Färg/Shade

Tandläkare
Patient
Batch nr
Work nr
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KOPIA
Adress
Nollställ formuläret
Postadress
Mottaget på lab.:
TEETHRUS SWEDEN AB
Telefon
Box 7257, 402 35 Göteborg
Tel 031-120 330 • Fax 031-120 360
[email protected] • www.teethrus.us
Datum
Högädla Konstruktioner (AU 75% PD 19%)
Pers.nr
ålder / age
Kvinna /female
Tandnr. / Tooth No.
Returdatum:
man/male
OBS + 15 dgr. efter prep.
Mellanled / Pontic:
Metal design
High noble constructions (AU 75% PD 19%)
Utan metallkant /No metal margin
MK-krona (led) / PFM HP unit . ....................................930
Guldkrona / Full metal crown HP .................................935
Gjuten pelare / Pin-core HP .........................................936
Implantat-krona (led) / Implant crown HP ....................960
Lingual metallkant / Lingual metal margin
Skulder porslin / Porcelain margin
932
Färg/Shade
Metallkant / Small metal margin
Oädla Konstruktioner (Extreme-bond (Cr 55% Co 35%)
Non precious constructions made with Extreme-bond (PC NP SP
MK-krona (led) / PFM NP unit ....................................940
Maryland bridge ..........................................................997
Metallkrona / Full metal crown NP ...............................945
Gjuten pelare / Pin-core NP .........................................946
Implantat-krona (led) / Implant crown NP ....................965
Special quick comments /Interna
kommentarer
Flat cusps
Ideal curve
Space preps 2 times
all the way down to margin
Helkeramik / Full ceramic
E-max krona inlägg, onlay / E-max crown inlay, onlay....973
Zirconiumoxide ............................................................979
ÖK / Upper jaw
UK / Lower jaw
Krona / Crown
Bro / Bridge
Sufficiant interdental gaps
No characteristics
Try in cast
Erase all teeth
Anmärkningar / Remarks
Avtagbar protetik, övriga arbeten / Other constructions
Skeletterad delprotes CrCo färdig /
Partial denture CrCo, made ready ...............................981
Gjutet stålskelett / PD Framework with biteblocks .......980
Gjutet stålskelett med tanduppsättning i vax /
PD Framework with teeth in wax ................................982
Delprotes i mjukplast (VALPLAST) PD .......................988
Helprotes / full denture ................................................986
Protes tanduppsättning i vax / Denture set up in wax 984
Protes färdigställande (pressning) / Denture finish ......985
Individuell sked / individual tray ...................................993
Bitschablon / Biteblock .................................................994
Bettskena / Bitetray ......................................................991
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Beställarens signatur
Avtrycken är desinficerade
Signatur av laboratoriet
Theethrus Sweden AB
Härmed intygas att denna specialanpassade produkt, är framtagen
för ovanstående patient enligt de krav som ställs i läkemedelsverkets
föreskrift. LFVS 2003:11 Bilaga 1 och bilaga 8
Blekskena / Bleaching guide ........................................992
Riskanalys:
...........................................................................................
Kontakt:
Signature by
Cheif technician
We hereby confirm that this product is produced for the above patient
and according to the rules & regulations of the Swedish (läkemedelsverkets föreskrift. LFVS 2003:11 Bilaga 1 och bilaga 8