Voyager Case Portal

Doctor

Clinic

Case/Patient ID (Required)

Denture Label

Patient Appointment

Patient Scheduled

Patient Unscheduled

(complete dentures standard delivery in 10 business days, partial 15 business days)

Select Full Denture or individual teeth (Partial Denture)

Full Upper Denture (FUD)

MAXILLARY (Upper) - Teeth 2-15

2 M2

3 M1

4 PM2

5 PM1

6 C

7 LI

8 CI

9 CI

10 LI

11 C

12 PM1

13 PM2

14 M1

15 M2

MANDIBULAR (Lower) - Teeth 18-31

18 M2

19 M1

20 PM2

21 PM1

22 C

23 LI

24 CI

25 CI

26 LI

27 C

28 PM1

29 PM2

30 M1

31 M2

Full Lower Denture (FLD)

Immediate
Try-In

Vertical Dimension of Occlusion:

Maintain

Open

Close

Anterior Vertical Change (mm):

Midline:

Use Palatal Suture

Match Upper

Match Lower

Tooth Shade

Gingiva Shade

Material (Complete):

TrueDent

Lucitone

Milled

Material (Partial):

Acrylic (incl CoCr frame)

Flexible

Acetal

Final:

Design Only:

IOS Portal:

Note: Please enter all relevant Rx information on this form - IOS Portal will be accessed for downloading .stl scan files only.

MX

FILE UPLOAD AREA

MD

NATURAL DENTITION

DENTURE

Patient and Appointment Information

Design Specifications

Fabrication Options

Special Instructions