Contact information:

3Shape Implant Studio

Surgical Report

Order Details APPROVED

Patient Name: Tuong Cong

Client Order Reference: 97728_20210415_1359_05

Creation Date: 4/15/2021 2:12:02 PM

Approved by Dr Bao Duy

(0e7819ef-c561-4b98-9627-c7bf8025089b)

Lower Jaw

Implant information
Implant position (FDI) 35 36
Manufacturer DIO DIO
Type UF(II) 4507 UF(II) 4507
Order number UF(II) 4507 UF(II) 4507
Length, mm 7 7
Diameter (Ø), mm 4.5 4.5
Color Gray Gray

Limitation of Liability: Page 1

This instruction incorporates a custom document that is based on a surgical plan proposed by the surgeon before operation. The surgeon,
therefore, takes full medical responsibility for the design and the application of the surgical guide, the intended used surgical tray kit, implants and
sleeves – all as specified on the order form received by the supplier. The custom document shall be considered as an addition to all other
documents sent with and pertaining to the case, and it does not replace any of those other documents.
 Implant Information

Implant position (FDI) 35

Manufacturer DIO

Type UF(II) 4507

Order number UF(II) 4507

Length, mm 7

Diameter (Ø), mm 4.5

Color Gray

Safety zone - apical distance 2.0

Safety zone - radial distance 1.5

Buccal Mesial Lingual Distal

M D

Limitation of Liability: Page 2

This instruction incorporates a custom document that is based on a surgical plan proposed by the surgeon before operation. The surgeon,
therefore, takes full medical responsibility for the design and the application of the surgical guide, the intended used surgical tray kit, implants and
sleeves – all as specified on the order form received by the supplier. The custom document shall be considered as an addition to all other
documents sent with and pertaining to the case, and it does not replace any of those other documents.
 Implant Information

Implant position (FDI) 36

Manufacturer DIO

Type UF(II) 4507

Order number UF(II) 4507

Length, mm 7

Diameter (Ø), mm 4.5

Color Gray

Safety zone - apical distance 2.0

Safety zone - radial distance 1.5

Buccal Mesial Lingual Distal

M D

Limitation of Liability: Page 3

This instruction incorporates a custom document that is based on a surgical plan proposed by the surgeon before operation. The surgeon,
therefore, takes full medical responsibility for the design and the application of the surgical guide, the intended used surgical tray kit, implants and
sleeves – all as specified on the order form received by the supplier. The custom document shall be considered as an addition to all other
documents sent with and pertaining to the case, and it does not replace any of those other documents.