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Oral And Maxillofacial Surgeon
5-10 minutes

Maxillofacial Implant Template

This Implant Template, tailored for Maxillofacial Surgeons, facilitates the meticulous documentation of patient details, clinical assessments, and treatment strategies for dental implant procedures. It encompasses sections for tooth condition, diagnostic imaging, and medical history, ensuring thorough and comprehensive records. Additionally, the template addresses patient preferences and follow-up care, making it an indispensable resource for maxillofacial surgery documentation. Optimized for use with s10.ai, this template streamlines the creation of precise and detailed implant notes, thereby improving patient care and communication with referring dentists. Ideal for professionals seeking maxillofacial implant documentation solutions.

1,657 uses
4.2/5.0
D
Dr. Emily Carter
Template Structure

Organized sections for comprehensive clinical documentation

Patient Details:
Full Name: [Patient's Full Name]
Consultation Date: [Date]
Referring Dentist: [Referring Dentist’s Name and Clinic]
Referral Reason: [Reason for Referral, e.g., broken teeth, root fractures]
Clinical Observations:
Condition of Teeth:
Affected Teeth: [e.g., 25, 26, 27]
Current Status:
Tooth [25]: [e.g., Broken root, no pain, etc.]
Tooth [26]: [e.g., Insufficient bone, requires extraction]
Tooth [27]: [e.g., Confirmed root fracture, extraction recommended]
Existing Spaces: [e.g., Gaps in the upper left arch after extractions]
Diagnostic Imaging:
X-rays/CT Findings: [Details about any findings from X-rays, e.g., insufficient bone, sinus proximity]
Bone Quality: [E.g., 4-6 mm bone depth at the implant site]
Treatment Strategy:
Extractions:
Teeth for Extraction: [e.g., 25, 27]
Planned Implant Locations: [Specify tooth positions, e.g., 25, 27, etc.]
Implant Placement:
Implant Count: [e.g., 2 implants]
Site Information:
Implant [1, 2] in position [25/26/27].
Sinus Lift Needed: [Yes/No, specify if Summer's Osteotomy will be used]
Anticipated Healing Duration: [e.g., 3 months for bone integration]
Post-healing Restoration: Referring dentist to place crowns.
Special Considerations:
Bone Grafting: [Yes/No, specify if autograft, cow bone, or human allograft]
Potential Complications: [e.g., difficulty due to sinus proximity or limited bone]
Medical Background:
Cardiac Conditions: [e.g., Enlarged ascending aorta, mitral valve leakage]
Diabetes: [Controlled/Uncontrolled, mention HbA1c levels]
Hypertension: [Controlled/Medicated/Monitored weekly]
Lifestyle/Exercise Tolerance: [e.g., active lifestyle with regular outdoor work]
Patient Preferences:
Sedation Choice: [Yes/No, specify intravenous sedation or local anesthesia]
Crown/Bridge Preferences: [e.g., prefers implants over bridges, crown restoration plan]
Cost Estimate Provided: [Yes/No, approximate cost, if discussed]
Follow-up:
Subsequent Steps: [e.g., surgery scheduled for implant placement, referral to dentist for crowns, patient to confirm final treatment plan]
Post-operative Care: [e.g., prescription provided, post-op instructions]
Surgeon’s Advice:
Final Implant Decision: [e.g., proceed with two implants at sites 25 and 27]
Additional Remarks: [e.g., bridge recommendation, alternative options like root canal, long-term prognosis of implants]
Sample Clinical Note

Example of completed documentation using this template

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: Root fracture confirmed, extraction advised  
Tooth 15: Inadequate bone, extraction necessary  
Tooth 16: Root broken, no pain present  
Existing Gaps: Gaps in the upper right arch post-extractions  
Diagnostic Imaging:
X-rays/CT: Inadequate bone at site 15, sinus proximity observed  
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 utilized  
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: Challenges 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
Clinical Benefits

Key advantages of using this template in clinical practice

  • This comprehensive dental referral template is designed to streamline the communication between referring dentists and specialists, ensuring a seamless transition of care for patients requiring advanced dental procedures. With sections dedicated to patient information, clinical findings, diagnostic imaging, and a detailed treatment plan, this template facilitates precise documentation and enhances clinical decision-making. It includes critical details such as tooth condition, planned extractions, implant placement, and special considerations like bone grafting and potential complications. The template also addresses medical history, patient preferences, and follow-up care, providing a holistic view of the patient's needs. By adopting this template, clinicians can improve patient outcomes, optimize treatment planning, and ensure a coordinated approach to dental care. Explore this template to enhance your practice's efficiency and patient satisfaction.
Frequently Asked Questions

Common questions about this template and its usage

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Maxillofacial Implant Template