Please Fill HDL LAB SLIP FORM Below:
Doctor's Name
Email
Phone
Esthetic Check List
PRE-OP
Opposing model
Pre-op photos
Pre-op models
PREPARATIONS
Anterior bite/cotton stick aligned to horizon
Shade of preparations (prep shade)
Photographs of preparations
Working impression
Bite registration
TEMPORARIES
Study model of temps that patient has accepted
Photographs of patient with provisionals
Length of centrals to soft tissue
Occlusal Stain
None
Light
Medium
Dark
Surface Texture
Smooth
Moderate
Heavy
PFM HIGH-FUSING CERAMICS
Porcelain Fused to White Gold 52%
Porcelain Fused to Semi Precious
(See COPING DESIGN on right)
IMPLANT RESTORATION
Screw-Retained Restoration
Cement-Retained Restoration
ALL-CERAMIC
e.Max Veneer/Crown/Inlay/Onlay
Feldspathic Porcelain Veneer
Lava Zirconia Crown
Noritake Full Contour Zirconia
Others
COPING DESIGN
No metal collar (360° ceramo-metal margin)
0.5 mm metal lingual collar
360° 0.5 mm metal collar
Metal lingual/centric
Metal occlusal
Facial/Buccal porcelain margin
Facial/Buccal ceramo-metal junction margin
RX
TERMS: Customer agrees to
company policy
as stated on reverse.
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