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ABOI/ID Part II Case Presentation – Template
2013
+ Case #
Type of Case:
+ Implant Surgery
Date of Initial implant surgery:
Number of implants placed and where:
Did this case require pre-implant placement grafting of any
kind?
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Date of final prosthesis insertion
Type of restoration
Opposing dentition
Current status
+ Patient Medical History
ASA Classification
Patient’s mental status
Relevant past/and current medical history
Medications
Allergies
+ Dental History
Missing teeth
Periodontal status
Occlusion/ Angle Classification
+ Pre-Surgical X-Ray (insert)
+ Social History
Smoking
Alcohol
Drug/substance abuse
+ Treatment Planning
Surgical Plan
+ Prosthetic Plan
Prosthetic plan
+ Informed Consent (insert)
+ Alternative treatment plans discussed with patient Alternative treatments discussed:
+ Implant Surgery
Operative report of actual implant surgery
+ Post Surgical x-ray
+ Post-Operative Care
What were your post-operative instructions for this patient?
+ Maintenance
What is your maintenance protocol?
List this patients maintenance history
+ Prosthetic Restoration
What type of restoration was placed?
Explain
+ Immediate post prosthetic placement x-ray (insert)
+ Occlusal view of maxillary arch (insert)
+ Occlusal view of mandibular arch (insert)
+ Frontal view in maximum intercuspation position (insert)
+ Left side (insert)
+ Right side (insert)
+ For cases that involve implant supported/retained prostheses Insert views of all implant attachment mechanisms (intra-oral)
Views of tissue surface areas of the removable prostheses
(add slide if necessary)
+ One year post prosthetic placement x-ray (insert)
+ Revision (if necessary)
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