MHRA:CA Damas - DLA member - Orion Business Park, Unit A, Northfield Avenue, West Ealing, London, W13 9SJ, England. Acc./PO no.

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1 MediMatch dental laboratory T: MHRA:CA009 - Damas - DA member - Orion Business Park, nit A, Northfield Avenue, West Ealing, ondon, W 9SJ, England Patient: M/F Delivery date (d/m/y) D.O.B (d/m/y): / / Standard is 0 full working days. Study model / / = working day before the real appointment Instructions - For anterior cases: F CERAMIC... Wax up Stent for temporaries on wax up E.MAX VENEER INAY ONAY ZIRCONIA BRIDGE VENEER e.max press, posterior and anterior Shade use VITA guide hour in lab express service made model free direct from scan, you must send an stl file hours in lab express service if from impression, we will make a scan of the model - 0 Transport is always at a surcharge. over 8 hour service still charged at 0 BIG SPAM BRIDGE A zirconia core with porcelain build up - 8 Full contour zirconia, Posterior With staining & glazing of the core but no porcelain build up - Cercon Zirconia, the original brand At a surcharge - 0 (please circle and indicate: B, C, I, O, V) Bridge Crown Inlay Onlay Veneer B C I O V Remarks / Notes December 0 Zirconia aesthetic, posterior and anterior e.max cad cam - speed service available ONAY Standard is 0 full working days. A very aesthetic option - 0 days in lab needed - 8 Optional: INAY Return special delivery.90 always applicable for express cases. Any transport different from a Royal Mail next day is at a surcharge. I have enclosed the following new or old components

2 MHRA:CA009 - Damas - DA member - Orion Business Park, nit A, Northfield Avenue, West Ealing, ondon, W 9SJ, England F CERAMIC ADVICE AND INFORMATION AS A GIDEINE ONY T: Instructions - For anterior cases: Manage the expectation of your patient by making a wax up and requesting a stent over the wax up to be able to base your temporaries on the wax up. Send us an impressions of the temporaries and tell us what you would like to copy and what you would like to improve. E.MAX Contraindications: very deep sub preparations patients with severely reduced residual dentition parafunctions, e.g. bruxism provisional insertion/trial wear period bridges with a pontic beyond s or bigger then 9mm cantilever bridges R more then unit bridges adjustments without polishing (please use appropriate burs ) always indicate if there is strong discolourations on the die don t make sharp corner preparations 7 for inlays/onlays the preparation margins must not be located on centric antagonist contacts P ZIRCONIA Contraindications: very deep sub preparations provisional insertion/trial wear period adjustments without polishing (please use appropriate burs ) always indicate if there is strong discolourations on the die don t make sharp corner preparations for veneer cases give us a wrap around the edge Shade ** Do you want to a picture? Show the shade tab in the picture, specify what shade you have used and send it to questions@medimatch.co.uk. Please put patient name and post code in the subject field of your . December 0 7 Cements advice for E.MAX VARIOINK ESTHETIC or MTIINK ATOMIX Cements advice for ZIRCONIA SPEEDCEM or MTIINK ATOMIX egal disclaimer: In addition to MediMatch s normal terms and conditions we would like to point out that: This protocol is based on very limited experience Medimatch has with their cases and should be used as an indication and not restrictive in any way or form. This protocol was not based on experience in a clinical environment. Clinicians will use their own technique, according to individual experience and training. This protocol should not be followed if the circumstances are different or if in any way or form it is clinically not appropriate to follow it even if the circumstances are similar as in the protocol. Each clinician should make their own decisions and not restrict himself or herself to following a protocol made by Medimatch dental laboratory ltd. MediMatch dental laboratory td is in no way liable for any clinical procedures and will not take responsibility for the use of the content of this protocol in a clinical or non clinical environment. Each clinician is ultimately responsible for their own clinical decisions regardless of any advice given by MediMatch dental aboratory ltd in any form.

