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CHROME Patient Records

Accurate and detailed patient records are essential to starting a CHROME GuidedSMILE case properly. This page will detail the necessary records for all patient types. Read this page throughly and if you have any questions please call us – 800-228-6663.

This page contains information on the following record aspects:

  1. Patient Records Checklist
  2. Appliance Fabrication
  3. CHROME Photographs

Patients Records Checklist

Click the appropriate patient scenario to see appropriate record requirements.

Single Dentate Arch with opposing Dentate
Single Dentate Arch with opposing Edentulous
Single Edentulous with opposing Dentate
Single Edentulous with opposing Edentulous
Double Dentate
Double Edentulous
Double Arch Dentate with opposing Edentulous
Single Dentate Arch with opposing Dentate
  • Photographs – Full face full smile photo, plus profile photo if Class II or III. Retracted photographs front, left side, right side IN occlusion, see below. We suggest capturing photos before taking impressions to keep the lips and teeth clean.
  • Maxillary & mandibular master casts or impressions – must capture all land are-as including full vestibule. Must capture full palate if spare denture is to be ordered.
    If patient has an existing partial on the surgery arch, capture two
    impressions: one with the partial seated, one with the partial removed.
  • Bite registration – Centric occlusion bite
  • CBCT — Scan of patient OPEN biting on cotton rolls or the bite fork with PARTIAL OUT OF THE MOUTH. Place cotton rolls between cheeks and teeth for better image.
    * Two scans are sent: 1) scan of maxillary arch 2) scan of mandibular arch. Both scan must be captured out of occlusion
Single Dentate Arch with opposing Edentulous
  • Photographs – Full face full smile photo, plus profile photo if Class II or III. Retracted photographs front, left side, right side IN occlusion, see below. We suggest capturing photos before taking impressions to keep the lips and teeth clean.
  • Dentate surgery arch – Master cast—must capture ALL land areas. Must capture full palate if spare denture is to be ordered Edentulous opposing arch – Impression capturing the teeth of the opposing dentition—a crown and bridge impression of the denture.
  • Bite registration – Suggestion: 3 small bites to tripod the bite registration rather than full arch bite
  • CBCT – Dual Scan Technique*—place 6 scan markers on the denture (www.suremark.com) or place 6 random gutta percha markers in the pink area of the labia flange.
    * Dual Scan definition: one scan of the denture sveated in the mouth IN occlusion. One scan of the denture alone sitting on foam or the chin rest of the scanner, not on plastic. Do not scan the patient alone w/o the denture.
    * Two scans are sent: 1) scan of maxillary arch 2) scan of mandibular arch. Both scan must be captured out of occlusion
Single Edentulous with opposing Dentate
  • Photographs – Full face full smile photo, plus profile photo if Class II or III. Retracted photographs front, left side, right side IN occlusion, see below. We suggest capturing photos before taking impressions to keep the lips and teeth clean.
  • Edentulous surgery arch – Use existing denture as a dual scan appliance. Denture must fit perfectly to the tissue and exhibit ideal tooth position. NO soft relines. Must use either hard reline if fit is not ideal, or reline with Blue Mousse impression material for both scans. Place 6 scan markers on the denture (www.suremark.com) or place 6 random gutta percha markers in the pink area of the labial flange.
  • Dentate opposing arch – Master cast must capture ALL land areas. Must capture full palate if spare denture is to be ordered.
  • Bite registration – Suggestion: 3 small bites to tripod the bite registration rather than full arch bite.
  • CBCT – Dual Scan Technique
    * Dual Scan definition: one scan of the denture seated in the mouth IN occlusion. One scan of the denture alone sitting on foam or the chin rest of the scanner,
    not on plastic. Do not scan the patient alone w/o the denture.
    * Two scans are sent: 1) scan of maxillary arch 2) scan of mandibular arch. Both scan must be captured out of occlusion
Single Edentulous with opposing Edentulous
  • Photographs – Full face full smile photo, plus profile photo if Class II or III. Retracted photographs front, left side, right side IN occlusion, see below. We suggest capturing photos before taking impressions to keep the lips and teeth clean.
  • Edentulous surgery arch – Use existing dentures as dual scan appliances (defined below). If patient does not have existing denture(s), fabricate new dentures to completion. If existing dentures are far from ideal, and teeth are not in the proper position, fabricate new dentures.
  • Denture rules:
    • Dentures must fit perfectly to the tissue and exhibit ideal tooth position.
    • NO soft relines. Must complete hard reline(s) if fit is not ideal, or reline with Blue Mousse impression material for the dual scan described below.
    • Place 6 scan markers on each denture (www.suremark.com) or place 6 random gutta percha markers in the pink area of the labial flanges.
  • Edentulous opposing arch – Impression capturing the teeth of the opposing dentition—a crown and bridge impression of the denture.
    Bite registration – Suggestion: 3 small bites to tripod the bite registration rather than full arch bite.
  • CBCT – Dual Scan Technique
    Dual Scan definition: one scan of the denture seated in the mouth IN occlusion. One scan of the denture alone sitting on foam or the chin rest of the scanner, not on plastic. Do not scan the patient alone w/o the denture.* Two scans are sent: 1) scan of the surgery arch with 6 markers on the denture, IN OCCLUSION 2) scan of the denture alone with markers in exact same positions.
Double Dentate
  • Photographs – Full face full smile photo, plus profile photo if Class II or III. Retracted photographs front, left side, right side IN occlusion, see below. We suggest capturing photos before taking impressions to keep the lips and teeth clean.
  • Maxillary & mandibular master casts or impressions – Must capture ALL land areas is. Must capture full palate if spare denture is to be ordered.
    If patient has an existing partial or the surgery arch(es), capture two impressions: one with the partial seated, one with the partial removed.
  • Bite registration – Centric occlusion bite
  • CBCT* – 2 Scans of the patient are sent and must exhibit the patient OPEN biting on cotton rolls or the bite fork. Place cotton rolls between cheeks and teeth for better image.
    * Two scans are sent: 1) scan of maxillary arch 2) scan of mandibular arch. Both scan must be captured out of occlusion
Double Edentulous
  • Photographs – Full face full smile photo, plus profile photo if Class II or III. Retracted photographs front, left side, right side IN occlusion, see below. We suggest capturing photos before taking impressions to keep the lips and teeth clean.
  • Prepare Dentures – Use existing dentures as dual scan appliances. If patient does not have existing denture(s), fabricate new dentures to completion. If existing dentures are far from ideal, and teeth a not in the proper position, fabricate new dentures.
  • Denture rules:
    • Dentures must fit perfectly to the tissue and exhibit ideal tooth position.
    • NO soft relines. Must complete hard reline(s) if fit is not ideal, or reline with Blue Mousse impression material for the dual scan described below.
    • Place 6 scan markers on each denture (www.suremark.com) or place 6 random gutta percha markers in the pink area of the labial flanges.
  • 3 CBCT Scans – Must follow the Dual Scan Technique
    1. Scan of the maxillary denture alone resting on foam or similar.
    2. Scan of the mandibular denture alone resting on foam or similar.
    3. Scan of BOTH dentures, in the mouth, in occlusion, not separated, and ensure the scan includes the patient from the chin up to the nasal cavity.
  • Bite registration – Suggestion: 3 small bites to tripod the bite registration rather than full arch bite.
Double Arch Dentate with opposing Edentulous
  • Photographs – Full face full smile photo, plus profile photo if Class II or III. Retracted photographs front, left side, right side IN occlusion, see below.
    We suggest capturing photos before taking impressions to keep the lips and teeth clean.
  • Prepare Denture – Use existing denture as dual scan appliance. If patient does not have existing denture(s), fabricate new dentures to completion.
    If existing dentures are far from ideal, and teeth are not in the proper position, fabricate new dentures.
  • Denture rules:
    • Dentures must fit perfectly to the tissue and exhibit ideal tooth position.
    • NO soft relines. Must complete hard reline(s) if fit is not ideal, or reline with Blue Mousse impression material for the dual scan described below.
    • Place 6 scan markers on each denture (www.suremark.com) or place 6 random gutta percha markers in the pink area of the labial flanges.
  • 3 CBCT Scans – Must follow the Dual Scan Technique
    1. Scan of the maxillary denture alone resting on foam or similar.
    2. Scan of the mandibular denture alone resting on foam or similar.
    3. Scan of BOTH dentures, in the mouth, in occlusion, not separated, and ensure the scan includes the patient from the chin up to the nasal cavity.
  • Bite registration – Suggestion: 3 small bites to tripod the bite registration rather than full arch bite.

2. Appliance Fabrication

Step One – Design Ideal Denture or modify existing

You may use the patient’s existing denture if the criteria below can be met. If not, duplicate the denture in clear acrylic and adjust as necessary.

  • Teeth are proper size, shape & length
  • Occlusion and vertical dimension are properly established
  • No metal components
  • Sufficient thickness (2.5 – 3mm)
  • Buccal flanges of sufficient length for scan markers / support anchor pins
  • Excellent fit to soft tissue
  • Hard reline only‐no soft reline
  • No radio-opaque components or coating (no barium sulfate)

Step Two – Fully Edentulous

Order SureMarks (www.suremark.com) or add gutta percha markers

  • 6 gutta percha markers
  • Place half lingual and half buccal
  • Place on varying horizontal planes
  • Place on flange, below gingival plane of the teeth
  • Use a #6 or #8 round bur to a depth of 1mm. Keep markers spherical in shape, no larger than illustrated.
  • Fill flush with gutta percha

Step Two – Partially Edentulous

Order SureMarks (www.suremark.com) or add gutta percha markers. If the patient is missing many teeth, has metal‐based restorations on most of the teeth, or the bite is being opened more than 2mm, order a Scan Appliance.

  • Send models and a bite to ROE with instructions on implant placement and future restorations
  • Doctor receives scan appliance, seats and adjusts if there is a rock or ill fit (must fit with NO rock)
  • Perform dual scan protocol

Patient CBCT Scan Instructions—Dual Scan Protocol

1st scan appliance in the mouth                                        2nd scan appliance alone

Scan 1

  • Seat appliance(s) and ensure fit with no rocking—if there is a rock, hard reline or adjust until good seating (NO soft relines ever)
  • Fully Edentulous scan appliance—important to bite IN OCCLUSION with No space between the opposing! No bite material, no cotton rolls.
  • Partially Edentulous scan appliance—important to place bilateral cotton rolls and capture the CT
    • Bite with medium pressure and do not move

Scan 2

  • Scan appliance by itself sitting on any type of foam or scan table that is NOT plastic. Must sit above plastic scan table!

3. CHROME Photographs

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