Implant template (Maxillofacial)

Patient Information: Name: John Doe Date of Consultation: October 15, 2023 Referring Dentist: Dr. Emily Smith, Smile Dental Clinic Reason for Referral: Root fractures and missing teeth Clinical Findings: Tooth Condition: Teeth Affected: 14, 15, 16 Current Condition: Tooth 14: Confirmed root fracture, extraction recommended Tooth 15: Insufficient bone, requires extraction Tooth 16: Broken root, no pain Existing Gaps: Gaps in the upper right arch after extractions Diagnostic Imaging: X-rays/CT: Insufficient bone at site 15, sinus proximity noted Bone Quality: 5 mm bone depth at the implant site Treatment Plan: Extractions: Teeth to be Extracted: 14, 15 Planned Implant Sites: 14, 15 Implant Placement: Number of Implants: 2 implants Site Details: Implant #1 in position 14 Implant #2 in position 15 Sinus Lift Required: Yes, Summer's Osteotomy will be used Expected Healing Time: 4 months for bone integration Post-healing Restoration: Referring dentist to place crowns. Special Considerations: Bone grafting: Yes, human allograft Possible complications: Difficulty due to sinus proximity Medical History: Heart Conditions: None Diabetes: Controlled, HbA1c at 6.5% Hypertension: Medicated, monitored weekly Lifestyle/Exercise Tolerance: Active lifestyle with regular outdoor work Patient Preferences: Sedation Preference: Yes, intravenous sedation Crown/Bridge Preferences: Prefers implants over bridges, crown restoration plan Cost Estimate Provided: Yes, approximate cost discussed Follow-up: Next Steps: Surgery scheduled for implant placement, referral to dentist for crowns, patient to confirm final treatment plan Post-op Care: Prescription provided, post-op instructions Surgeon’s Recommendations: Final Implant Decision: Proceed with two implants at sites 14 and 15 Additional Notes: Consideration for bridge if implant fails, long-term prognosis of implants is favorable