Brad Jones, FAACD
Aesthetic Prescription

Print on our website
whoisbradjones.com
1-208-484-2222

8952 Misty Leaf Ave.
Las Vegas, NV 89148

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