Case Submission Guidelines

• Case # - Participant Name - State Abbreviation

Required Documents: requires the following (legible) documents for case approval:

1. Patient Health History and Patient Medical Release Form
2. Diagnostic Quality FMX, Pano, PA of Implant Site, (Optional Kentucky Conebeam or Kansas Cat scan with calipers)
3. Diagnosis and Periodontal Health Status
4. Poured Models, Copy of Full Arch Scans (Export STL File Instructions), or Intraoral photo of Probe measurements 

Approval Guidelines: Cases will be approved and ranked based on the surgical difficulty level scale of 1 to 5.

• (Slight to moderate difficulty 1-3) = automatic approvals
• (Above moderate difficulty 4) = Clinical Director approval required
• (High degree of difficulty 5) = will not be approved 

Please allow 7-10 business days for an email response from your mentor.

 Course Requirements

Cases must be submitted with all required documents and approved by the host mentor before your workshop date

Cases will be approved and ranked based on the difficulty level on a scale of 1 to 5.  
 

• 1-3 are automatic approvals
• 4 requires Clinical Director approval
• 5 is not approved

You must register at least 2 weeks prior to the workshop to receive appropriate supplies.

Review page 2 of the Clinical Foundations Workshop Flyer prior to completing this form to select the correct Workshop

The following documentation is required for case approval:
If treating more than one patient, documentation is required for each patient.   
For each case submission, you will use a new submission form.

 

1. Patient Health History 
2. signed Patient Medical Release Form
3. Pano, FMX, BW's, PA of teeth to be treated
4. Intraoral Photos 
5. Diagnosis, Teeth #'s, and Perio Health Status

Reminder: All 3 procedures must be approved and completed and a post-op endo PA submitted to receive CE Credit.  
The post-op PA needs to be submitted through a separate Submittable portal on the day of the workshop 

Deadlines:

Cases must be submitted no later than 11:59 PM the day of your workshop to qualify for CE for the Implant Continuum Session III Workshop.

You will submit ALL of your cases in one submission. 

Follow the instructions below.


Required Submission:

1. Patient First Initial and Last Name

2. Provide short narrative of what procedures were completed. 

Example: #4 site placed 4.2x10 mmD Simply Legacy 2 implant, 35 Nm Torque level achieved, cover screw placed, primary closure achieved

Upload a labeled (example: J.Doe #5) final PA and Intra Oral Image for each site. 

Deadlines  1st Case must be submitted no later than March 28th and Solo Case is Due by April 11th.  

Please allow 7-10 business days for an email response.  Cases will be approved by April 25th and ranked based on the difficulty level from a scale of 1 to 5.

• 1-3 are automatic approvals
• 4 requires Clinical Director approval
• 5 is not approved

Upon approval, final diagnostics must be sent to the lab no later than May 2nd.   

Required Documents: The patient requires the following (legible) documents for case approval: 

1. Patient Health History and Patient Medical Release Form
2. FMX or Pano
3. Diagnosis and Periodontal Health Status
4. AC Photo Series (10 Photos) with Stick Bite Photo
5. Aesthetic Evaluation Form

Approval Guidelines: Cases will be approved and ranked based on the difficulty level on a scale of 1 to 5. 

• (Slight to moderate difficulty) = automatic approvals
• (Above moderate difficulty) = Clinical Director approval required
• (High degree of difficulty) = will not be approved 

Please allow 7-10 business days for an email response from our Cosmetic Evaluators of the Universe before it's assigned to your mentor doctor for Final Approval!