Removable - lintecdental.comRemovable Partial Dentures Splints/Nightguards Repair Ivoclar DCL...

843 Quince Orchard Blvd. Ste C&DGaithersburg MD, 20878Ph: 240.912.9670info@lintecdental.comwww.lintecdental.com

Doctor’s Name:AddressPhone # Acct #Email Address

Patient’s Name:Age Female MaleDeliver by 5 p.m. on Review Time:

Enclosed with case:Impressions Models Bite Photos Other:

Denture

Removable Partial Dentures

Splints/Nightguards

Repair

Ivoclar DCL DentureCAD/CAM DentureImmediate Denture

Doctor’s Name: Signature License #:

Custom TrayOcclusion RimWax setup try-inFinish

SLA metal frameValplastFlipperUltaire AKP

Frame try-inFrame w/occlus. RimFrame w/setup try-inFinish

Hard Soft Hard & Soft

Reline Breaks/Cracks

Add Clasp Add Tooth Add Retention

Minor ConnectorMaxillary Mandibular Clasp Options Tooth #

Rest Areas Tooth #

Lab Select Lab Select Lab SelectMetal

Lab Select Lab Select EsthetiClasp Thermoflex

Removable

Additional Notes

SHADE