Your Name Here, DDS/DMDMonth 30, 2013

Patient’s Chief Complaint

Medical History

Dental History (chronologically how they’ve gotten to this point)

Medications

Preexisting Implant Information (type, size, when they were placed)

Diagnosis

• Perio:

• Dentition:

• TMD/MFP:

Diagnostic Notes

Patient PhotosPatient Photos

Full face smiling Full face profile

Patient Photos

Close up smile Close up profile

Patient Photos

Patient Photos

Tipped down smile Rest position

Patient Photos

Patient Photos

Retracted - teeth apart Retracted - MI

Patient Photos

Patient Photos

Upper occlusal Lower occlusal

Patient Photos

CBCT Scan

X-rays

X-rays

Panograph

Patient Chart

Tentative Treatment Plan