Please fill in the form below

* 1. TTC Reference number

* 2. Dentist name

* 3. Date Fitted

On what date was this restoration fitted?
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* 4. Cement Used

* 7. What was the quality of the crown like?

  Excellent Good Average Poor
Marginal Fit
Anatomic Form
Overall Aesthetics

* 8. Was there any adjustment required on this restoration by yourself?

  None Minor Significant Cooling Polish
Occlusal
Marginal
Contact
Fit Surface
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