Welcome! 

Select the appropriate program below to begin.....   

Important:

  • You can save a draft of your work if you would like to finish filling out the form at a later date or to make edits.
  • Be sure to read the instructions for your program to ensure timely submission.
  • Follow-up regarding your submission will be provided to your Heartland email account. Please be sure that you check your emails regularly. 
  • Please reach out to Submittable's Customer Support team with any technical questions at support@submittable.com.

 Endo Submission Reminder  

  • 1 of 3 cases submitted must include a molar endo
  • Pre and Post - Xrays are also required
  • Click the link to complete Endo Assessment - 80% Pass Rate is required

 Crown Submission Reminder 

  • 3 Cases must be submitted
  • Pre and Post Xray, Scan, and Intra-Oral Image required
  • Use the following STL file instructionsto upload your scan
  • Click the link to complete Crown Assessment- 80% Pass Rate is required

 Invisalign Submission Reminder 

  • Cases started from September 1 - October 31st are only counted as starts
  • 1 completed case must be submitted
  • Pre and Post Photo Series and a Scan of the completed case are required for submission
  • Use the following STL file instructions to upload your scan
  • Use the following PPT templateto upload your series - note only 1 image file allowed
  • Click the link to complete Clear Aligner Assessment - 80% Pass Rate is required

 

Click here for FAQ

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Case Submission Guidelines

  • Case # - Participant Name - State Abbreviation


Required Documents: requires the following (legible) documents for case approval:

  1. Patient Health History and Patient Medical Release Form
  2. Diagnostic Quality FMX, Pano, PA of Implant Site, (Optional Kentucky Conebeam or Kansas Cat scan with calipers)
  3. Diagnosis and Periodontal Health Status
  4. Poured Models, Copy of Full Arch Scans (Export STL File Instructions), or Intraoral photo of Probe measurements 


Approval Guidelines: Cases will be approved and ranked based on the surgical difficulty level scale of 1 to 5.

  • (Slight to moderate difficulty 1-3) = automatic approvals
  • (Above moderate difficulty 4) = Clinical Director approval required
  • (High degree of difficulty 5) = will not be approved 



Please allow 7-10 business days for an email response from your mentor.