Send New Cosmetic Design Case

Doctor Name*
Email*
Phone Number*
Patient Name*
Patient Seat Date*

MonthDayYear
Date
Email to send files / designs*
Additional Email
Restoration Design*
No. of teeth to be included in the Trial Smile?*
Who is printing the design?*
Shade*
Use my previously approved design diagnostic wax-up design by ROE?*
- Trial Smile design STLs will be provided in 24 hrs.
- Trial Smile's fabricated by ROE will be shipped in 3 days.
Restoration Type*

Full Coverage Crowns3/4 CrownsVeneersBridgeOther
Pontic Design*
* For Bridge
Final Restoration Material*
Final Restoration Material*
* For Veneers
Who is milling the final restoration?*
Turnaround Time: It will take 5 days in lab for eMax or Bespoke zirconia, or 8 days in lab for PFZ upon either digital receipt or physical receipt of all appropriate records.
Stump Shade*
Shade*
Turnaround Time*
Have you pre-booked design services?*

Yes, I have pre-booked resourcesNo, I have NOT pre-booked resources. I will call ROE to confirm available resources (800-228-6663 x511).
In order to guarantee a 1-hour turnaround time you need to have pre-scheduled planning resources 48 hours in advance. If you have not done so call us 800-228-6663 to confirm available resources.
Teeth to be restored*
Planned Restoration Type
Planned Restoration Type*

Full Coverage Crowns3/4 CrownsVeneersBridgeOther
Pontic Design*
Occlusal Anatomy*
Occlusal Guidance*
Occlusal Contact*
Lingual Anatomy*
Contour Instructions*
Hollywood
Additional incisal length to the central incisor?*
Create ideal gingival architecture?**
* This may require a gingivectomy or crown lengthening to achieve the final results.
Create uniform gum heights?*
Please include -

Reduction GuidesPrinted Diagnostic ModelPutty Matrix
Explain what you wish to achieve with the gum height*
Lack of Restorative Space*
How do you want to print your temporary restorations?*
Patient Records
Scan type being submitted*
Confirm Individual Scans*

Prep ScanTemp Scsn
How are you submitting your files?*
Confirm the required photos are being uploaded with this case*

Preop - Full face, full smile photoPreop - Full face, retracted smile photoPreop - Close-up smile photoIn temps - Full face, full smile photoIn temps - Full face, retracted smile photoIn temps - Close-up smile photo
Confirm the required photos are being uploaded with this case*

Full face, full smile photoFull face, retracted smile photoClose-up smile photo
IOS Portal*
Digital preparations: Only need pre-op scan. Post-operative for temps/veneers: Need post-op scans and HIGHLY RECCOMEND pre-op as well
Other IOS Portal*
Additional Notes
Patient Files

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Please verify that you are human*
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Patient Records