Order Form

General Details

INSTRUCTIONS FOR PROSTHESIS WORK

Doctor's details

Patient's details

Gender

Select Type

ZIRCONIA
DENTSPLY CERCON
IVOCLAR
DMLS PFM
CAD / CAM IVOCLAR FFM
PRECISION ATTACHMENTS
CONVENTIONAL PFM's
IMPLANT SCREW RETAINED
BPS
ACRYLIC DENTURE
Trails
FLEXIBLE DENTURE
RPD
OTHERS
If no occlusal clearance
RCT Done

Form Section

Discoloration
Stump Shade
Gingiva Colour
Transculancy
Value
Occlusal Staining
Enclosures

Select Teeth

Upper Teeth
Lower Teeth
Pontic Design ( Please tick one)