Brad Jones, FAACD
Aesthetic Prescription

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whoisbradjones.com
1-208-484-2222

7875 Prospector Hollow Ln
Pocatello, ID 83201

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:
 Portrait of Pre-operative Natural Smile
Portraite of Provisionals Natural Smile
Smile profile
Master Impression
Opposing Impression or Model
Impression of Provisionals
Stratos 200 Face Bow Transfer
Kois earless facebow bite plate
Pre-operative Models
 Stick Bite
Picture of Stick Bite

 

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