Smile in a box

Are you a registered customer of "Smile in a Box"?*

YesNo
Please submit your information and Straumann will contact you shortly
Please enter your e-mail address
Customer Name*

First NameLast Name
Customer e-mail Address*
Please enter the e-mail address associated to your Smile in a Box clinician account.
Company Name
Shipping Address*

Street Address

CityState/ Province

Zip CodeCountry
Shipping address
Street address, City, State, Zip Code, Country
Phone Number*
Straumann customer number
1. Patient Information
Case reference number*
Case type*

SingleMultiple unitsFull arch edentulous
Condition and treatment scope
Arch*
Condition*
Loading approach*
Temporary restoration*
Additional clinical observations
2. Implant configuration
Implant system
Surgical kit
Number of implants
Preferred alignment
Numbering System*
Please select a numbering system to be able to indicate the implant sites.

Preferred guided surgery solution*

Sequential pin-supported solutionStackable solution
Additional instructions:
3. Prosthesis design
Would you like to order a temporary restoration?

YesNo
Coloring/Shades
Tooth shade*
Gum shade
Will you be providing a mock-up of the temporary?

YesNo
Additional instructions
4. Workflow Planning & Form Submission
Additional ordered services

Custom trayScan applianceFast delivery (Priority line)Anatomical model
Preferred treatment plan review method*

INTERACTIVE: Straumann will contact you to schedule an online meeting to review and adjust the plan prior to submitting the report (mandatory for full arch restoration).DOCUMENT-BASED: Straumann will submit a report for you to review and approve.
Preferred treatment plan review method*

INTERACTIVE: Straumann will contact you to schedule an online meeting to review and adjust the plan prior to submitting the report (mandatory for full arch restoration).DOCUMENT-BASED: Straumann will submit a report for you to review and approve.
IMPORTANT NOTE ON SURGERY SCHEDULING

Our design and manufacturing turnaround is 10 business days, initiated following the approval of the final plan by the clinician.As case initiation (submission and lab processing) turnarounds are less predictable, we highly recommend to schedule the surgery after submitting the treatment plan approval.
Planned Surgery Date ( if known, see above)

AñoMesDía
Please upload your files here:

Browse Files
Please note that the maximal file size is 1 Go for single file upload and 100 Mo for multiple files upload. Please upload CT scans in .zip format. Cancelof
If your files cannot be uploaded, please provide a link to a cloud storage (dropbox, box, drive, hightail, etc.):
Signature*

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1. Patient Information

2. Implant configuration

3. Prosthesis design

4. Workflow Planning & Form Submission

IMPORTANT NOTE ON SURGERY SCHEDULING