Case Sheet | NexDent Prosthetics

NexDentPROSTHETICS

Laboratory prescriptionCase Sheet

Clinic

Doctor

Date sent

Patient reference

Age and sex

Date required

Work required

Zirconia crown or bridge Infinity-Zir (lifetime warranty) DMLS crown or bridge Implant, cement retained 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 and finish

Shade (guide and tab)

Stump or die shade

Translucency

Monolithic Layered High gloss Natural texture Characterisation Shade photo attached

Implant details, if applicable

System and brand

Diameter and platform

Abutment supplied by

Enclosed with this case

Working impression Opposing impression Bite record Face bow or photos Previous prosthesis Digital scan sent

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 9am to 9pm