Patient Name * First Name Last Name Type Of Metal Silver925 Select Number Of Teeth (Top) * 1 2 3 4 5 6 7 8 9+ 0 Select Number Of Teeth (Bottom) * 1 2 3 4 5 6 7 8 9+ 0 Color * Natural Silver Gold Plated Rose Gold Plated Please describe the style the patient would like * Thank you! We’ll reach out to you to confirm this order with you!
