+ ABOI/ID Part II Case Presentation – Template

+ 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)

+ 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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