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2018

2018. American Board of Oral Implantology /Implant Dentistry Case Submission template. Candidate # Case and Patient initials:. Case # 7.

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2018

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  1. 2018 American Board of Oral Implantology/Implant Dentistry Case Submission template

  2. Candidate #Case and Patient initials:

  3. Case # 7 • Case showing the management of a width deficient bony ridge (less than 3mm) requiring augmentation or manipulation (excluding ridge reduction) and the placement of two(2) or more root form implants with a minimum diameter of 3.0mm.

  4. Medical History Write a narrative to provide a detailed medical history of the patient

  5. Patient Examination • Describe the chief complaint and patients medical /dental histories. • Include the following: • ASA Classification • House Classification • Relevant past/and current medical history • Medications • Allergies • Missing teeth • Periodontal status • Occlusion/ Angle Classification

  6. Social History • Smoking • Alcohol • Drug/substance abuse

  7. Pre augmentation or manipulation radiograph • Include panoramic, periapical and/or CBCT if applicable with the date the radiograph was taken

  8. Post augmentation or manipulation radiograph • Include panoramic, periapical and/or CBCT if applicable with the date the radiograph was taken

  9. Pre Implant placement radiograph • Include panoramic, periapical and/or CBCT if applicable with the date the radiograph was taken

  10. Pre Surgical Photographs • Include the date the photograph was taken • Views desired: • Occlusal view of maxillary arch • Occlusal view of mandibular arch • Frontal view in Maximum Intercuspation Position (MIP) • Left side in MIP • Right side in MIP Pre op photographs are optional. However, the more complete your case documentation is the easier it is for examiners to evaluate your case.

  11. Treatment Planning/ Goals • Surgical Plan/ Goals- provide details

  12. Prosthodontic Rehabilitation Plan • Describe Prosthodontic Rehabilitation Plan

  13. Informed Consent (insert) • (de-identify your document)

  14. Alternative Treatment Plans • Describe alternative treatment plans

  15. Implant Surgery • Operative report of actual implant surgery. • Details to include instrumentation, materials techniques and implant information.

  16. Post Surgical Radiograph • Include panoramic, periapical and /or CBCT if applicable with the date the radiograph was taken

  17. Post-Operative Care / Instructions You may scan a copy of the form/s that you use or type a narrative with details of post-operative instructions.

  18. Maintenance • Describe your maintenance protocol for this patient • List this patients maintenance history

  19. Prosthetic Restoration • Describe the type of implant restoration placed for this patient

  20. Immediate post prosthetic placement radiograph • Include panoramic, periapical and/or CBCT if applicable with the date the radiograph was taken.

  21. Occlusal view of maxillary arch photograph (date your photo)

  22. Occlusal view of mandibular arch photograph (date your photo)

  23. Frontal view in maximum intercuspation position photograph (date your photo)

  24. Left side photograph MIP(date your photo)

  25. Right side photograph MIP (date your photo)

  26. For cases that involve implant supported/retained prostheses • Insert photographic views of all implant attachment mechanisms (intra-oral) • Photographic views of tissue surface areas of the removable prostheses • (add slides if necessary)

  27. One year post prosthetic placement radiograph with date • Include panoramic, periapical and/or CBCT if applicable with the date the radiograph was taken.

  28. Revision (if necessary) • If you provide information on a revision, provide a detailed explanation and other documentation that is necessary to evaluate the case.

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