LAB FORM to OTELLA DENTAL
" Please complete the form with all relevant details so we can have a clearer understanding of the work requested."
Date - Today
DUE DATE
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Patient Name
First Name
Last Name
Clinic
Location
Doctor Name
Telefone
e-Mail
SURGICAL GUIDES
Implants Surgical Guide (regular Implants)
2 Zigomatics Implants Surgical Guide
4 Zigomatics ImplantsSurgical Guide
1 Pterigoids Implant Surgical Guide
2 Pterigoids Implant Surgical Guide
Combination Zig, Pter, Regular Implants Surgical Gide
DESCRIPTION
SURGICAL GUIDES
All On X Surgical Guides
Base Guide
Anchor Pin Guide
Osteotomy Guide
MUAs Guide
Scalloping Guide (for FP1 Bridge)
Temporay Denture Guide
Today Surgery Temporary Denture over MUAs (for FP1)
7 Days After Surgery Temporary Denture over MUAs ( Ti-Bar + Acrylic)
Anchor Pins
1 Anchor Drill
2 Anchor Drill
DSD: Digital Smile Design
IMPLANTS BRAND
IMPLANTS POSITIONS
DESCRIPTION OF THE CASE WITH IMPLANTS
GUIDES
Gingivectomy Surgical Guide
Gingiva Reduction Surgical Guide (Bone Reduction+Gingiva)
Composite Smile Design Surgical Guides
DESCRIPTION
ALL ON X - RESTORATION
Titanium Bar + Acrylic Denture
Titanium Bar + Full Zirconia Bridge
Titanium Bar + Malo Bridge (Individual Zirconia Crowns over Ti-Bar+Pink Gum)
Titanium Bar + Temporary Denture (7 days after Surgery)-Screw Retained
Titanium Bar + Scalloping Zirconia Crowns over MUAs. (FP1) FINAL
DESCRIPTION
ZIRCONIA- RESTORATION
Zirconia Monolithc Crowns Over Natural Teeth
Zirconia Monolithc Crown Over Implants
Zirconia Monolithc Bridge over Natural Teeth
Zirconia Monolithc Bridge over Implants
Zirconia Layered Crowns Over natural Teeth
Zirconia Layered Crowns Over Implants
Zirconia Layered Bridge over natural teeth
Zirconia Layered Bridge over implants
DESCRIPTION
VENEER- RESTORATION
Zirconia Veneers
e-Max Veneers
DESCRIPTION
SHADE
Vita Classic
Vita 3D master
Other
SHADE
UPLOAD ANY AND ALL RELEVANT FILES
Raw-DICOM Data- .zip
.STL files
Photos-.zip
Drawings-.zip
Others-.zip
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