CHROME Digital Rx

Doctor and Patient Info

Are you the...*

Doctor name*

First Last

Doctor Address*

Street Address City State / Province / Region ZIP / Postal Code

Doctor email*

Doctor phone*

Placing Doctor name*

First Last

Placing Doctor Address*

Street Address City State / Province / Region ZIP / Postal Code

Placing Doctor email*

Placing Doctor phone*

Restorative Doctor name*

First Last

Restorative Doctor Address*

Same as Placing Doctor

Street Address City State / Province / Region ZIP / Postal Code

Restorative Doctor email*

Restorative Doctor phone*

Shipping Address*

What account should this be assigned to*

CHROME Experience*

Patient name*

First Last

Patient Age*

Treatment Info

Select case type*

Single arch type*

Choose the CHROME product*

CHROME package options for single arch*

Ivotion GuidedSMILE*

Price:

GuidedSMILE LITE (Plastic Version)*

Price:

CHROME Surgical Package includes model work, articulation, record analysis, articulation, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance.
CHROME Full Package includes ALL ITEMS from Surgical Package, plus PreVu smile simulation, iJIG, long-term Printed Try-In, final restoration, miniComfort guard.

For more information CHROME click here.

Ivotion GuidedSMILE includes model work, articulation, record analysis, articulation, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance.

CHROME Natural package options for single arch*

Full package selection results in 8-10% savings vs. al a carte

CHROME Natural Surgical Package includes model work, articulation, record analysis, articulation, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance.
CHROME Natural Full Package includes ALL ITEMS from Surgical Package, plus PreVu smile simulation, iJIG, long-term Printed Try-In, final restoration, miniComfort guard.

For more information on CHROME Natural click here.

Include the optional metal scallop guide?*

Full scalloped guide for labial reduction guidance and socket shaping or labial reduction guide only.

CHROME Replica package options for single arch*

CHROME Replica only comes as a full package

CHROME Replica Full package includes, record diagnosis, articulation, printing models and bites, model pouring, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance, two long-term provisional prosthetics fabricated post-healing/integration.

For more information on CHROME Replica click here.

Specialty Implants (Maxilla Only)

Pterygoid Implant brand*

Pterygoid Guided kit*

Nasalis Implant brand*

Nasalis Guided kit*

Zygomatic Implant brand*

Zygomatic Guided kit*

Zygo Skull Model Print*

Price:

Single arch, describe the opposing condition*

Do you require a JC Try-in?

Yes, fabricate a JC Try-In to ensure the bite is ideal (CTJC). The fabrication of a JC Try-in will add 2 additional weeks to the timeline

Single arch additional options

Fabricate a JC Try-In to ensure the bite is ideal? (CTJC)

Single arch prosthetic design*

Additional costs can be incurred depending on the choice made

Note: C2F small hole technology will add to the cost of the first case $619. This example includes 6 x C2F Assemblies ($94 ea), 1 x Drill ($10), 1 C2F model ($45). Subsequent cases can be only $19/implant extra for C2F analogs and the $45 C2F model.

ROE recommends chairside assistance for the first C2F case to teach this new conversion process.

If you are unaware of the power of C2F please watch the C2F educational videos https://www.roedentallab.com/C2F.

Smileloc costs very according to the number of implants. Smileloc cost is approx. $235-260 per implant. This will be discussed at the planning meeting.

ROE recommends chairside assistance for the first Smileloc case to teach this new conversion process.

If you are unaware of the power of Smileloc please watch the Smileloc educational videos https://www.roedentallab.com/smileloc.

Maxillary Arch

Maxillary CHROME product*

CHROME package options for maxillary arch*

Ivotion GuidedSMILE*

Price:

GuidedSMILE LITE (Plastic Version)*

Price:

CHROME Surgical Package includes model work, articulation, record analysis, articulation, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance.
CHROME Full Package includes ALL ITEMS from Surgical Package, plus PreVu smile simulation, iJIG, long-term Printed Try-In, final restoration, miniComfort guard.

For more information CHROME click here.

Ivotion GuidedSMILE includes model work, articulation, record analysis, articulation, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance.

CHROME Natural package options for maxillary arch*

Full package selection results in 8-10% savings vs. al a carte

CHROME Natural Surgical Package includes model work, articulation, record analysis, articulation, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance.
CHROME Natural Full Package includes ALL ITEMS from Surgical Package, plus PreVu smile simulation, iJIG, long-term Printed Try-In, final restoration, miniComfort guard.

For more information on CHROME Natural click here.

Include the optional metal scallop guide?*

Full scalloped guide for labial reduction guidance and socket shaping or labial reduction guide only.

CHROME Replica package options for maxillary arch*

CHROME Replica only comes as a full package

CHROME Replica Full package includes, record diagnosis, articulation, printing models and bites, model pouring, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance, two long-term provisional prosthetics fabricated post-healing/integration.

For more information on CHROME Replica click here.

Maxillary occlusion*

Maxillary prosthetic design*

Additional costs can be incurred depending on the choice made

Note: C2F small hole technology will add to the cost of the first case $619. This example includes 6 x C2F Assemblies ($94 ea), 1 x Drill ($10), 1 C2F model ($45). Subsequent cases can be only $19/implant extra for C2F analogs and the $45 C2F model.

ROE recommends chairside assistance for the first C2F case to teach this new conversion process.

If you are unaware of the power of C2F please watch the C2F educational videos https://www.roedentallab.com/C2F.

