+ ABOI/ID Part II Case Presentation – Template 2016

+ Key Points for quality case submissions Please only use this template Do not change the case submission template Be sure to number your cases in numerical order as listed on the Required Cases listing (on next slide) Panorex or CT scans are required. Photos must be of diagnostic quality and must clearly show the soft tissue response to the implant/s De-Identify your cases No patient name should be shown on documents, only initials Your practice name should not be shown on any consent forms etc.

+ More key points for case submission All of your cases must be from different patients and must be restored and functional with the final prosthesis for a minimum of one year at the time of case submission Date your x-rays and photographs Make sure you provide as much detail about the case as possible The ABOI/ID Board of Directors expect a high level of expertise to be shown in your case presentations, please do not rush through this process.

+ Required Cases Label your cases according to the following list: Case 1- Full arch removable implant overdenture Case 2- Edentulous posterior maxillae with compromised vertical height (less than 5 mm) requiring at least 3 mm of sinus augmentation and two or more implants. Case 3-Anterior maxillae with implant support that includes one or more root form implants with a minimum diameter of 3.0 mm. Case 4-Extraction with immediate implant placement or extraction with ridge preservation and delayed implant placement. Case 5-Edentulous mandible with implant support that includes four or more root form implants with a minimum diameter of 3.25 mm

+ Required Cases continued Case 6- A posterior quadrant in a partially edentulous mandible or maxillae with implant support that includes two or more root form implants with a minimum diameter of 3.25 mm. Case 7- Case showing the management of a width deficient bony ridge (less than 3 mm ) requiring augmentation or manipulation and the placement of two or more root form implants with a minimum diameter of 3.0. Cases 8-10 Cases to be determined by the applicant. No more than one of these cases can be a single tooth replacement.

+ 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?

+ 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)(date)

+ Social History Smoking Alcohol Drug/substance abuse

+ Treatment Planning Surgical Plan

+ Prosthetic Plan Prosthetic plan

+ Informed Consent (insert) (de-identify)

+ Alternative treatment plans discussed with patient Alternative treatments discussed:

+ Implant Surgery Operative report of actual implant surgery (detailed)

+ Post Surgical x-ray (date)

+ 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) (date)

+ 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)(date)

+ Revision (if necessary)

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