Contact information:

Surgical Report

Order Details FOR APPROVAL

Patient Name: Raid_Zuabi_SO2101702

Client Order Reference: 105004451_20210202_1542_55

Creation Date: 02/03/2021 9:55:27 AM

‫( אפטסומ אאלע רד‬Feb 6, 2021 14:02 GMT+2)

Created by: Alpha Bio Tech - alphabioabc@gmail.com _______________

Approved by

Lower Jaw 7 - 2 '‫תכנון בעמ‬

36 ‫ מוקם שתל נוסף באזור‬,‫שמאלי‬/‫ עקב חוסר עצם באזור הקדמי‬,‫שם לב‬

Implant information
Implant position (FDI) 33 34 36
Manufacturer Alpha-Bio Tec Alpha-Bio Tec Alpha-Bio Tec
Type LP ICE Ø3.75mm x 11.5mm ICE Ø3.75mm x 8mm
Order number 65047 1011 1018
Length, mm 29.3 11.5 8
Diameter (Ø), mm 1.5 3.75 3.75
Color N/A Dark Blue Dark Blue

Implant information
Implant position (FDI) 41 43 44
Manufacturer Alpha-Bio Tec Alpha-Bio Tec Alpha-Bio Tec
Type ICE Ø3.75mm x 11.5mm LP ICE Ø3.75mm x 11.5mm
Order number 1011 65047 1011
Length, mm 11.5 29.3 11.5
Diameter (Ø), mm 3.75 1.5 3.75
Color Dark Blue N/A Dark Blue

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) 33

Manufacturer Alpha-Bio Tec

Type LP

Order number 65047

Length, mm 29.3

Diameter (Ø), mm 1.5

Color N/A

Safety zone - apical distance 2.0 (custom)

Safety zone - radial distance 0.1 (custom)

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) 34

Manufacturer Alpha-Bio Tec

Type ICE Ø3.75mm x 11.5mm

Order number 1011

Length, mm 11.5

Diameter (Ø), mm 3.75

Color Dark Blue

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.
 Implant Information

Implant position (FDI) 36

Manufacturer Alpha-Bio Tec

Type ICE Ø3.75mm x 8mm

Order number 1018

Length, mm 8

Diameter (Ø), mm 3.75

Color Dark Blue

Safety zone - apical distance 2.0

Safety zone - radial distance 1.5

Buccal Mesial Lingual Distal

M D

Limitation of Liability: Page 4

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) 41

Manufacturer Alpha-Bio Tec

Type ICE Ø3.75mm x 11.5mm

Order number 1011

Length, mm 11.5

Diameter (Ø), mm 3.75

Color Dark Blue

Safety zone - apical distance 2.0

Safety zone - radial distance 1.5

Buccal Mesial Lingual Distal

M D

Limitation of Liability: Page 5

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) 43

Manufacturer Alpha-Bio Tec

Type LP

Order number 65047

Length, mm 29.3

Diameter (Ø), mm 1.5

Color N/A

Safety zone - apical distance 2.0 (custom)

Safety zone - radial distance 0.1 (custom)

Buccal Mesial Lingual Distal

M D

Limitation of Liability: Page 6

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) 44

Manufacturer Alpha-Bio Tec

Type ICE Ø3.75mm x 11.5mm

Order number 1011

Length, mm 11.5

Diameter (Ø), mm 3.75

Color Dark Blue

Safety zone - apical distance 2.0

Safety zone - radial distance 1.5

Buccal Mesial Lingual Distal

M D

Limitation of Liability: Page 7

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.