nSequence® Scan Review RX Order Form

Please complete the entire form below. All fields indicated by * are required. Fee of $100 per arch reviewed.

Important Information to Review:

  • For a scan review, you will need a CT scan of the patient. For edentulous patients, a dual scan is recommended.
  • Unless otherwise instructed, we will perform an initial assessment of the arch indicated for restoration with an FP3 (traditional All-on X) prosthesis. Assessment of potential bone reduction and implant placement will be based upon the current tooth position in the scan. If no teeth are present, and/or the scan was not taken at the desired VDO, the required vertical restorative space cannot be accurately assessed. We will plan for 16mm of restorative space (bone/implant level to incisal edge/cusp tip) in the anterior and 14mm in the posterior.
  • CBCT technology only captures relative bone density. Both the Hounsfield values and the Bone Density categories (D1-D4) generated by a CBCT may not correspond to clinical bone density and are not a reliable guide for choosing an osteotomy protocol.
  • Any recommendations of number and position of implants is only based upon prosthetic requirements, with only the CT data and must be re-assessed clinically.
  • While we will provide our best evaluation for case efficacy, this laboratory review is not a definitive qualifier or disqualifier for a case. The initial evaluation must be supplemented with a thorough clinical assessment, using complete and accurate records.
  • For more detailed instructions for scanning of various configurations of dentition, please see:

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Failure to submit necessary records will result in delays to your case.

 

Patient Identification

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Billing Doctor Details

The case will be entirely billed to this doctor.
 
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If you are an existing customer, you can skip this.

Treatment Plan Information

 
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Please provide as much treatment information as possible so our technicians know what to look for in the CBCT

Note: A tech will reach out via email to review the scan.