S&S design C&B US&EU

Disclaimer:

This form should be completed and submitted in one session. You will not be able to continue filling this form on another device.
Digital Impression upload form for Single unit up to 7-unit bridge
Dr. First and Last Name*

First NameLast Name
Dental Clinic Name and Address*

Clinic Name

Street Address

CityZIP code

CountryCountry
Case Instruction
Email address to receive CAD*
Choose booked designer name*
Choose type of requested CAD design*

matrix provisional implant crownmatrix provisional implant bridge
Dental Clinic Case ID*
e.g. patient last name - this allows to identify the work precisely back to you
Number of teeth required to be designed*
Calculation - hidden field
Design Preferences
Mesial/Distal Contacts Distance [mm]*
Occlusion Distance [mm]*
Indicate matrix® platform and pontic

Upper arch: Please type "37 or 45" for platform and "P" for pontic

	17 (2)	16 (3)	15 (4)	14 (5)	13 (6)	12 (7)	11 (8)	21 (9)	22 (10)	23 (11)	24 (12)	25 (13)	26 (14)	27 (15)
Type: P37, P45, "P" pontic

Lower arch: Please type "37 or 45" for platform and "P" for pontic

	47 (31)	46 (30)	45 (29)	44 (28)	43 (27)	42 (26)	41 (25)	31 (24)	32 (23)	33 (22)	34 (21)	35 (20)	36 (19)	37 (18)
Type: P37, P45, "P" pontic

Minimum of upper, lower and bite files to be uploaded. Any pre-op would also helpful, especially for 4-unit to 7-unit bridge.*

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By default we design with 2.8-L screws. If screw channel is going through the esthetic zone of the restoration (e.g. labial) would you like us to use 2.6 screw instead? If so you must have 2.6 screw in your clinic.*
Do you want to check design before finalizing?

YesNo
We will send the design for approval to your email. Please be informed that this will cause extra time. Your designs will not be completed within 20mins or 1hr
Additional Notes
Payment

Payment will be refunded in case the CAD design doesn't meet your request.

Digital Impression upload form for Single unit up to 7-unit bridge