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NexDent Prosthetics laboratory case sheet

NexDentPROSTHETICS

Laboratory prescriptionCase SheetNexDent case no.

Clinic

Doctor

Date sent

Mobile

Email, for the case acknowledgement

Patient's full name

Age and sex

Date required

Work required

Zirconia Premium Infinity-Zir (lifetime warranty) DMLS Implant, screw retained Complete denture Partial denture Temporary or mock up Repair or addition

Teeth (FDI). Circle the units

Upper right | Upper left

1817161514131211 2122232425262728

Lower right | Lower left

4847464544434241 3132333435363738

Shade

Shade (guide and tab)

Stump or die shade

Translucency

Implant details, if applicable

System and brand

Diameter and platform

Abutment supplied by

Enclosed with this case

Patient's casts, upper and lower Bite registration Photos Digital scan Previous prosthesis Impression trays

Instructions to the laboratory

Doctor's signature

Collected by / date

NexDent Prosthetics Pvt Ltd · Masab Tank, Hyderabad WhatsApp 8886 777 392 · 8886 777 391 · nexdentindia.com Collection and delivery Monday to Saturday, 9am to 9pm