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Dental Card-E Rev.09-13 - EnG
Dental Card-E Rev.09-13 - EnG
Card
Certificate
of Originality
and Care
Patients name
Address
Telephone
D
a
Date
Implant position
UR
UL
18 17 16 15 14 13 12 11
21 22 23 24 25 26 27 28
48 47 46 45 44 43 42 41
31 32 33 34 35 36 37 38
LR
LL
IMPLANT TYPE
Diam / Length
IM
D
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
TR
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
C
A
NOTES
ackage
IMPLANT TYPE
Diam / Length
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
NOTES
IMPLANT TYPE
Diam / Length
IM
D
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
TR
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
C
A
NOTES
ackage
IMPLANT TYPE
Diam / Length
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
NOTES
IMPLANT TYPE
Diam / Length
IM
D
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
TR
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
C
A
NOTES
ackage
IMPLANT TYPE
Diam / Length
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
NOTES
IMPLANT TYPE
Diam / Length
IM
D
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
TR
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
C
A
NOTES
ackage
IMPLANT TYPE
Diam / Length
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
NOTES
IMPLANT TYPE
Diam / Length
IM
D
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
TR
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
C
A
NOTES
ackage
IMPLANT TYPE
Diam / Length
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
NOTES
IMPLANT TYPE
Diam / Length
IM
D
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
TR
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
C
A
NOTES
ackage
IMPLANT TYPE
Diam / Length
POSITION
DATE OF IMPLANT
DATE OF RE-OPENING
TRANSMUCOUS SCREW
DATE OF PROSTHESIS
Code of ABUTMENT,
ATTACHMENT, OTHER
NOTES
Follow-up
Date
Comments
Date
Comments
Date
Comments
Follow-up
Date
Comments
Date
Comments
Date
Comments
Follow-up
Date
Comments
Date
Comments
Date
Comments
Follow-up
Date
Comments
Date
Comments
Date
Comments
Materials
The Sweden & Martina dental implants are made of
th
of
contact him if you have doubts on how to clean and care for
st
st
your implant.
Certification of Quality
This Dental Card certifies that the implants and prosthetic
to
te
fr
im
No. 37/2010.
fi
Scientific Research
ur
c a r d - e
d e n t a l