Smileloc costs very according to the number of implants. Smileloc cost is approx. $94 per implant. This will be discussed at the planning meeting.

ROE recommends chairside assistance for the first Smileloc case to teach this new conversion process.

If you are unaware of the power of Smileloc please watch the Smileloc educational videos https://www.roedentallab.com/smileloc.

Is the Mandibular CHROME Product the same as the Maxillary?*

Mandibular Arch

Mandibular CHROME product*

CHROME package options for mandibular arch*

Ivotion GuidedSMILE*

Price:

GuidedSMILE LITE (Plastic Version)*

Price:

CHROME Surgical Package includes model work, articulation, record analysis, articulation, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance.
CHROME Full Package includes ALL ITEMS from Surgical Package, plus PreVu smile simulation, iJIG, long-term Printed Try-In, final restoration, miniComfort guard.

For more information CHROME click here.

Ivotion GuidedSMILE includes model work, articulation, record analysis, articulation, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance.

CHROME Natural package options for mandibular arch*

Full package selection results in 8-10% savings vs. al a carte

CHROME Natural Surgical Package includes model work, articulation, record analysis, articulation, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance.
CHROME Natural Full Package includes ALL ITEMS from Surgical Package, plus PreVu smile simulation, iJIG, long-term Printed Try-In, final restoration, miniComfort guard.

For more information on CHROME Natural click here.

Include the optional metal Scallop Guide?*

Full scalloped guide for labial reduction guidance and socket shaping or labial reduction guide only.

CHROME Replica package options for mandibular arch*

CHROME Replica only comes as a full package

CHROME Replica Full package includes, record diagnosis, articulation, printing models and bites, model pouring, virtual tooth set-up, implant and bone reduction planning, live online planning session, day of surgery CHROME package with long term provisional and RAPID appliance, two long-term provisional prosthetics fabricated post-healing/integration.

For more information on CHROME Replica click here.

Mandibular occlusion*

Mandibular prosthetic design

Additional costs can be incurred depending on the choice made

Note: C2F small hole technology will add to the cost of the first case $619. This example includes 6 x C2F Assemblies ($94 ea), 1 x Drill ($10), 1 C2F model ($45). Subsequent cases can be only $19/implant extra for C2F analogs and the $45 C2F model.

ROE recommends chairside assistance for the first C2F case to teach this new conversion process.

If you are unaware of the power of C2F please watch the C2F educational videos https://www.roedentallab.com/C2F.

Smileloc costs very according to the number of implants. Smileloc cost is approx. $235-260 per implant. This will be discussed at the planning meeting.

ROE recommends chairside assistance for the first Smileloc case to teach this new conversion process.

If you are unaware of the power of Smileloc please watch the Smileloc educational videos https://www.roedentallab.com/smileloc.

Mobile teeth*

Identify mobile teeth number(s)

Provisional tissue shade*

Provisional tooth shade*

Provisional tooth shade (Ivotion)*

Patient Records & Case Design

Please use our checklists to help with record collection. They are based on how patient presents - CHROME Patient Record Checklists

Analog Records submitted

CBCT Records submitted

IOS Records submitted

Click here for a UPS label

Other IOS scanner*

Doctor or office submitting files*

Doctor or office phone*

Photographs*

To whom did you provide the photos?*

Enter the name of the person

Email address?

Smile design options for full package

Smile design options for surgical package

Smile design notes

VDO change*

Adjust VDO in mm's

Hidden

Adjust VDO in mm’s (enter value)

Additional VDO option

JC Try-In will add 6 to 8 business days to the production schedule, assuming immediate patient try in appointment.

Labial injection points for prosthetic pick-up

ROE will create holes from the labial and buccal that allow the pick-up material to be injected with the prosthetic seated on the Carrier Guide with the patient biting in occlusion.

Surgical bite Included?

Surgery Information

Implant brand*

Several implant brands require OEM parts for some or all of the final restorative steps. The price of these OEM parts differ per brand and will raise the cost - call for pricing if needed. Full package Rx cost estimates DO NOT include the cost for OEM parts.

Implant line (specific name of the implant)*

Hidden

Guided kit (must involve a fully or partially guided kit)*

Guided kit*

Chairside support*

Fixation kit (pins and drills)*

CHROME uses specific, custom designed fixation drills and pins. The standard kit includes one drill and four pins. This is determined after the planning meeting and the pins and drills will be sent with the case, if the doctor does not already have a set. It is recommended to purchase a full kit when starting the first case. The drills and pins are reusable for multiple surgeries. Cost subject to change based on case details.

Include GuidedSMILE LITE Fixation Pins*

Hidden

Prosthetic conversion materials*

Stellar DC acrylic pink kit (PCK4)

Price: $98.00

Stellar DC acrylic white kit (PCK5)

Price: $110.00

VOCO Quick-Up self cure kit (PCK1)

Price: $230.00

Maxillary arch denture

Whether you need a back-up or are restoring the opposing arch, ROE offers three types of CHROME dentures - 1) economy back-up for the day of surgery (not to be connected to implants), 2) a standard denture that can be converted to implants later, and 3) a Premium version with cards of traditional teeth. All are very esthetic. They just differ in strength to meet your needs.

Mandibular arch denture

Acknowledgment*

I recognize that my impressions need to include full palate and all land areas.

What is the final restorative material?*

Schedule surgery after the online meeting*

I AGREE

CHROME Timeline
- 5 business days - Record analysis and case workup
- 2/3 business days - Schedule and attend live planning meeting
- 10 business days - Fabrication
- 2 business days - Shipping

Additional notes