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Restorative Package $449 Ti - $499 ZR: Tooth #

This document is a lab order form for a titanium or zirconia abutment restoration package from Allure Dental Studio. The package costs $449 for titanium or $499 for zirconia and includes the abutment, final screw, lab screw, analog, soft tissue model, and shipping of parts and final restoration within 10 business days. The form requests information about the doctor, patient, implant details, abutment selection, restoration type, shade, and any special instructions.

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Jean-Christophe Pope
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584 views

Restorative Package $449 Ti - $499 ZR: Tooth #

This document is a lab order form for a titanium or zirconia abutment restoration package from Allure Dental Studio. The package costs $449 for titanium or $499 for zirconia and includes the abutment, final screw, lab screw, analog, soft tissue model, and shipping of parts and final restoration within 10 business days. The form requests information about the doctor, patient, implant details, abutment selection, restoration type, shade, and any special instructions.

Uploaded by

Jean-Christophe Pope
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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$449 Ti - $499 Zr RESTORATIVELab PACKAGE 10 Business Days In

INCLUDES: Titanium or Zirconia abutment*, final screw, lab screw, lab analog, soft tissue model, shipping and handling of parts and final restoration. DOCTOR ADDRESS CITY PHONE EMAIL STATE FAX ZIP PATIENT NAME AGE MALE/FEMALE

Blending Nature, Art and Technology

TODAYS DATE
*Applies only for: Astra Branemark Biomet 3i Internal Biomet 3i External Keystone PrimaConnex 3.0, 3.5/4.0, 4.5/5.0 NP, RP, WP 3.4, 4.1, 5.0, 6.0 3.75, 5.0 3.5, 4.0, 4.5, 5.0 5.5

/ /

DUE DATE

/ /
3.5, 4.0, 5.0, 5.5 NP, RP, WP, 6.0 NP, RP 3.5, 4.5, 5.7

Neoss NobelReplace NobelActive Zimmer Screw-Vent

MARGINAL PLACEMENT

Tooth #

Implant Type

Diameters

Buccal/ Lingual Mesial Facial

Distal

Abutment Selection

Titanium

Zirconia Restorations Shade Emergence Width


No Tissue Displacement (Default) Tissue Displacement Surgical Placement

Zirconium PFM Temporary CAD


($65 extra) ($149)

e.max

(alloy surcharge may be applied)

Semi Precious Screw Retained


($149)

Over Temporary Abutement

Instructions:

DOCTORS SIGNATURE

460 West Larch Road, Suite #1 Tracy, Ca 95304 Toll Free: (877) 325-5873 Fax: (209) 221-6792 [email protected]

LICENSE NUMBER

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