Download ABOI/ID Part II Case Presentation – Template

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ABOI/ID Part II Case
Presentation – Template
2016
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Key Points for quality case
submissions
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Please only use this template
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Do not change the case submission template
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Be sure to number your cases in numerical order as listed on the Required Cases listing
(on next slide)
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Panorex or CT scans are required.
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Photos must be of diagnostic quality and must clearly show the soft tissue response to
the implant/s
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De-Identify your cases
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No patient name should be shown on documents, only initials
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Your practice name should not be shown on any consent forms etc.
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More key points for case
submission
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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
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Date your x-rays and photographs
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Make sure you provide as much detail about the case as possible
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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.
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Required Cases
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Label your cases according to the following list:
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Case 1- Full arch removable implant overdenture
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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.
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Case 3-Anterior maxillae with implant support that includes one or more root form
implants with a minimum diameter of 3.0 mm.
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Case 4-Extraction with immediate implant placement or extraction with ridge
preservation and delayed implant placement.
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Case 5-Edentulous mandible with implant support that includes four or more root form
implants with a minimum diameter of 3.25 mm
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Required Cases continued
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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.
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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.
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Cases 8-10 Cases to be determined by the applicant. No more than one of these cases
can be a single tooth replacement.
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Case #
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Type of Case:
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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
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Type of restoration
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Opposing dentition
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Current status
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Patient Medical History
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ASA Classification
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Patient’s mental status
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Relevant past/and current medical history
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Medications
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Allergies
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Dental History
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Missing teeth
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Periodontal status
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Occlusion/ Angle Classification
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Pre-Surgical X-Ray (insert)(date)
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Social History
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Smoking
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Alcohol
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Drug/substance abuse
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Treatment Planning
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Surgical Plan
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Prosthetic Plan
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Prosthetic plan
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Informed Consent (insert)
(de-identify)
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Alternative treatment plans
discussed with patient
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Alternative treatments discussed:
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Implant Surgery
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Operative report of actual implant surgery (detailed)
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Post Surgical x-ray (date)
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Post-Operative Care
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What were your post-operative instructions for this patient?
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Maintenance
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What is your maintenance protocol?
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List this patients maintenance history
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Prosthetic Restoration
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What type of restoration was placed?
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Explain
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Immediate post prosthetic
placement x-ray (insert) (date)
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Occlusal view of maxillary arch
(insert)
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Occlusal view of mandibular arch
(insert)
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Frontal view in maximum
intercuspation position (insert)
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Left side (insert)
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Right side (insert)
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For cases that involve implant
supported/retained prostheses
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Insert views of all implant attachment mechanisms (intraoral)
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Views of tissue surface areas of the removable prostheses
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(add slide if necessary)
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One year post prosthetic
placement x-ray (insert)(date)
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Revision (if necessary)
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