discuss options - see protocols below
Arches *

Maxillary (6 Implants) Mandibular (4 Implants) Dual Arch Uploading supplemental material
Complete Denture Scan 1 *

Browse Files
Scan the denture with radiographic markers attached Cancel of
Complete Denture Scan 2

Browse Files
Scan the denture with radiographic markers attached Cancel of
Complete Denture Scan 1

Browse Files
With PVS wash impression Cancel of
Complete Denture Scan 2

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) *
Scan the patient wearing the denture with radiographic markers. Please upload a zipped folder of raw .DCM slices.
RX Form

Browse Files

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
Required unless an RX form is uploaded
Should be Empty: