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Dr Name and Address
Email Address
Patient
Surgery Date
Please construct
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Upper Guide
Lower Guide
Upper and Lower Guides
Other
Guide type required
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Pilot Drill Guide Only
Semi Guided Drill Guide
Fully Guided Drill Guide
I will supply:
CBCT in DICOM Format
PVS Impression or Stone Model
Intra Oral Scan
Blue Sky Plan File
Plan Setup to be done by
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Doctor
Laboratory
Teamviewer Collaboration
Implant brand to be used
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Adin
Ankylos
Astra Tech
BioHorizons
Blue Sky Bio
Dentium
Dentsply Implants
Implant Direct
MIS
Nobel Biocare
Osstem
Straumann
TRI
Southern Implants
Zimmer Biomet
Other
Case Description and Notes
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