Guided Surgery Parts Order Form

ROE Dental Laboratory has simplified the ordering of components for guided surgery. Our aim is to provide accurate OEM information to the doctor, the doctor’s implant representative, and for ROE’s permanent record, to ensure the doctor receives the correct parts and quantities and the rep receives a commission for the order.

This form generates your implant order. Send the order to your implant rep for fulfillment.

Implant Sizes and Angulation

ROE encourages doctors to connect with their local implant rep for OEM parts. This order form contains OEM implants, limited and specific multi-unit abutments (with collar heights appropriate for tissue depths), and temp copings (remember to order 2 temp copings per implant site for every case). Use this form for your upcoming CHROME GuidedSMILE case.

Implant representative, please contact the doctor to confirm this order.
This form generates your implant order. Send the order to your implant rep for fulfillment.

Implants


Copy and paste catalog code from the above table.
Implants (Click + to add additional implants)
Implant Catalog #
Tooth #
 


MUA's


Copy and paste catalog code from the above table.
MUAs (Click + to add additional implants)
MUA #
Tooth #
 


Case Information

Important Dates
MM slash DD slash YYYY
MM slash DD slash YYYY


Patient Info
Patient Name(Required)


Implant Rep Info
Implant Rep Name


Doctor Info
Doctor Name(Required)



This form generates your implant order. Send the order to your implant rep for fulfillment.