Full Arch RX

Full Arch RX Form

Doctor/Practice Name *

Patient Name *

Email Address *

License # *

Date *

Gender *

MaleFemale

Age *

Restoration *

UpperLower

Shade *

Light (OM3)Medium (A1)Dark (A3)

Face Form *OvoidSquare TaperingSquareTapered

1 - Immediate Denture *

UpperLower

2 - 2nd Stage *

Verification Jig & Custom TrayWax Rim / Bite BlockTooth set up Try in

3 - Provisional Try-In *

UpperLower

Implant Manufacturer *

OEMSKDLA Non-OEM

4 - Final Restoration *

Zirconia FinalCrystal Ultra / NanoceramicsAcrylic with Titanium Bar

Instructions

Upload file

Drag and Drop (or) Choose Files

Information

* Default Gum Shade = Original Pink unless Light or Dark Pink is requested.

Digital Files
3Shape TRIOS – digital@killiandental.com
iTero – ID# 6167
Sirona Connect – info@spectrumdental.com
Medit Link – digital@killiandental.com
Midmark (3M) – Killian Dental Ceramics
Carestream – Killian Dental Ceramics

Physical Impressions
SKDLA
2850 Red Hill Ave.
Suite 200
Santa Ana, CA 92705
1.800.317.7100

Signature *

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Creating a consistent output that our doctors fall in love with. We look forward to supporting your practice and delighting your patients!

Products

Porcelain-Layered-Zirconia (PFZ)
IPS eMax
Porcelain-Fused-To-Metal (PFM)

Company

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Get in Touch

(800) 317-7100
sales@skdla.com