CHROME Lab Checklist

Case Information

Pan Number(Required)

Surgery Date (mm/dd/yyyy)(Required)

Delivery Date (mm/dd/yyyy)(Required)

Name of Lab

Date(s) of planning meeting(s)

Lab Email(Required)

Date of plan approval

Tech reviewed w/ Dr.(s)(Required)

Case placed on hold for

Setup Change Instructions

Implant List Email Sent?

Fabrication

CHROME Package(Required)

Package Prices. Days are business days.

Natural(Required)

Replica

Zygo

Tooth Shade(Required)

Tissue Shade(Required)

No. of Implants: Upper(Required)

No. of Implants: Lower(Required)

Upper Denture(Required)

Lower Denture(Required)

Brand/Line (or N/A) OLD(Required)

Guided Kit (or N/A) OLD(Required)

Guided Kit (or N/A)(Required)

ParentsChildren

Brand/Line (or N/A)(Required)

Please Select a Implant Brand

Guided Kit (or N/A)(Required)

C2F(Required)

Include the optional metal scallop guide?(Required)

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

Surgimat?(Required)

Labial Injection Points 4 Pick-up

Smileloc

Fabrication Notes

Additional Info

Fixation Kit(Required)

Upgrade CHROME to C2F(Required)

Please go to the Lab Dashboard and select the components needed.

Stacking Pins (Required for LITE cases)(Required)

Prosthetic Conversion Kit(Required)

C2F Kits

A la Carte

C2F Analogs

C2F Assemblies

OEM Sleeves

Smileloc

Notes

SurgiMAT Notes

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Case Information

Fabrication

Additional Info

Notes