ISOI FELLOWSHIP APPLICATION
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ISOI FELLOWSHIP APPLICATION. NAME: ADDRESS: MOBILE No.:. CASE 1. Name of Patient : Age/Sex : Type of case : (Single/ multiple/ Full Max / Mand.) Procedure : (Surgical/ Flapless/ CT Guided etc)

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Isoi fellowship application

ISOI FELLOWSHIP APPLICATION

NAME:ADDRESS:MOBILE No.:


Case 1
CASE 1

Name of Patient: Age/Sex:

Type of case: (Single/ multiple/ Full Max / Mand.)

Procedure: (Surgical/ Flapless/ CT Guided etc)

Implant: Name & Company, Length & diameter with details, if any

(e.g. IMPLANT, XYZ Co, Manufacturer, Place

4mm diameter x 10mm length

Blasted surface, Acid-etched, Custom-made etc)

Medical History:


Case 1 post restoration photos date of photos
CASE 1 Post-Restoration photos Date of photos:

FRONTAL

PROTRUSIVE

OCCLUSAL, MANDIBULAR

OCCLUSAL, MAXILLARY


Case 1 photos continued date of photos
CASE 1 Photos (continued)Date of photos:

LEFT LATERAL VIEW

RIGHT LATERAL VIEW

RIGHT WORKING

LEFT WORKING


Case 1 radiograph views
CASE 1 - RADIOGRAPH VIEWS

Pre-op OPG

Date of photo:

Post-surgical OPG (IOPA sufficient for single implant) Date of photo:

Post-restoration (with prosthesis in place)

Date of photo:

OPG (after 1 year of restoration)

Date of photo:


Instructions
INSTRUCTIONS

  • REPEAT SLIDES LIKE CASE 1 FOR CASES 2 to 10 WITH CORRECT CASE NUMBER ON EACH SLIDE.

  • CLICK ‘ insert picture ’ ICON ON TEMPLATE TO ADD PICTURES

    FROM YOUR COMPUTER.

  • TOTAL NUMBER OF SLIDES = 41.

    1 INTRODUCTION SLIDE + 40 SLIDES.

    DO NOT INCLUDE THIS PARTICULAR SLIDE.

  • PLEASE DO NOT SUBMIT CASES RESTORED WITH IMPLANTS WHOSE DIAMETER IS LESS THAN 3 MM.

  • USE ONLY THIS TEMPLATE ALONG WITH ITS LAYOUT,

    BACKGROUND & FONTS. DO NOT USE OTHER FORMATS.

  • IF ANY QUERIES, E-MAIL TO THE SECRETARY, ISOI.