ESTETICA British Dental Te(hnoioqy

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DAMAS
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PRACTICE NAME _

DENTAL LAB DENTIST NAME _

Email: info@esteticadentallab.com PATIENT NAME DOB _

Web:www.esteticadentallab.com LAB USEONLY
Tel: 020 8222 8484
POSTCODE _
Member2016
Bishop's Park House - 1 st Floor,
25-29 Fulham High St, London SW6 3JH DATESENT RETURN DATE

PROSTHETIC \ \ \ \
ALWAYS ALLOW 8 WORKING DAYS
The return date should be at least one working day
FIRST STAGE before the appointment
D lvolene Special Tray
D Bite Block lvolene Plate
Draw Design Chart 11 21
D Confirmation Jig 12 22

D Study Model ~ ,-
13#· ~~23 -~

14 l"r) ~ 24

MATERIAL 151
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16 1.
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25
26
DAcrylic
D Chrome Cobalt Frame
17 J~\ ~ 27

D Milled Titanium Frame

TRY-IN STAGE
DwaxTry-ln
D Wax Try-ln Screw Retained Shade
DTitanium Milled BarTry-ln
D Cast BarTry-ln

FINAL STAGE
D Full Denture
lnstructions
D Partial Denture
D lmmediate Denture
D Denture On Locators
ADDITIONAL SERVICES
D Reline / Rebase
0Tooth Addition
D Clasp Addition
D CeramicTeeth
D Acrylic Stent

lmpression sterilised with -----------

Approved for manufacturing (Name)

This custom-made dental appliance will be created as prescribed by the above dentist for the exclusive use of the above named patient.
Made in the UK. (AII the used materia Is are CE conformed) Custom Made Device. DO NOT OVERHEAT.UNSTERILISED STATE.