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
Case Submission Guidelines
- Case # - Participant Name - State Abbreviation
Required Documents: requires the following (legible) documents for case approval:
- Patient Health History and Patient Medical Release Form
- Diagnostic Quality FMX, Pano, PA of Implant Site, (Optional Kentucky Conebeam or Kansas Cat scan with calipers)
- Diagnosis and Periodontal Health Status
- 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.