Orderform OT-F1 Prosthetic - OT medical GmbH
Orderform OT-F1 Prosthetic - OT medical GmbH
Orderform OT-F1 Prosthetic - OT medical GmbH
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>Orderform</strong><br />
<strong>OT</strong>-F 1 <strong>Prosthetic</strong><br />
Innovative Präzision<br />
Made in Germany<br />
Please enter quantities, customer number<br />
and stamp and return by fax to<br />
+49 421 557161-95<br />
Stamp<br />
Customer ID number<br />
<strong>OT</strong>-F 1 ø 3.30 <strong>OT</strong>-F 1 ø 3.80 <strong>OT</strong>-F 1 ø 4.10 <strong>OT</strong>-F 1 ø 4.90<br />
Healing Abutments<br />
cylindrical<br />
GH 2.0 mm 01-2339022600 _____ GH 2.0 mm 01-2389022600 _____ GH 2.0 mm 01-2419022600 _____ GH 2.0 mm 01-2499022600 _____<br />
GH 4.0 mm 01-2339042600 _____ GH 4.0 mm 01-2389042600 _____ GH 4.0 mm 01-2419042600 _____ GH 4.0 mm 01-2499042600 _____<br />
GH 6.0 mm 01-2339062600 _____ GH 6.0 mm 01-2389062600 _____ GH 6.0 mm 01-2419062600 _____ GH 6.0 mm 01-2499062600 _____<br />
Healing Abutments<br />
conical<br />
GH 4.0 mm 01-2339042700 _____ GH 4.0 mm 01-2389042700 _____ GH 4.0 mm 01-2419042700 _____ GH 4.0 mm 01-2499042700 _____<br />
Impression Coping<br />
Open 01-6339003000 _____ Open 01-6389003000 _____ Open 01-6419003000 _____ Open 01-6499003000 _____<br />
Closed 01-6339002000 _____ Closed 01-6389002000 _____ Closed 01-6419002000 _____ Closed 01-6499002000 _____<br />
Implant Analog<br />
ø 3.30 mm 01-6339003000 _____ ø 3.80 mm 01-6389003000 _____ ø 4.10 mm 01-6419003000 _____ ø 4.90 mm 01-6499003000 _____<br />
ø 3.30 mm 01-6339002000 _____ ø 3.80 mm 01-6389002000 _____ ø 4.10 mm 01-6419002000 _____ ø 4.90 mm 01-6499002000 _____<br />
CREATIVELINE (Temporary Abutment)<br />
ø 3.30 mm 01-2339005500 _____ ø 3.80 mm 01-2389005500 _____ ø 4.10 mm 01-2419005500 _____ ø 4.90 mm 01-2499005500 _____<br />
VERSALINE (Titanium Abutment)<br />
ø 3.30 mm 01-3339753500 _____ ø 3.80 mm 01-3389753500 _____ ø 4.10 mm 01-3419753500 _____ ø 4.90 mm 01-3499753500 _____<br />
NATURALLINE (Titanium Abutment)<br />
0°, Version A<br />
GH 1.2 mm 01-3339012500 _____ GH 1.2 mm 01-3389012500 _____ GH 1.2 mm 01-3419012500 _____ GH 1.2 mm 01-3499012500 _____<br />
GH 2.0 mm 01-3339032500 _____ GH 2.0 mm 01-3389032500 _____ GH 2.0 mm 01-3419032500 _____ GH 2.0 mm 01-3499032500 _____<br />
15°, Version A<br />
GH 1.2 mm 01-3339012100 _____ GH 1.2 mm 01-3389012100 _____ GH 1.2 mm 01-3419012100 _____ GH 1.2 mm 01-3499012100 _____<br />
25°, Version A<br />
GH 1.2 mm 01-3339012300 _____ GH 1.2 mm 01-3389012300 _____ GH 1.2 mm 01-3419012300 _____ GH 1.2 mm 01-3499012300 _____<br />
15°, Version B<br />
GH 1.2 mm 01-3339012200 _____ GH 1.2 mm 01-3389012200 _____ GH 1.2 mm 01-3419012200 _____ GH 1.2 mm 01-3499012200 _____<br />
25°, Version B<br />
GH 1.2 mm 01-3339012400 _____ GH 1.2 mm 01-3389012400 _____ GH 1.2 mm 01-3419012400 _____ GH 1.2 mm 01-3499012400 _____<br />
BASICLINE (Titanium Abutment)<br />
0°, Version A<br />
GH 1.0 mm 01-3339011500 _____ GH 1.0 mm 01-3389011500 _____ GH 1.0 mm 01-3419011500 _____ GH 1.0 mm 01-3499011500 _____<br />
GH 3.0 mm 01-3339031500 _____ GH 3.0 mm 01-3389031500 _____ GH 3.0 mm 01-3419031500 _____ GH 3.0 mm 01-3499031500 _____<br />
15°, Version A<br />
GH 1.0 mm 01-3339011100 _____ GH 1.0 mm 01-3389011100 _____ GH 1.0 mm 01-3419011100 _____ GH 1.0 mm 01-3499011100 _____<br />
GH 3.0 mm 01-3339031100 _____ GH 3.0 mm 01-3389031100 _____ GH 3.0 mm 01-3419031100 _____ GH 3.0 mm 01-3499031100 _____<br />
25°, Version A<br />
