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+(1) 123 456 789

329 Queensberry Street, North Melbourne VIC 3051, Australia.
hi@educrat.com

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Lab Sheet

Please complete this RX Form online to submit your case details directly to our lab.

A printable version of this RX Form is also available; download it here!

Your Name

Date Send

Your Email

Date Due

Case Number

Product Types

Fixed Restorations Removable Restorations Fixed + Removable

We Send

Impression Model Bite Study model Photo Analog Transfer Abutment

FIXED RESTORATIONS

Restorations

Crown Bridge

Product Types

PFM Full Metal Cast Porcelain Zirconia Full Contour Zirconia E-max Post Only (No Crown) Integrated Post＋Crown Separate Post＋Crown Maryland Bridge Temporary Teeth Veneer/ Inlay Coping try in

Alloy

Non-Precious (Ni-Cr) Non-Precious (Co-Cr) Titallium Semi-Precious High Noble

Pontic:

Full Ridge Partial Ridge Point Contact No Contact

Metal Design

Full Metal Lingual Full Porcelain Coverage No Metal Exposed Metal Lingual Collar 3/4 Metal Lingual Buccal Metal Collar Metal Margin 1/2 Metal Occlusal Full Metal Occlusal

Contact

Light Medium Heavy

Embrasure

Close Open Normal

Stain

None Light Medium Heavy

Surface Texture

Smooth Moderate Heavy

Occlusal

In Occlusion Light Occlusion Out of occlusion

If No Occlusal Clearance

Reduction Coping Mark/Reduce Opposing Place Metal Island Lab Should Contact Us

REMOVABLE RESTORATIONS

Restoration

Upper Lower

Product Types

Framework Acrylic Denture Set Up Teeth Valplast Orthodontic & Retainer Night Guard-SOFT Night Guard-HARD Night guard-SOFT/HARD

Case Stage

For try-in Finish

Tooth & Shade

SPECIFIC INSTRUCTION:

About Bestodental

Est. 2012, Bestodental is a full-service dental lab in China, providing reliable outsourcing solutions to dental and orthodontic clinics. We only use FDA-approved and CE-marked materials, our turnaround time is just 3-7 days.

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Add: 5/F, Building B, Xinyuan Industrial Park, Hangcheng Avenue, Fuyong Street, Bao’an District, Shenzhen, China 518103
Email: info@bestodental.com
Mob/Whatsapp: +86 18123916637

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