Application for ISOI Fellow, Mastership, Diplomate - Patient Case Details
"This application details a patient case for ISOI Fellow, Mastership, or Diplomate status, including diagnosis, treatment plan, procedure, implants used, medical and dental history, along with post-operative photographs and OPG radiographs. Explore comprehensive case documentation."
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Presentation Transcript
APPLICATION FOR ISOI FELLOW/MASTERSHIP/DIPLOMATE (Retain applicable level) APPLICANT: ADDRESS: Mobile: Email:
CASE No. Name of Patient: Age/Sex: Diagnosis: Type of case & Treatment plan: (Single/Multiple/Full arch - Mx. or Md. Explain in detail) Procedure: (Surgical/ Flapless/ CT Guided etc. - Explain in detail) Implants & augmentation material: Name & Company, Length & diameter with details (e.g IMPLANT, XYZ Co, Manufacturer & Country Blasted, Acid-Rxed, Custom-made etc.) Graft material full details. Medical History: Dental History:
CASE NO: PHOTOGRAPHS 1-4 POST-OP (MIN. 1 YEAR) View 1 View 1- - Front: Centric Occlusion Front: Centric Occlusion View 2 View 2- - Front: Protrusive Front: Protrusive View 4 View 4- - Left: Centric Occlusion Left: Centric Occlusion View 3 View 3- - Right: Centric Occlusion Right: Centric Occlusion
CASE NO: PHOTOGRAPHS 5-8 POST-OP (MIN. 1 YEAR) View 5 View 5- - Front: Front: Right Excursive Right Excursive View 6 View 6- - Front: Front: Left Excursive Left Excursive View 7 View 7- - Maxillary Maxillary Occlusal Occlusal View 8 View 8- - Mandibular Occlusal Mandibular Occlusal
CASE NO: OPG RADIOGRAPHS 1-4 (MIN. 1 YEAR) View 2 View 2 - - Immediate Immediate Post Surgical Post Surgical View View 1 1 Pre Pre- -surgical surgical View 3 View 3- - Immediate Post Prosthetic Immediate Post Prosthetic View 4 View 4 - - 1 1 Year Follow Year Follow up up
