Crown + Bridge

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Max file size: 20MB

PRACTICE *

NAME OF DENTIST *

PATIENT NAME *

First

Last

[object Object]

PATIENT SEX *

Email *

SHADE GINGIVAL *

SHADE MID *

SHADE INCISAL EDGE *

STUMP SHADE *

TOOTH # *

OPACITY LEVEL *

TRANSLUCENCY LEVEL *

MATERIAL USED *

SURFACE ANATOMY *

SMOOTH MEDIUM HEAVY

INCISAL TRANSLUCENCY *

HEAVY MEDIUM LIGHT NONE

OPTIONS *

REDUCTION COPING CALL ME TO DISCUSS CHAIRSIDE ASSITANCE $90 A HR RUSH CASE $100 FAMILY / OFFICE MEMBER DISCOUNT SENDING PATIENT TO THE LAB

Choose One *

CENTRIC CONTACT LATERAL EXCUSION LABIAL MARGIN MARGIN ADAPTATION FOIL RELIEF CEMENT GAP DUAL CUSPID GUIDANCE EXACTLY TO FINISH LINE NONE OF THE ABOVE

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POSITIVE CONTACT GROUP FUNCTION SLIGHT OVEREXTENSION CHAMFER MARGIN NONE OF THE ABOVE

PFM *

PRECIOUS SEMI PRECIOUS NONE PRECIOUS

RX COMMENTS *

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