ISOI DIPLOMATE APPLICATION

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ISOI DIPLOMATE APPLICATION
NAMEADDRESSMOBILE No.
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Applicants Bio Data Photograph
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CASE 1
Name of Patient 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
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PHOTOGRAPH VIEWS

• FRONTAL
• PROTRUSIVE
• OCCLUSAL, MANDIBULAR
• OCCLUSAL, MAXILLARY
• LEFT LATERAL VIEW
• RIGHT LATERAL VIEW
• RIGHT WORKING
• LEFT WORKING

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CASE 1 PHOTOS 1- 4 clockwiseDate of photos
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CASE 1 PHOTOS 5 - 8 clockwiseDate of photos
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RADIOGRAPHS

• Pre-op OPG
• Post-op OPG or post-op IOPA (for single-tooth
  implant (within 3 days of surgery)
• Post-prosthetic (with prosthesis in place)
• OPG after 1 year of prosthetic placement

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CASE 1 - RADIOGRAPH VIEWS
View 1- Date of photo
View 2- Date of photo
View 4- Date of photo
View 3- Date of photo
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CASE 2
Name of Patient 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
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CASE 2 PHOTOS 1- 4 clockwiseDate of photos
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CASE 2 PHOTOS 5 - 8 clockwiseDate of photos
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CASE 2 - RADIOGRAPH VIEWS
View 1- Date of photo
View 2- Date of photo
View 4- Date of photo
View 3- Date of photo
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Repeat slides for cases 3-100 with correct case
no. on slides

• DO NOT ADD EXTRA SLIDES
• TOTAL NUMBER OF SLIDES -----, NOT INCLUDING
  THIS PARTICULAR SLIDE