3 MHRA:CA009 - Damas - DA member - Orion Business Park, nit A, Northfield Avenue, West Ealing, ondon, W 9SJ, England Stage Always give us full working days Indicate implant system + Platform (please circle) Delivery Date T: IMPANT Shade - use VITA guide AB SE ONY System acc. no. Platform on no. 7 Restoration will be Cement retained Screw retained Crown Bridge Full-ceramic E.max (pressed ceramic) Zirconia (Cad-Cam) Porcelain Bonded non precious (Co-Cr) semi precious (Pd) precious, gold (Au) Abutment material 8 9 Chrome Cobalt Titanium Zirconia with Ti-base... I have sent: Abutment ab screw Analogue Abutment: made by MediMatch * ordered from supplier... * please check availability and pricing (always send bite on implant/preparation) enclosed please amount order of Final screw: Ti Gold enclosed please order Implants May 07 I have enclosed new or old components Custom Made Device Supplied in an unsterilized state Terms and conditions apply Visit medimatch.co.uk Instructions for use, storing & handling: It is highly recommended that the product is stored in a clean and safe environment if not used immediately. It is also advised that there must

4 MHRA:CA009 - Damas - DA member - Orion Business Park, nit A, Northfield Avenue, West Ealing, ondon, W 9SJ, England Specify: or or MediFlex Stage Bite Special Tray Try In Finish Acrylic Denture or: Finish in one session Shade - use VITA guide Metal Frame (please circle) Delivery Date PEASE CIRCE T: DENTRE or FRAME Instructions Telescopic crowns on: Special attachment on: Immediate denture teeth on: PEASE, tell us if roots will be extracted and at what stage Make clasps try finish For lab use, enclosed / missing: Return special delivery min..90 I have enclosed the following new or old components May 07

5 MediMatch dental laboratory MHRA:CA009 - Damas - DA member - Orion Business Park, nit A, Northfield Avenue, West Ealing, ondon, W 9SJ, England Delivery date (d/m/y) / / = working day before the real appointment Margin (for porcelain bonded) No metal margin Metal margin lingual / palatal (= standard) Metal all around by mm (standard <0,mm) Metal backing Metal backing + metal palatal cusp Porcelain facing I have disinfected the impression *!* For lab use, enclosed / missing: with: Pictures? to: questions@medimatch.co.uk * See also dedicated order form Restoration Full-ceramic* E.max T: & BRIDGE Press (= very aesthetic) 8.0 Faster delivery or CAD-CAM products available at a surcharge Zirconia full contour (posterior ).0 with porcelain(=aesthetic) 8.0 Porcelain bonded non precious (Co-Cr) semi precious (Pd) precious, Gold (Au) Full Metal Co-Cr Pd Au Post and core Co-Cr Pd Au Integral Separate 7 Shade - use VITA guide (please circle and indicate: B, C, I, O, V) Instructions Bridge B Crown C Inlay I Onlay O Veneer V Wings on nr: Porcelain butt margin on: Telescopic crowns on: Special attachments on: Wax up on: Zirconia (Cad-Cam) is available as the original cercon zirconia - 0 Return special delivery min..90 I have enclosed new or old components May 07

6 MHRA:CA009 - Damas - DA member - Orion Business Park, nit A, Northfield Avenue, West Ealing, ondon, W 9SJ, England Stage Bite Special Tray Try In Finish Acrylic Denture or: Finish in one session Shade - use VITA guide Metal Frame OPTIONAY Specify: or MediFlex (please circle) ONY Delivery Date PEASE CIRCE T: DENTRE or FRAME Instructions PEASE, tell us if roots will be extracted and at what stage Immediate denture teeth try finish Make clasps on: Please always check your impressions, poor impressions may be liable to a minimum handling charge of 0 Return special delivery min..90 I have enclosed new or old components May 07

7 MediMatch dental laboratory MHRA:CA009 - Damas - DA member - Orion Business Park, nit A, Northfield Avenue, West Ealing, ondon, W 9SJ, England Crown or Bridge number of units: Porcelain bonded Full metal (Co-Cr / silver colour) Maryland Bridge number of wings: Delivery date (d/m/y) / / = working day before the real appointment T: & BRIDGE Inlay or Onlay Post & Core Integral Separate For lab use, enclosed / missing: Veneer Shade - use VITA guide (please circle) Please always check your impressions, poor impressions may be liable to a minimum handling charge of 0 I have enclosed new or old components 0 Model back.00 0 Return spec. delivery min Multiple shading.0 0 Metal backing.0 0 Fit crown under denture Case = units.00 0 Case > units Case units 0.00 May 07

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