Doctor Preferences Removable PreferencesDr.This field is hidden when viewing the formCustom Trays: Choose One Perforated Non-Perforated This field is hidden when viewing the formHandles: Choose One Straight Up Up and Out This field is hidden when viewing the formExtensions: Choose One Full Extensions 2mm Short of Full Extension Custom Trays: Choose OnePerforatedNon-PerforatedHandles: Choose OneStraight UpUp and OutExtensions: Choose OneFull Extensions2mm Short of Full ExtensionThis field is hidden when viewing the formBase and Rims: Choose One Composite Base SR Ivocap® Processed Base (recommended) This field is hidden when viewing the formIf Processed: Choose One Clear Pink Base and Rims: Choose OneComposite BaseSR Ivocap® Processed Base (recommended)If Processed: Choose OneClearPinkArticulator Type Options: Choose OneStratus 200HanauPanadentWhip MixDenarThis field is hidden when viewing the formArticulator Type Options: Choose One Stratus 200 Hanau Panadent Whip Mix Denar Set Ups Anterior ArrangementUpper (Choose One)IdealCharacterizedLower (Choose One)IdealCharacterizedThis field is hidden when viewing the formUpper (Choose One) Ideal Characterized This field is hidden when viewing the formLower (Choose One) Ideal Characterized Cast Metal FrameworksThis field is hidden when viewing the formChoose One Lingual Bar Lingual Plate This field is hidden when viewing the formChoose One I-Bar Akers Choose OneLingual BarLingual PlateChoose OneI-BarAkersFinishesThis field is hidden when viewing the formRugae: Choose One Yes No This field is hidden when viewing the formChoose One With Labial Anatomy and Stippling Smooth Finish Rugae: Choose OneYesNoChoose OneWith Labial Anatomy and StipplingSmooth FinishDigital Dentures (milled)Choose OnePremium Ivotion®EconomyThis field is hidden when viewing the formChoose One Premium Ivotion® Economy Hybrid DenturesTeeth Type: Choose OneZirconia (individual crowns)Zirconia (monolithic w/ integrated bar)Acrylic (milled teeth)Acrylic (carded teeth)This field is hidden when viewing the formTeeth Type: Choose One Zirconia (individual crowns) Zirconia (monolithic w/ integrated bar) Acrylic (milled teeth) Acrylic (carded teeth) Nightguards|TMJ SplintsChoose OneErkodent Dual LaminateKeysplint ThermoplasticPromotech HardChoose One Finish Option For the Above GuardsFlat Plane with Anterior GuidanceFlat Plane OnlyChoose OneComfort H/S (from scan)This field is hidden when viewing the formChoose One Erkodent Dual Laminate Keysplint Thermoplastic Promotech Hard This field is hidden when viewing the formChoose One Finish Option For the Above Guards Flat Plane with Anterior Guidance Flat Plane Only This field is hidden when viewing the formChoose One Finish Option For the Above Guards Flat Plane with Anterior Guidance Flat Plane Only This field is hidden when viewing the formComfort H/S (from scan) Comfort H/S (from scan) Crown & Bridge PreferencesOcclusion: Choose OneHYPER – Open Adjacent Teeth 0.20mmPOSITIVE/FIRM – Same as Adjacent TeethFOIL RELIEF – Out of Occlusion 0.15mmPDL RELIEF – Out of Occlusion 0.3mmInterproximal Contacts: Choose OneHEAVY: You would like to adjustIDEAL: Design and finish with goal of minimal adjustmentBROAD: Contact as much of adjacent teeth as possiblePINPOINT: Single point of contactOcclusal/Facial Anatomy: Choose OneDEEP: Defined cusps and ridges, deep occlusal or heavy facial anatomySOFT: Softer cusps and ridges, not as defined facial and occlusal anatomyMATCH ADJACENT: We will design and finish to blend with patient’s existing dentitionThis field is hidden when viewing the formOcclusion: Choose One HYPER – Open Adjacent Teeth 0.20mm POSITIVE/FIRM – Same as Adjacent Teeth FOIL RELIEF – Out of Occlusion 0.15mm PDL RELIEF – Out of Occlusion 0.3mm This field is hidden when viewing the formInterproximal Contacts: Choose One HEAVY: You would like to adjust IDEAL: Design and finish with goal of minimal adjustment BROAD: Contact as much of adjacent teeth as possible PINPOINT: Single point of contact This field is hidden when viewing the formOcclusal/Facial Anatomy: Choose One DEEP: Defined cusps and ridges, deep occlusal or heavy facial anatomy SOFT: Softer cusps and ridges, not as defined facial and occlusal anatomy MATCH ADJACENT: We will design and finish to blend with patient’s existing dentition ImplantsPreferred Implant System(s):Choose OnePrefer screw retained restorations whenever possiblePrefer custom abutment and cementable crownDo you place your own implants?YesNoThis field is hidden when viewing the formChoose One Prefer screw retained restorations whenever possible Prefer custom abutment and cementable crown This field is hidden when viewing the formDo you place your own implants? Yes No If no, what specialists do you refer to?This field is hidden when viewing the formDo you have an intraoral scanner? Yes No If Yes, Type:OtherDo you have an intraoral scanner?YesNoThis field is hidden when viewing the formDo you have an intraoral scanner? Yes No If yes, which system?Shade Guide(s) Used:Articulator(s) Used:Other C&B Specifics Δ
