INTERNATIONAL DENTAL LABORATORY
Phone:
+36-70/3835562
1054 Budapest, Bank u. 6.
(Map)
Home
Gallery
Order
Contact us
Online Worksheet
Dentist:
Company:
Email (Dentist's):
Patient:
Color:
color
Neck color:
color
Body color:
color
Incisal color:
color
Vita Classic
Next time
OTHER
A1
A2
A3
A3.5
A4
B1
B2
B3
B4
C1
C2
C3
C4
D2
D3
D4
Vita 3D Master
1M 1
1M 2
2L 1.5
2L 2.5
2M 1
2M 2
2M 3
2R 1.5
2R 2.5
3L 1.5
3L 2.5
3M 1
3M 2
3M 3
3R 1.5
3R 2.5
4L 1.5
4L 2.5
4M 1
4M 2
4M 3
4R 1.5
4R 2.5
5M 1
5M 2
5M 3
Bleaching
BL1
BL2
BL3
BL4
OM1
OM2
OM3
clear field
cancel
Transparency:
size
no
0.5 mm
1 mm
1.5 mm
2 mm
2.5 mm
3 mm
3.5 mm
4 mm
cancel
None
Light
Medium
Hight
Occlusal staining:
None
Light
Medium
Hight
Appointment:
@ hour:
the same day
When?
The same day
7:00
7:30
8:00
8:30
9:00
9:30
10:00
10:30
11:00
11:30
12:00
12:30
13:00
13:30
14:00
14:30
15:00
15:30
16:00
16:30
17:00
17:30
18:00
18:30
19:00
19:30
20:00
cancel
Antagonist will change
Antagonist will NOT change
Porcelain shoulder
Metal collar
all round
palat. / lingv.
Irregularity
Diasthema
Appo. type:
Special try /
Bite
Frame try in
Biscuit try in
Wax try in
Fit
Gender:
Male
Female
Age:
10 - 19 yrs
20 - 29 yrs
30 - 39 yrs
40 - 49 yrs
50 - 59 yrs
60 - 69 yrs
70+
In case of implant
Implant type:
Implant size:
Cement-retained
Screw-retained
Digital impression
Manual impression
Teeth:
18
17
16
15
14
13
12
11
21
22
23
24
25
26
27
28
Upper
48
47
46
45
44
43
42
41
31
32
33
34
35
36
37
38
Lower
Post & core
Frame
Crown
Bridge
Study model
Inlay/Onlay
Veneer
Provisory
Zirconium
Press
Gradia
PBC
Gold
Metal
PMMA
Acrylic
even these can save:
18
17
16
15
14
13
12
11
21
22
23
24
25
26
27
28
48
47
46
45
44
43
42
41
31
32
33
34
35
36
37
38
SAVE
+
cancel
Prosthesis
Metal plate
Special tray
Wax bite
Bleaching tray
Retention tray
Night guard
1 mm
2 mm
3 mm
SAVE
cancel
List:
(The list is empty, click on the tooth buttons above)
Notice:
Impression:
Bite:
Model:
Laborimplant:
Alloy:
Weight:
clear fields
Call me back!
Photo sent
Guarantee
