My Case Preferences with Streamline Dental Laboratory
Doctor Name
Your answer
Account Number
Your answer
Email
Your answer
MATERIAL OPTIONS
Crown & Bridge Default Material (if no selection on Rx)
Choose
Full Strength Zirconia (Class 5 Zirconia)
HT Layered Zirconia (Class 4 Zirconia)
PFZ - Porcelain Layered to Zirconia (Class 2)
Emax
PFM - Non-Precious Nickel Free
PFM Semi-Precious 25 (Noble)
PFM Semi-Precious 50 (Noble)
PFM White Gold 40 (High Noble)
Implant Default Material (if no selection on Rx)
Choose
Screw Retained HT Zirconia with Ti-Base
Screw Retained PFM Non-Precious with UCLA
Cement Retained PFZ with Cast Abutment
Cement Retained PFZ with Titanium Abutment (3 week turnaround)
Cement Retained PFM with Cast Abutment
Cement Retained PFM with Titanium Abutment (3 week turnaround)
Denture Bite Block Wax
Choose
Soft Wax on Base Plate
Hard wax on Base Plate
Denture Teeth
Choose
Lab Stock Teeth
Portrait IPN Teeth
Ivoclar Blue Line Teeth
DESIGN OPTIONS
Preparation
Choose
Chamfer
Long Chamfer
Chamfer with Bevel
Shoulder
Shoulder with Bevel
Knife Edge / Feather Edge
Die Spacer / Cement Gap
Choose
Standard - 0.07mm
Tight - 0.04mm
Loose - 0.14mm
Interproximal Contacts
Choose
Normal
Tight
Tight and Broad
If no Occlusal Clearance
Choose
Reduce Opposing
Change to Full Strength Zirconia
Leave Metal Stop (PFM)
Leave Metal Occlusal (PFM)
Reduce Abutment and Provide Reduction Coping (additional fee)
Reduce Abutment and DO NOT Provide Reduction Coping. Mark Die Only
Contact Me
Occlusal Contact
Choose
Normal (0.4mm gap with opposing)
Light (0.5mm gap with opposing)
Out of Occlusion (0.7mm gap with opposing)
In Occlusion - No Gap
Occlusal Staining
Choose
None
Light
Medium
Dark
Removal Button / Handle (PFM Only)
Choose
No Removal Button / Handle
Yes Removal Button / Handle
PFM Margin Design
Choose
No Metal Showing (All Porcelain)
Lingual Metal Hairline
Metal Occlusal / Lingual
Pontic Designs
Choose
Modified Ridge Lap
Full Ridge Lap
Ovate
Bullet
Sanitary
Implant Tissue Displacement
Choose
Moderate Tissue Displacement (up to 1mm)
Anatomical Displacement (>1mm)
No Displacement
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms