1. + ABOI/ID Part II Case Presentation – Template

2. + Case # Type of Case:

3. + Implant Surgery Date of Initial implant surgery: Number of implants placed and where: Did this case require pre-implant placement grafting of any kind?

4. + Date of final prosthesis insertion Type of restoration Opposing dentition Current status

5. + Patient Medical History ASA Classification Patient’s mental status Relevant past/and current medical history Medications Allergies

6. + Dental History Missing teeth Periodontal status Occlusion/ Angle Classification

7. + Pre-Surgical X-Ray (insert)

8. + Social History Smoking Alcohol Drug/substance abuse

9. + Treatment Planning Surgical Plan

10. + Prosthetic Plan Prosthetic plan

11. + Informed Consent (insert)

12. + Alternative treatment plans discussed with patient Alternative treatments discussed:

13. + Implant Surgery Operative report of actual implant surgery

14. + Post Surgical x-ray

15. + Post-Operative Care What were your post-operative instructions for this patient?

16. + Maintenance What is your maintenance protocol? List this patients maintenance history

17. + Prosthetic Restoration What type of restoration was placed? Explain

18. + Immediate post prosthetic placement x-ray (insert)

19. + Occlusal view of maxillary arch (insert)

20. + Occlusal view of mandibular arch (insert)

21. + Frontal view in maximum intercuspation position (insert)

22. + Left side (insert)

23. + Right side (insert)

24. + 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)

25. + One year post prosthetic placement x-ray (insert)

26. + Revision (if necessary)

27. +