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$499 RESTORATIVE PACKAGE

10 Business Days In Lab


INCLUDES: authentic Straumann Titanium or Zirconia abutment, final screw, lab screw, lab analog, soft tissue model, shipping and handling of parts and final restoration. DOCTOR ADDRESS CITY PHONE EMAIL STATE FAX ZIP PATIENT NAME AGE MALE/FEMALE

STRAUMANN LIKE-ON-LIKE Rx

TODAYS DATE

/ /

DUE DATE

/ /

DIAMETERS

MARGINAL PLACEMENT

Tooth #

NC

RC

NN

RN

WN

Buccal/ Lingual Mesial Facial

Distal

Abutment Selection

Titanium

Zirconia

Zirconium PFM Temporary CAD


($65 extra) ($149)

Restorations

e.max

Shade

Emergence Width
No Tissue Displacement (Default) Tissue Displacement Surgical Placement

(alloy surcharge may be applied)

Semi Precious Screw Retained


($149)

Over Temporary Abutment

Instructions:

DOCTORS SIGNATURE

460 West Larch Road, Suite #1 Tracy, Ca 95304 Toll Free: (877) 325-5873 Fax: (209) 221-6792 asds@alluredentalstudio.com

LICENSE NUMBER

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