DOLDER ® U HADER ® ACKERMANN OTHERS: CREATECH BAR DOLDER ® BAR LOCATOR ® BAR PRECI-VERTIX ® BAR TITANIUM BARS ORDER FORM ATTACHMENT * I hereby confirm that the information given is correct and the model and wax-up are accurate and have been correctly disinfected. I authorize Createch Medical to design and manufacture the framework based on the impression and order form given. BAR PROFILES OPTIONS IMPLANT SYSTEM THE CREATECH RESTORATION IS DELIVERED WITH THE APPROPRIATE AMOUNT OF SCREWS. WOULD YOU LIKE ADDITIONAL PROSTHETIC COMPONENTS? IF YES, SELECT: ADDITIONAL NOTES: DATE: SIGNATURE: Polígono Kurutz Gain, P. 3-B 20850 Mendaro (Guipúzcoa) Spain CREATECH MEDICAL S.L. T. +34 943 708951 [email protected] www.createchmedical.com DOCTOR: PATIENT NAME | CODE: LAB: CASE INFORMATION MICRO MACRO CUSTOMER NUMBER: CREATECH LOCATOR ® PRECI-HORIX ® PRECI-VERTIX ® DOLDER ® Y MICRO MACRO YES NO GOLD SHADED TYPE PLATFORM BONE LEVEL SOFT TISSUE LEVEL SYNOCTA ® 1.5 ABUTMENT SCREW-RETAINED ABUTMENT MULTI-BASE ABUTMENT NC RC NN Ø 3,5 OTHER STRAUMANN PLATFORM NNC Ø 3,5 RN Ø 4,8 WN Ø 6,5 Ø 3,5 Ø 4,5 Ø 6,5 ANGLED ABUTMENT Ø 3,5 Ø 4,6 RN Ø 4,8 WN Ø 6,5 IMPLANT POSITION ABUTMENT-LEVEL IMPLANT-LEVEL