Orderform OT-F2/OT-F3 Prosthetic - OT medical GmbH
Orderform OT-F2/OT-F3 Prosthetic - OT medical GmbH
Orderform OT-F2/OT-F3 Prosthetic - OT medical GmbH
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<strong>Orderform</strong><br />
<strong>OT</strong>-F 2 /<strong>OT</strong>-F 3 <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 2 ø 3.40 <strong>OT</strong>-F 2 /<strong>OT</strong>-F 3 ø 3.80 <strong>OT</strong>-F 2 /<strong>OT</strong>-F 3 ø 4.10 <strong>OT</strong>-F 2 /<strong>OT</strong>-F 3 ø 5.00<br />
Healing Abutments<br />
straight<br />
GH 4.0 mm 02-2349042710 _____ GH 4.0 mm 02-2389042710 _____ GH 4.0 mm 02-2419042710 _____ GH 4.0 mm 02-2509042710 _____<br />
Healing Abutments<br />
flared<br />
GH 2.0 mm 02-2349022610 _____ GH 2.0 mm 02-2389022610 _____ GH 2.0 mm 02-2419022610 _____ GH 2.0 mm 02-2509022610 _____<br />
GH 4.0 mm 02-2349042610 _____ GH 4.0 mm 02-2389042610 _____ GH 4.0 mm 02-2419042610 _____ GH 4.0 mm 02-2509042610 _____<br />
GH 6.0 mm 02-2349062610 _____ GH 6.0 mm 02-2389062610 _____ GH 6.0 mm 02-2419062610 _____ GH 6.0 mm 02-2509062610 _____<br />
Impression Coping<br />
open 02-6349003010 _____ open 02-6389003010 _____ open 02-6419003010 _____ open 02-6509003010 _____<br />
closed 02-6349002010 _____ closed 02-6389002010 _____ closed 02-6419002010 _____ closed 02-6509002010 _____<br />
Transfer Coping<br />
pack of 5 02-6349004000 _____ pack of 5 02-6389004000 _____ pack of 5 02-6419004000 _____ pack of 5 02-6509004000 _____<br />
Implant Analog<br />
ø 3.40 mm 02-6349001000 _____ ø 3.80 mm 02-6389001000 _____ ø 4.10 mm 02-6419001000 _____ ø 5.00 mm 02-6509001000 _____<br />
CREATIVELINE (Temporary Abutment)<br />
ø 3.40 mm 02-2349005510 _____ ø 3.80 mm 02-2389005510 _____ ø 4.10 mm 02-2419005510 _____ ø 4.90 mm 02-2509005510 _____<br />
VERSALINE (Titanium Abutment)<br />
ø 3.40 mm 02-3349753510 _____ ø 3.80 mm 02-3389753510 _____ ø 4.10 mm 02-3419753510 _____ ø 4.90 mm 02-3509753510 _____<br />
NATURALLINE (Titanium Abutment)<br />
0°<br />
GH 1.2 mm 02-3349012510 _____ GH 1.2 mm 02-3389012510 _____ GH 1.2 mm 02-3419012510 _____ GH 1.2 mm 02-3509012510 _____<br />
GH 2.0 mm 02-3349032510 _____ GH 2.0 mm 02-3389032510 _____ GH 2.0 mm 02-3419032510 _____ GH 2.0 mm 02-3509032510 _____<br />
15°<br />
GH 1.2 mm 02-3349012110 _____ GH 1.2 mm 02-3389012110 _____ GH 1.2 mm 02-3419012110 _____ GH 1.2 mm 02-3509012110 _____<br />
25°<br />
GH 1.2 mm 02-3349012310 _____ GH 1.2 mm 02-3389012310 _____ GH 1.2 mm 02-3419012310 _____ GH 1.2 mm 02-3509012310 _____<br />
GOLDLINE (Goldbase Abutment)<br />
PM 0.43g 02-5349001010 _____ PM 0.52g 02-5389001010 _____ PM 0.59g 02-5419001010 _____ PM 0.67g 02-5509001010 _____<br />
HIGHLINE (CAD/CAM Abutment)<br />
ø 3.40 mm 02-5349002010 _____ ø 3.80 mm 02-5389002010 _____ ø 4.10 mm 02-5419002010 _____ ø 5.00 mm 02-5509002010 _____<br />
CERALINE (Zirconia Abutment)<br />
