Snap-On Smile Evaluation & Rx This evaluation and prescription form is designed to help you educate and manage patient expectations. Snap-On Smile is most often a full arch or full mouth reconstruction case utilizing an additive process (snaps over the existing teeth making them larger), deserving special attention to design. The DenMat Lab has included a “best practices” page with numerous tips, key questions to address, and important guidelines were created by leading Snap-On Smile clinicians and lab technicians, and, if followed, will communicate relevant details to the DenMat Lab and ensure a successful outcome. Dr. Name ______________________________________________ Office Address ________________________________________________________________ Acct. #____________________________ Phone # ( _________ ) __________________________ Email Address_______________________________________ Dr. License # __________________________________________ Signature _____________________________________________________________________ Patient Name ___________________________________________________ Male Step 1 Patient/Doctor Consultation and Smile Evaluation How would you like to improve your smile? Close diastema(s) Improve alignment Replace missing teeth Open bite Change shade Change shape Widen buccal corridor Lengthen teeth Eliminate “gummy” smile (extend tissue margin) Y es, I have verified the patient has natural undercuts on their existing teeth, crown and/or bridgework to retain the Snap-On Smile appliance. See “Tooth Born Retention” on page 4 under “Snap-On Smile Best Practices”. Other comments by patient on what they would like to change about their smile:________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ Based on the smile evaluation, what “can” and “can’t” be accomplished with a Snap-On Smile additive process? If you’re not sure if all the patient’s issues can be solved with a Snap-On Smile, call your DenMat Lab Consultant (800) 872-8384 x5520. Step 2 Designing the Smile with the Patient Snap-On Smile will add a minimum of .5mm - .75mm of buccal and lingual thickness and at least .75mm of occlusal thickness. DenMat sells a Snap-On Smile Starter Kit with a demo model and appliance designed to show patients exactly how this technology works. What tooth numbers does the appliance cover? Upper Appliance: Tooth#_______ to #_______ Lower Appliance: Tooth#_______to #_______ 2. Provide the desired length of teeth (discuss with patient) #8 ______mm #9 ______mm Design laterals ______mm shorter vs. the centrals • Make this decision with your patient. The average length for a central is 10-11mm #24 ______mm #25 ______mm Design laterals ______mm shorter vs. the centrals • Make this decision with your patient. The average length for lower centrals is 7-8mm *Appliance will always add at least 1mm in length to natural teeth. 3. Alignment (discuss with your patient if alignment is an issue) Enhance the alignment (recommended) • Enhancement is often the best choice vs. ideal alignment to avoid bulky and oversized teeth. • Call your DenMat Snap-On Smile Consultant if you have any questions. Idealize the alignment • ll teeth are brought out to be in alignment with the most prominent anterior tooth. Caution: using the most prominent tooth as the guide can A sometimes add too much bulk. Review the most prominent tooth and determine consequences of bulk to align. An improvement/esthetic enhancement may be the better choice. Keep existing alignment — keep bulk and size of the teeth to a minimum. Please call to discuss when you receive the case. 4. Occlusion (refer to “Best Practices” on page 4 for important considerations) eave an anterior open centric — minimize lingual bulk on the maxillary teeth and/or lower L anterior flare, thickness and length. E stablish or maintain anterior centric occlusion — this may cause the lingual of the anterior teeth to be bulky. When making an upper and lower appliance, the lower anteriors may have to be flared and lengthened facially to maintain centric occlusion, which the patient may not tole

5. V.D.O. (Open patient’s bite) P lease design with posterior occlusal holes to minimize the bite opening. (There are limited cases where occlusal holes can be placed without weakening the appliance.) Yes, open the bite ______mm in the anterior or posterior (circle one). 6. Shade – The DenMat Snap-On Smile® Shade Guide is strongly recommended since it is made of the same material as the appliance. When using an alternative shade guide, the Lab will pick the closest corresponding Snap-On Shade, but it will not be an exact match. Pre-op Shade (if we are changing shade radically we may have to thicken...

At any time, should you have any questions concerning Snap-On Smile® please call us at 1-800-872-8384 ext. 5520 , Additional Services I would like a digital preview — $25 additional charge I would like a duplicate appliance at 25% off (order must accompany original case submission). Highly recommended for bruxers and excessive users. Clean model fees — Light: N/C Moderate: $25 Heavy: $50 (only charged if we need to clean to proceed with case) Digital print model fee – $18 per arch Rush Fees — Business days, not calendar days Standard 10-day turnaround time (no charge) 7-9 day turnaround — $52...

Snap-On Smile® Best Practices Alignment — Perfection is not always best. It is important to discuss relevant considerations with the patient to ensure the final smile design meets their expectations. Always be cognizant of the end result and the size of the teeth. Correcting alignment, especially on anteriors, and using the most prominent tooth as the guide can sometimes add too much bulk. Too much bulk can lead to a rejected case. Try to follow and work within the boundaries of nature and the patient’s natural dentition when possible. Have the lab add minimal bulk and length to all the teeth,...