Dental Prosthetics QC Form
Please complete this quality control form for each dental prosthetic item inspected. Ensure all assessment criteria are addressed.
Prosthetic Item ID or Case Number
*
Type of Prosthetic
*
Please Select
Crown
Bridge
Denture
Implant
Veneer
Other
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
QC Reviewer Name
*
Inspection Criteria Assessment
*
Rows
Pass
Fail
N/A
Fit and Margins
1
2
3
Aesthetics (Color/Shape)
4
5
6
Material Integrity
7
8
9
Occlusion
10
11
12
Surface Finish
13
14
15
Overall Quality Rating
*
1
2
3
4
5
QC Outcome
*
Pass
Fail
Conditional Pass (with remarks)
Follow-up Action Required?
*
No Action Needed
Remake
Adjustment/Repair
Other
Comments / Notes
Upload Photo of Prosthetic (if applicable)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit QC Review
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