Scan&Smile Full Arch Design

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This form should be completed and submitted in one session. You will not be able to continue filling this form on another device.
Scan&Smile Full Arch Design
Dr. First and Last Name*

First NameLast Name
Dental Clinic Name*

Clinic Name

Delivery Address

CityState

Zip Code
Country*
Phone for any issues / question arises*

Country CodeArea CodePhone Number
Dental Clinic Case ID*
e.g. patient last name - this allows to identify the work precisely back to you
E-Mail to receive STL files and for us to contact*

Confirmation Emailexample@example.com
Planned Date and Time of surgery (in your time zone)*

MonthDayYear
Date
Hour MinutesAM/PM Option
US Timezone*
Write your timezone*
Full Arch consultancy design preferences
Full Arch Design for*
Number of Units in the Case*
Preferred Fixed Prosthesis Type*
Use of ScanBridge or Photogrammetry*
Brand of Photogrammetry*
Tell us technical information about the case and your design preferences
Midline*
How many mm to move
Incisal edge position*
How many mm to move
VDO*
How many mm to move
Occlusion*
list any changes needed to current bit relationship e.g. class1, edge to edge, open bite by how many mm
For surgical planning, specify desired implant positions, quantities, and sizes*
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.*
Tell us more about the case and your design preferences
Load required files up on booking *

Cancelof
Pre-op I/O Scans*

Cancelof
Promocode
calculation

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Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Disclaimer:

Scan&Smile Full Arch Design

Full Arch consultancy design preferences

Tell us technical information about the case and your design preferences