December 25, 2009
Happy Holidays

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Before & After

Photography

Diagnostic Wax Up

IPS Empress Esthetic

Cerec In-Lab

IPS d.Sign

IPS e.max®

IPS Concept H.P.

Implants

Functional Splints

Procera

Laser Technology

Digial Shade Taking System

PPM™
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Comprehensive Restorative Prescription

Patient
Clinician
Date
Return Date
Critical Evaluation/
Treatment
Patient Expectations
Photographic Documentation Please send digital images directly to images@burlingtondentalstudio.com
Shade/Characterization


Please, fill up fields 1-12:
1 7
2 8
3 9
4 10
5 11
6 12
Ingot Choice
StumpShade
Surface Texture
Incisal Translucency
Value
  Shape/Contour/Proportion
Width/Height Ratio
11 %    21 %
Copy Diagnostic Wax up
Copy Provisionals
Smile Catalogue
Photograph Included
Other:
Enclosed
Final Impression
Pre-op Models
Diagnostic Wax Up
Bite Registration
Opposing Model
Facebow
Photos
All Items Recieved
Articulator
Impression of Provisionals
Model of Provisionals
Radiographs
Implant Components
Other: