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SURGICAL PACKAGE-10% OFF

INCLUDES: Scan Template, Plan, and Surgical Guide DOCTOR ADDRESS CITY PHONE EMAIL STATE FAX ZIP PATIENT NAME AGE MALE / FEMALE

GUIDED SURGERY Rx
5 Business Days In Lab

TODAYS DATE

/ /

DUE DATE

/ /

Scan Template:
Partially Edentulous Fully Edentulous 1-8 Teeth 9+ Teeth

STEP 1

STEP 2
Plan:
Doctor Plans Case Allure Dental Studio Creates Proposal* Email Address:

STEP 3

Surgical Guide:
Straumann Other Manufacturer* Size:
*Does not include Depth Control

From Existing Denture Diagnostic Tooth Setup Celera Impression Technique

*Doctor must approve final plan

Surgery Type
Flapped Flapless Immediate Extraction

Abutment Selection

Emergence Width
No Tissue Displacement
(Default)

Zirconium PFM Temporary CAD


($65 extra) ($149)

Restorations

e.max

Tissue Displacement

(alloy surcharge may be applied)

Semi Precious Screw Retained


($149)

Titanium

Zirconia

Surgical Placement

Over Temporary Abutment

Instructions:

Shade

DOCTORS SIGNATURE

460 West Larch Road, Suite #1 Tracy, Ca 95304 Toll Free: (877) 325-5873 Fax: (209) 221-6792 asds@alluredentalstudio.com

LICENSE NUMBER

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