Implant Rx

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Implant Rx

Laboratory Procedure Prescription

Required Information

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Implant

To be included





Case Instructions

Please CHECK below single units and BRACKET splinted units

Metal

Zirconia/All Ceramic

Restoration

Return for

Cement Retained abutment type



Design





Emergence Profile

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Margin Design

Please circle your choice(s) of margin combination

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Crown Design

(REQUIRE)
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Show no metal 360°

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Lingual metal collar (Traditional)

If Insufficient Room








Occlusal Clearance




Contact




RX Specific Instructions

Please provide any photos, study models, diagnostic casts with case

Email photos to: cs@xdentcenter.com

*Standard design if an option is not selected
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XDENT LAB Co.,LTD

Factory 1: 101 Tran Van Kieu Street, Ward 10, District 6, HCMC, Vietnam

Factory 2: Kizuna 3 Industrial Park, Long An Province, Vietnam

www.xdentlab.com

The undersigned, as an authorized signer for the dental practice, accepts full responsibility for payment of all associated charges.