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Account ID
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This is case-sensitive. If you are unsure, go into the the Account Information tab and copy directly.
First Letter of the First Name
*
First Three Letters of the Last Name
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Will you be providing a presurgical design for this case?
*
Please Select
No, I need you to make the design for me.
Yes, I will be providing a presurgical design.
Please select "No" for the option above
Arch Selection
*
Please Select
Maxillary
Mandibular
Both
***Please include project file, original scan records, etc.***
File Upload
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Browse Files
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Setup Information
What's the manufacturer of your scanbody?
*
Please Select
iCAM
IOConnect
MicronMapper
OptiSplint
PIC
Shining Elite
Tupel
Other
Other Scanbody
*
Screw Information
*
Please Select
DESS
SIN
VORTEX
Other
N/A
Other Screw Brand
*
DESS Screw Type
*
Please Select
Multi-Unit RP 19.018
Multi-Unit RP 19.069
Other
SIN Screw Type
*
Please Select
PRH30
Smart Angle Screw
Other
Vortex Screw Type
*
Please Select
1.0 Seat
1.2 Seat
1.4 Seat
Other
Other Screw Type
*
What's the manufacturer of your photogrammetry scanbody?
Please Select
Micron Mapper
iCAM
IOConnect
Arch Selection
*
Please Select
Maxillary
Mandibular
Both
Tooth Form
Please Select
Masculine
Feminine
Tooth Mould Selection
Please Select
Match Current Mould
Other
***If the specified mould is unavailable, we will select the closest matching alternative***
Enter Mould Type
*
Extend design to
*
First molar
Second molar
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Part 1 - Incisal Display
Digital Prescription
Options
*
Please Select
Maintain
Increase
Decrease
By (X) mm
*
Based on tooth number
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Part 2 - Midline
Digital Prescription
Midline Movement (Maxilla)
*
Please Select
Maintain
Move to the patient's left
Move to the patient's right
Midline Movement (Mandible)
*
Please Select
Maintain
Match to the maxilla
Move to the patient's left
Move to the patient's right
By how many mm?
*
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Part 3 - Lip Support/Buccal Lingual Position
Digital Prescription
Options
*
Please Select
Maintain
Change
In which direction
*
Please Select
Facially (Increase)
Palatally/Lingually (Decrease)
By (X) mm
*
Based on tooth
*
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Part 4 - Vertical Dimension of Occlusion
Digital Prescription
Changes to the VDO
*
Please Select
Maintain
Increase
Decrease
Through the
*
Please Select
Maxilla
Mandible
Split Evenly
By how many mm (as measured at the articulator pin)
*
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Part 5 - Overjet and Overbite
Digital Prescription
Vertical Overbite
*
Please Select
Maintain
Set to (X) mm
Based on what tooth combination (e.g. 8/25; 9/24)
*
Vertical Overbite (in mm)
*
Horizontal Overjet
*
Please Select
Maintain
Set to (X) mm
Based on what tooth combination (e.g. 8/25; 9/24)
*
Horizontal Overjet (in mm)
*
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Additional Notes
Please enter any additional notes in the field below
Additional notes
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Maxillary File
*
Browse Files
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Mandibular File
*
Browse Files
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Bite Record 1
*
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Bite Record 2
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Patient Photo(s)
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Quick Convert Order Form
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( X )
Single Conversion
$
500.00
Double Conversion
$
1,000.00
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