Zirconia lab slip

Print or download — include with every Dentran case.

Download PDF Digital case →

TIPS

· Mark tooth #, product, and shade before sending.

· Implant: system, platform/SKU, retention.

· Physical: place printed slip inside the case box.

Preview · one US Letter page

PracticePractice nameDoctor

PhoneEmail

Ship / pickup address

CasePatient name / chart #

Due dateDate sent

Case / ref #

Submission

Digital scanPhysical impressionModel

Product

Modeless crown ($45)Crown with model ($55)Zr bridge ($59/unit)Zr implant crown ($105)Units #

Tooth chart

Universal numbering · mark as if facing the patient · bridge: circle abutments, X pontics · shaded cells (7–10, 23–26) not offered

←PATIENT'S RIGHT

PATIENT'S LEFT→

UPPER1–16

12345678

910111213141516

LOWER32–17

3231302928272625

2423222120191817

Shade & designShade (Vita Classical / 3D-Master)

Shade photo

AttachedN/A

Occlusion

LightNormalHeavyOut of occ.

Contact

LightNormalHeavy

Embrasure

StandardOpenClosedNotes

Implant crown (if applicable)Implant system / manufacturerPlatform / connection / SKU

Retention

Screw-retainedCement-retained

Abutment provided by

Lab fabricatesDoctor provides

If lab fabricates

Full custom milled (+$100)

If doctor: type sending (Ti-base / Custom / Stock)Screw / access preference

Special instructions

Write notes here…

Authorization

Doctor signature

Date:

Include with every case. Incomplete slips may delay fabrication.

Ready to send?

Pickup or digital · 7–10 business days

Request pickup Digital impression →