Case Submission Protocal

Section 1: Required Digital Files

All files should be clearly labeled using a consistent naming convention (e.g., PatientLastName_FirstName_ScanType). Please send all files in a single compressed/zipped folder.

1.1. Cone Beam Computed Tomography (CBCT) Scans: This is the most critical component. High-quality, artifact-free scans are essential.

• Scan 1: Patient Scan (Without Prosthesis)

  • Field of View (FOV): Must capture the entire desired surgical arch (maxilla or mandible), including relevant anatomy (e.g., maxillary sinuses, inferior alveolar nerve, mental foramina, nasal floor).

  • Patient Position: The patient should be biting on cotton rolls to ensure separation of the arches, preventing streak artifacts. Lips should be relaxed.

  • Resolution: High resolution (e.g., 0.2−0.3 mm voxel size).

  • Format: DICOM (Digital Imaging and Communications in Medicine) files, provided as a multi-file folder.

• Scan 2: Prosthesis Scan (Dual-Scan Protocol)

  • This scan is required for edentulous or partially edentulous cases to capture the desired tooth position and soft tissue contours from an existing denture or a diagnostic wax-up.

  • Procedure: Place 6-8 radiopaque fiducial markers (e.g., gutta-percha points or specialized scan markers) on the flange and/or intaglio surface of the patient's existing denture or the diagnostic wax-up model.

  • First Scan: Scan the patient wearing the prosthesis (same settings as Scan 1).

  • Second Scan: Scan only the prosthesis by itself, placed on a foam block.

  • Format: Two sets of DICOM files.

1.2. Intraoral or Model Scans (STL Files): Digital scans are strongly preferred over physical impressions for accuracy.

• For Dentate/Partially Edentulous Patients:

  • Maxillary_Arch.stl: Full arch scan.

  • Mandibular_Arch.stl: Full arch scan.

  • Bite_Registration.stl: Scan of the patient in maximum intercuspation (MIP) or the desired centric relation (CR).

  • Scan_Body.stl (if applicable): For cases involving existing implants or a digitally-driven immediate provisional plan.

• For Edentulous Patients:

  • Edentulous_Arch.stl: Scan of the edentulous ridge.

  • Denture_Intaglio.stl: Scan of the tissue-fitting surface of the existing denture.

  • Denture_External.stl: Scan of the teeth and flange portion of the denture.

  • Denture_Bite.stl: Scan of the patient's dentures in occlusion.

1.3. Clinical Photography: High-resolution photos are vital for assessing aesthetics, phonetics, and smile design.

• Facial Views:

  • Full face, resting position (lips together).

  • Full face, natural smile.

  • Full face, exaggerated "E" smile (to show maximum incisal display).

  • Profile view, resting position.

• Intraoral Retracted Views:

  • Anterior view in occlusion.

  • Left and right lateral views in occlusion.

  • Occlusal views of the maxillary and mandibular arches.

Section 2: Detailed Prescription & Treatment Plan Information

This information must be clearly communicated on the laboratory prescription form.

2.1. Patient Information:

• Patient Name & Date of Birth.

• Lab Case ID (if applicable).

• Date of Surgery.

2.2. Surgical & Prosthetic Plan:

• Target Arch: Maxilla / Mandible.

• Implant System: Specify Manufacturer, Type, Diameter, and Length for each planned implant site (e.g., Nobel Biocare, NobelActive, Site #7: 4.3×11.5 mm).

• Implant Positions: List the tooth numbers for each implant position (e.g., #4, 6, 11, 13).

• Guide Fixation:

  • Specify the number and desired location of fixation pins for the base guide.

  • Default is typically 3-4 pins. Note any anatomical areas to avoid.

• Bone Reduction:

  • Specify the required amount of vertical bone reduction in millimeters (e.g., "3 mm reduction from the most coronal bone level").

  • Indicate if the reduction is to be flat/level or if it should follow the natural bone contour. This is critical for determining the restorative space for the final prosthesis (e.g., FP1 vs. FP3).

• Angulation of Distal Implants: Specify desired angulation for distal implants to avoid the sinus or nerve (e.g., "Angulate distal implants to emerge anterior to the maxillary sinus").

2.3. Restorative & Aesthetic Parameters:

• Vertical Dimension of Occlusion (VDO):

  • Confirm if the existing VDO (from denture or scans) is acceptable.

  • If a change is required, specify the desired increase/decrease in millimeters.

• Aesthetic & Occlusal Plane:

  • Midline: Confirm if the current midline is correct or specify the required deviation (e.g., "Shift midline 1 mm to patient's right").

  • Incisal Edge Position: Specify the desired incisal edge position relative to the upper lip at rest and during smiling. Reference clinical photos.

  • Occlusal Plane/Cant: Note any cant that needs to be corrected.

• Final Prosthesis Design:

  • Type: Screw-retained / Cement-retained.

  • Material: PMMA (for immediate provisional), Zirconia, etc.

  • Designation: FP1 (replaces only crown) or FP3 (replaces crown and gingival tissue).

2.4. Verification & Approval:

• Request Virtual Planning Session: Check a box to request a mandatory remote meeting with the lab technician to review and approve the final digital plan before any manufacturing begins. This is the most crucial step to prevent errors.

Section 3: Summary Checklist for Submission

Before sending, verify the following are included in the case submission folder:

• [ ] CBCT Data (DICOMs): Patient scan without prosthesis.

• [ ] CBCT Data (DICOMs): Dual-scan records (patient with prosthesis AND prosthesis alone), if applicable.

• [ ] STL Files: Maxillary, Mandibular, and Bite Registration scans.

• [ ] Clinical Photographs: Full facial and intraoral series.

• [ ] Completed Lab Prescription Form: All fields in Section 2 are filled out.

• [ ] Contact Information: Best phone number and email for the clinician for the virtual planning session.