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ZANN DENTAL LABORATORY

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Max file size: 20MB

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PRACTICE NAME *

NAME OF DENTIST *

PATIENT NAME *

First

Last

RETURN DATE *

PATIENT SHADE *

Email *

RX *

CROWN *

ZANN Zirconia High Translucent Zirconia Build Up ZANN ZANN Milled E.max ZANN Pressed E.max Zirconia Economy PFM Only / Inlay Long Term Temp Crown Gold Crown

tooth # *

stump shade *

opacity level *

Translucency Level *

surface anatomy *

Options *

Reduction Coping Call me to discuss Email me to discuss Chairside Assitance $90 a hr Rush Case $100 Family/ Office Member Discount Sending patient to the Lab

Indicate Below *

Centric Contact Lateral Excursion Labial Margin Foil Relief Cement Gap Dual Cuspid Guidance Exactly to Finish Line None of the above

Indicate below *

Positive Contact Group Function Slight Overextension Chamfer Margin None of the above

ESTHETIC *

Digital Wax Up Wax Up Traditional E.max Veneer Milled E.max Veneer Build Up Zirconia Build Up Matrix

tooth # *

Stump shade *

wax up on *

pre-op model duplicate model of pre-op model pink wax gum no wax up needed

wax up of *

Veneer Smile makeover Bite correction Implant wax up

goals of final case *

Change Incisal Edge Position Change Tooth Shape Change Tooth Shade Gingival Levels Alter Midline Other

Smile Catalog Selection *

options *

Call me to discuss Email me to discuss Chairside Assitance $90 a hr Custom Stain Chairside $90 Rush Case $100 Family/ Office Member Discount Sending patient to the Lab

THE IMPLANT COLLECTION *

STRAUMANN BIO HORIZON HIOSSEN NOBEL ASTRA ZIMMER

Tooth # *

Abutment Type *

Titanium Abutment CAD/CAM All Zirconia Abutment CAD/CAM UCLA w metal - white color Custom Abutment

Screw - Retained Restorations *

Zirconia CAD/CAM UCLA

Temporary Crown *

w/ Titanium Abutment w/ Temp Abutment w/ Zirconia Abutment

Abutment Emergence Profile *

Contour Tissue Tissue Displacement No Tissue Displacement

margins *

Restoration Type *

CAD/ CAM Fixed Bar - Hybrid Bar *

All on 4 All on _____ 3i Straumann Other

Hybrid Screw Retained Bridge *

Titanium Frame w PFM Restoration Titanium Frame w Zirconia Restoration Zirconia Frame w Zirconia Restoration

Hybrid Bar w Attachments *

Locators Ball Attachments

ORTHO *

ZANN Printable Guard NTI KOIS Deprogrammer Soft Night Guard

ORTHO SIDE *

Max Mand

ORTHO WIRE *

Max Mand Max + Mand

DENTURE *

Printable Custom Tray Digital Set Up Printable Denture Max Mand

TEETH IF PREFERENCE *

EXTRA *

Duplicate Master Model Call to Discuss Please Check Photo Sending Patient To Your Office We Need a Custom Stain

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