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ISOI FELLOWSHIP APPLICATION

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

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  1. ISOI FELLOWSHIP APPLICATION NAME:ADDRESS:MOBILE No.:

  2. 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:

  3. CASE 1 Post-Restoration photos Date of photos: FRONTAL PROTRUSIVE OCCLUSAL, MANDIBULAR OCCLUSAL, MAXILLARY

  4. CASE 1 Photos (continued)Date of photos: LEFT LATERAL VIEW RIGHT LATERAL VIEW RIGHT WORKING LEFT WORKING

  5. 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:

  6. 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.

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