Splint Preferences Form
Where applicable, 'ROE standard' preferences are preselected. You can change any of these to your specific preferences.
Labtrac ID
Preferences Complete
True
Name
*
First Name
Last Name
Email
*
example@example.com
Name of Dental Practice
*
Preferred Methods of Communication
*
Call Office
Call Cellphone
Text Cellphone
Email
Email and call
Cellphone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Arch
*
Upper (ROE standard)
Lower
Upper and Lower
L - Preferred Arch
Splint Material
*
Clearguard Hard
Clearguard Semisoft (ROE standard)
Clearguard Hard w/ Memory Liner
Comfort Hard/Soft
Mouth guard
L - Splint Material
Surface Design
*
Flat Plane (ROE standard)
Flat Plane with Posterior Indentation
L - Surface Design
Splint Design
*
Canine Guidance (ROE standard)
Anterior Ramp
No additional design
L - Splint Design
Labial Coverage
*
Yes - 3mm coverage over incisal edges (ROE standard)
No - do not extend over the incisal edges at anteriors
Yes - Other
Labial Coverage Other
L - Labial Coverage
Fabricate Models
*
Fabricate Model (ROE standard)
Model-less, if possible
L - Fabricate Models
Additional Notes
Submit
Should be Empty: