SimPlant - TP טופס הזמנת
HApro TP eForm (v1.1)
Please complete one TP eForm for each jaw.
Dentist 1 - Full Name
Address, Phone and e-mail
Dentist 2 - Full Name
Patient Full Name
Is a CT scan available?
We recommend the CT is less than 4 months old and the CT scan is done in Closed Centric Occlusion.
Please enter the details of the CT Center as: Address, Phone, e-mail and contact person.
Enter patient CT data:
Patient full name, Patient ID, Scan Date, Date of Birth (as recorded in the CT printout or PDF)
Both (mandible and maxilla in the same CT)
Teeth to be extracted
For example: 44, 45, 37 -or- Full clearance
Preferred surgical procedure
Flapless (For full edentulous flapless cases a dual scan radiographic stent must be used during the CT)
Was a radiographic stent used during the CT scan?
Dual scan protocol (with Gutta-Percha)
Single scan protocol (with Barium Sulfate)
Are there plaster study models available?
Desired quantity of implants
For example: 8 implants -or- From 2 to 6 implants (for more than one option to be included in the TP)
Preferred implant locations:
For example: 44, 45, 37
Preferred Implant Brand(s)
Special Implant Plan Configuration
Bone Grafts Options
Wish to avoid grafts
Sinus lift (open)
Sinus lift (closed)
Is immediate loading desired?
Fixed bridge cemented
Fixed bridge screwed
To be decided
Digital images of patient
Recommendation to send pictures: facial, facial high smile line, profile, full occlusion with retractors.
Available (I will send by email to
Preferred SurgiGuide Platform:
Tooth-mucosa supported (plaster model required)
Mucosa supported flapless (radiographic stent must be used during the CT scan)
To be determined
Special conversion requests
As separate masks for particular teeth, impacted teeth, old implants, etc.
FOR ANY QUESTION PLEASE CALL THE HAPRO HELP DESK 03 6138777 (int. 109)
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