PEOPLES DENTAL COLLEGE & HOSPITAL

Nayabazar, Balaju Kathmandu

Department of Prosthodontics and Maxillofacial Prosthesis
CASE RECORD SHEET
Patient Name: Case No:

No Procedure Date Signature Remarks
1. Case History
2. Diagnostic cast, wax up and bite
registration

3. Case Discussion
4. Tooth preparation
5. Temporary restoration fabrication
6. Tissue Retraction
7. Final impression
8. Cast and Die fabrication
9. Wax pattern fabrication
10. Metal crown / bridge/ substructure
fabrication

11. Metal crown / substructure try- in
12. Ceramic build up
13. Ceramic Try in
14. Cementation
15. Follow up





___________________
Signature of patient for Try in
Approval



_____________________
Signature for patient during
Cementation



___________________
Signature of HOD
Date: Date: Date: