Crown & Bridge Form - Z Dental Laboratory

Crown & Bridge Form EN

Brown & Bridge General Information

Overview information about the case. You can fill the form below or upload your avalable RX form at the end of this form. "*" this symbol is the required information sections.

Z DENTAL LABORATORY

No 9-9A Phung Van Cung Street, Ward 2,
Phu Nhuan District, Ho Chi Minh City, Vietnam

(+84) 901 456 029
zdentallabo.com
partner@zdentallabo.com

Male

Female

*

New Case

Redo Case

TRANSLUCENCY:

Low

Medium

High

FISSURE STAIN:

None

Light

Normal

RESTORATION:

Crown

Bridge

IF ROOM FOR CLEARANCE

Email

Adjust Opposing

Metal Occlusal/lingual

Reduce prep & reduction copying

Above - Left

01

02

03

04

05

06

07

08

Below - Left

32

31

30

29

28

27

26

25

Above - Right

09

10

11

12

13

14

15

16

Below - Right

24

23

22

21

20

19

18

17

Porcelain Margin

180°

360°

Proximal Contact

Normal

Extended

Embrasure

Normal

Close

Occlusal Contact

Heavy

Light

Open

Pontic Design

Hygentic

Full Ridge lap

Modified

Bullet

Ovate

Mental Design

1

2

3

4

5

6

7

INSTRUCTIONS DETAILS:

Product Option

Choose products you want us to do.

ALL CERAMIC

IPS e.max Crown

IPS e.max Veneer

IPS e.max Inlay/Onlay

Full Monolithic Zirconia Crown

Full Monolithic Zirconia Inlay/Onlay

Layered Zirconia Crown (PFZ)

Zirconia Veneer

Porcelain Veneer

IMPLANT RESTORATION

Full Zirconia on implant

Zirconia Layered on implant

PFM on implant

Emax on implant

Screw retain

Cement retain

Customize titanium abutment

Customize Zirconia abutment

MISCELLANEOUST

3D Printed Model (unilateral model)

3D Printed Model (full model)

Diagnostic Wax-Up (per tooth)

Digital PMMA Wax-Up

Temporary Putty Matrix

PORCELAIN FUSED TO METAL

Non-precious PFM

Semi-precious PFM

High Noble Precious PFM (Argen Euro)

Non-precious Post & Core

Semi-precious Post & Core

High Noble Precious Post & Core (Argen Euro)

Non-precious Maryland Wing

Semi-precious Maryland Wing

High Noble Precious Maryland Wing (Argen Euro)

FULL CAST METAL

Non-precious

Semi-precious

High Noble Precious White Gold (Argen Euro)

High Noble Precious Yellow Gold (Argen Euro)

Noble Argen Y+ 2% Yellow Gold

OTHER

Add metal porcelain

Add zirconia porcelain

Adapt crown to partial

Rest

Wing

PMMA try-in

Pink porcelain

ENCLOSED:

Impression U/L

Models U/L

Articulator

Crowns

Study model

Bite

Photos

Scanned File Upload (if any)

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Real Image of Patient Upload (if any)

Choose 5 image

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