0° straight 02-5349003500 _____ 0° straight 02-5389003500 _____ 0° straight 02-5419003500 _____ 0° straight 02-5509003500 _____<br />
I herewith accept the General Terms and Conditions<br />
Date<br />
Signature<br />
31.01.2012<br />
QM 7.2-A1_F7e (V1)
<strong>Orderform</strong><br />
<strong>OT</strong>-F 2 /<strong>OT</strong>-F 3 <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 2 ø 3.40 <strong>OT</strong>-F 2 /<strong>OT</strong>-F 3 ø 3.80 <strong>OT</strong>-F 2 /<strong>OT</strong>-F 3 ø 4.10 <strong>OT</strong>-F 2 /<strong>OT</strong>-F 3 ø 5.00<br />
PROFILINE (Bar Abutment) Adapter<br />
GH 2.5 mm 02-4349022010 _____ GH 2.5 mm 02-4389022010 _____ GH 2.5 mm 02-4419022010 _____ GH 2.5 mm 02-4509022010 _____<br />
GH 4.0 mm 02-4349042010 _____ GH 4.0 mm 02-4389042010 _____ GH 4.0 mm 02-4419042010 _____ GH 4.0 mm 02-4509042010 _____<br />
PROFILINE Bar Connector<br />
Titanium 02-4349002210 _____ Titanium 02-4389002210 _____ Titanium 02-4419002210 _____ Titanium 02-4509002210 _____<br />
Prec. metal 02-4349004010 _____ Prec. metal 02-4389004010 _____ Prec. metal 02-4419004010 _____ Prec. metal 02-4509004010 _____<br />
TECLINE (Ball Head Abutment)<br />
GH 2.0 mm 02-4349021010 _____ GH 2.0 mm 02-4389021010 _____ GH 2.0 mm 02-4419021010 _____ GH 2.0 mm 02-4509021010 _____<br />
GH 4.0 mm 02-4349041010 _____ GH 4.0 mm 02-4389041010 _____ GH 4.0 mm 02-4419041010 _____ GH 4.0 mm 02-4509041010 _____<br />
TECLINE Accessories<br />
O-Ring<br />
Dalbo®- Plus elliptic*<br />
Housing, incl. O-Rings 01-4009001600 _____ Retention Anchor, complete 01-4009001400 _____<br />
Housing, single 01-4009001100 _____ Lamellae Retention Insert, single 01-4009001700 _____<br />
O-Ring blue, laboratory 01-4009001300 _____ Activator Key for Retention Anchor 01-4009001800 _____<br />
O-Ring red, final 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 />
1.30 mm Hex (Latch for contra-angle) 02-7179003000 _____ 1.30 mm Hex (medium, 12 mm) 02-7139126000 _____<br />
1.30 mm Hex (long 18 mm) 02-7139166000 _____ Driver Octagon 01-7259106000 _____<br />
Cover Screws<br />
ø 3.40 mm Cover Screw 02-2349001000 _____ ø 4.10 mm Cover Screw 02-2419001000 _____<br />
ø 3.80 mm Cover Screw 02-2389001000 _____ ø 5.00 mm Cover Screw 02-2509001000 _____<br />
Impression Coping Screw<br />
M 1.6, 17 mm (open) 02-8169194000 _____ M 1.8, 17 mm (open) 02-8189194000 _____<br />
Abutment Screws<br />
Final Screw M1.6 für ø 3.40 02-8349104000 _____ Final Screw M1.8 für ø 4.10 02-8419104000 _____<br />
Final Screw M1.6 für ø 3.80 02-8389104000 _____ Final Screw M1.8 für ø 5.00 02-8509104000 _____<br />
Laboratory Screw M1.6 for ø 3.40/3.80 02-8169104100 _____ Laboratory Screw M1.8 for ø 4.10/5.00 02-8189104100 _____<br />
Scan Screw HIGHLINE M 1.6 02-5169002100 _____ Scan Screw HIGHLINE M 1.8 02-5189002100 _____<br />
I herewith accept the General Terms and Conditions<br />
Date<br />
Signature<br />
31.01.2012<br />
QM 7.2-A1_F7e (V1)
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