Professional Dental Arts
Aesthetic Prescription

You can type and print this on our website (www.secondonlytonature.com).
Doctor:

Due Date:

Patient:

Seat Date:
Gender: M F       Age:
Goals of the Final Case:
Teeth to Be Restored:
Type of Restoration:
 Pressed Ceramic  
Pressed to Metal
 Refractory
Sinfony®		 Other:

Case Checklist:
 Master Impression
Opposing Impression or Model 
Pre-operative Models
Bite Registration
Stick Bite
Picture of Stick Bite
Stratos 200 Face Bow Transfer Jig
Impression of Provisionals
Pictures of Provisionals
      Eyebrow to Chin Natural Smile (Not Numb)
     Smile Profile
Pictures of Pre-operative Natural Smile

 

 
Stump Shade:   

#'s   St.
#'s   St.
#'s   St.

Body Shade
Gingival Shade
Incisal Shade
Occlusal Staining


Lengths:
Centrals mm
Laterals mm
Canines mm

Gingival Recontouring:


Specific changes to be made from provisionals (e.g., midline, lengths, incisal edge position, shapes, occlusion, etc.):


Incisal Translucency: Minimal  Moderate  Maximum
Shade of Translucency: Clear   Smoke  Frosted  Amber
Surface Texture : High  Medium  Light  Smooth
Surface Finish : High Glaze  Polished Gloss  Satin  Low Gloss