GH 1.0 mm 01-3339011300 _____ GH 1.0 mm 01-3389011300 _____ GH 1.0 mm 01-3419011300 _____ GH 1.0 mm 01-3499011300 _____<br />
I herewith accept the General Terms and Conditions<br />
Date<br />
Signature<br />
31.01.2012<br />
QM 7.2-A1_F6e (V1)
<strong>Orderform</strong><br />
<strong>OT</strong>-F 1 <strong>Prosthetic</strong><br />
Innovative Präzision<br />
Made in Germany<br />
Please enter quantities, customer number<br />
and stamp and return by fax to<br />
+49 421 557161-95<br />
Stamp<br />
Customer ID number<br />
<strong>OT</strong>-F 1 ø 3.30 <strong>OT</strong>-F 1 ø 3.80 <strong>OT</strong>-F 1 ø 4.10 <strong>OT</strong>-F 1 ø 4.90<br />
GOLDLINE (Goldbase Abutment)<br />
PM 0.43g 01-5339001000 _____ PM 0.47g 01-5389001000 _____ PM 0.55g 01-5419001000 _____ PM 0.63g 01-5499001000 _____<br />
HIGHLINE (CAD/CAM Abutment)<br />
ø 3.30 mm 01-5339002000 _____ ø 3.80 mm 01-5389002000 _____ ø 4.10 mm 01-5419002000 _____ ø 4.90 mm 01-5499002000 _____<br />
CERALINE (Zirconia Abutment) 0°<br />
ø 3.30 mm 01-5339003500 _____ ø 3.80 mm 01-5389003500 _____ ø 4.10 mm 01-5419003500 _____ ø 4.90 mm 01-5499003500 _____<br />
PROFILINE (Bar Abutment) Adapter<br />
GH 2.0 mm 01-4339022000 _____ GH 2.0 mm 01-4389022000 _____ GH 2.0 mm 01-4419022000 _____ GH 2.0 mm 01-4499022000 _____<br />
GH 4.0 mm 01-4339042000 _____ GH 4.0 mm 01-4389042000 _____ GH 4.0 mm 01-4419042000 _____ GH 4.0 mm 01-4499042000 _____<br />
TECLINE (Ball Head Abutment)<br />
GH 2.0 mm 01-4339021000 _____ GH 2.0 mm 01-4389021000 _____ GH 2.0 mm 01-4419021000 _____ GH 2.0 mm 01-4499021000 _____<br />
GH 4.0 mm 01-4339041000 _____ GH 4.0 mm 01-4389041000 _____ GH 4.0 mm 01-4419041000 _____ GH 4.0 mm 01-4499041000 _____<br />
PROFILINE Bar Connector<br />
Acrylic 01-4009002100 _____ Titanium 01-4009002200 _____ Precious metal 01-4009002300 _____<br />
TECLINE Accessories<br />
O-Ring<br />
Dalbo®- Plus elliptic*<br />
Housing, complete incl. O-Rings 01-4009001600 _____ Retention Anchor, complete 01-4009001400 _____<br />
Housing, single 01-4009001100 _____ Lamellae Retention Insert, single 01-4009001700 _____<br />
blue (laboratory), single 01-4009001300 _____ Activator Key for Retention Anchor 01-4009001800 _____<br />
red (final), single 01-4009001200 _____ * Manufacturer: Cendres & Métaux, Switzerland<br />
Implant Analog for Ball Head Abutment 04-6009001300 _____ TECLINE Casting template 01-4009001500 _____<br />
<strong>Prosthetic</strong> Drivers<br />
1.70 mm Hex (Latch for contra-angle) 01-7179003000 _____ 1.70 mm Hex (short, 6 mm) 01-7179056000 _____<br />
1.70 mm Hex (medium, 12 mm) 01-7179126000 _____ 1.70 mm Hex (long 18 mm) 01-7179186000 _____<br />
Driver Octagon<br />
01-7259106000 _____<br />
Implant Cover Screw<br />
ø 3.30 mm Cover Screw 01-2339001000 _____ ø 4.10 mm Cover Screw 01-2419001000 _____<br />
ø 3.80 mm Cover Screw 01-2389001000 _____ ø 4.90 mm Cover Screw 01-2499001000 _____<br />
<strong>Prosthetic</strong> screws<br />
Impression Coping<br />
16 mm (closed) 01-8209164000 _____ 22 mm (open) 01-8209194000 _____<br />
Abutment Screw<br />
10 mm (Final Screw) 01-8209104000 _____ 11 mm (Final Screw) 01-8209114000 _____<br />
10 mm (Laboratory Screw) 01-8209104100 _____ PROFILINE, 14 mm (Final Screw) 01-8209024000 _____<br />
Scan Screw HIGHLINE (Laboratory Screw) 01-5009002100 _____ PROFILINE, 16 mm (Final Screw) 01-8209044000 _____<br />
I herewith accept the General Terms and Conditions<br />
Date<br />
Signature<br />
31.01.2012<br />
QM 7.2-A1_F6e (V1)
Change language