• Cell phone +372 528 8313
  • Phone +372 733 3005
  • info@dentes.ee
  • Ropka tee 6
  • Tartu 50113, ESTONIA

Erakliinik dentes
Dental Laboratory ISO 9001 - ISO 14001 - ISO 45001

ORDER FORM
Order date
Patient
(name or code)
Male
Female
Age
Impression taken:
  • Date
  • Time
  • Date
  • Time
  • Is the impression desinfected?
  • Is the centerline marked?
  • Is the facial arc included?
  • Company /
    Dental Clinic
  • Direct or
    cell phone
  • Doctor name
  • *
  • **
  • 1
  • 2
  • 3
  • L
  • P
  • A
  • Yes
  • Yes
  • Yes
  • No
  • No
  • No
  • Partial denture
  • Partial denture on
    metal frame
  • Full denture
  • Crown
  • Bridge
  • Facet
  • Facet
  • Dowel crown
  • Attachment work
  • Telescopic work
Cast-Post-and-core →
ZIRCONIA
CROWN WITH OCCLUSAL REST
Under opaque
Not opaque
  • Monolithic
  • Monolithic
  • Metal ceramics
  • Full cast
  • Covered
  • Covered
TYPE OF RESTORATION
METAL CERAMICS
Press ceramics
Pontic design
  • Full porcelain
    no metal showing
  • Lingual metal
    shoulder
  • Circumferential
    metal shoulder
  • Metal fissures
  • Partial metal
    occlusal
  • Full metal occlusal
Colour of ceramics
  • Porcelain shoulder
  • Mamelon
  • Coloured fissures
  • Photo:
Impression from
starting position
Impression from
the old prosthesis
  • Main shade
  • Neck
  • Incisal
  • Occlusal surface
INFO
INFO
INFO
NEXT TRY-ON
METAL
READY DATE
  • Custom tray
  • Wax occlusion
    rim
  • Setup for try-on
  • Rebasement
  • Surveying of cast
  • Metal frame try-on
  • Post & Core, root anchor
  • Porc./Comp./Acrylies
Precious metal
Non-precious metal
  • Date
  • Time
Dr.name