Dear Doctor: Thank you for enrolling in Basic Dental Implants Level 1 Implant Certification Workshop. Over the past several years we have worked hard on refining this workshop. This course is the best way we have found to help general dentists overcome their fears and begin placing implants in their practices. Implant Certification Workshops are held throughout Canada. Please consult with your Patterson Representative for the date and specifics of the course you will be attending. This course is unlike most other courses you have attended. You will have the opportunity to place an implant for one of your patients in a supervised educational setting. This is not a twoday course: Your education begins today. To prepare for the course, please view or download BASIC Dental Implants Protocol Manual which is available on our website. Pay particular attention to Chapter 1 Pick the Patient. It will also be helpful to watch Dr. Christensen s video a couple of times before the course. Then, begin looking at your patients and speaking with them about implants. When you believe you have found a patient who is medically, dentally, and psychologically appropriate for an implant, your Patterson representative will let you know where to forward duplicate records to: The necessary records are: 1. An excellent P.A. Radiograph 2. A Panograph (if available) 3. Soft Tissue measurements of the proposed site 4. An excellent impression 5. A patient history We have plenty of time before the workshop, but start actively looking for patients as soon as possible. Final records should be received by the laboratory no later than two weeks prior to the Workshop. We will review up to three patients (if necessary) and select the patient we think will be the best for your initial placement. The best areas of the mouth to begin with would be the upper or lower first or second bicuspids or first molar. You do not need to feel confined to these areas when selecting a patient, but you should be aware of the additional complexities in choosing an anterior site in an esthetic zone or a posterior site due to the possibility of poor bone quality and proximity to vital structures. Each of your selected patients should be open to the prospect of having others observe the procedure for educational purposes and should sign the release form later in this packet. 1
We will have our certified laboratory create a Model Tomograph and a Surgical Stent for your use in the course. On the first day of the course, we will cover the manual and give you a better understanding of patient selection as well as instrumentation, components, the procedure, and follow-up care. On the second day of the course, attendees will place implants. Half the class will place implants at 9:00am and the other half will place implants at 10:30am. If you have a time preference, please let us know and make plans to have your assistant attend. Your placement instruments will be sent to you shortly. On the day of placement, you will bring these instruments along with the items listed on the Equipment and Setup for Implant Placement form which is part of this packet. Instruments and equipment should be sterilized following the directions in the manual. We will provide you with the surgical motor system for implant placement. Basic Dental Implants will also bring your patient s records, Model Tomograph, Surgical Stent, and Implant Strip to the course. If you have any questions about the course, patient selection or your responsibilities, please do not hesitate to call your Patterson Dental Representative. Your representative will make sure your questions answered ASAP. We look forward to seeing you at the Certification Workshop. I am sure you will find this to be one of the best investments you have made. Sincerely, Dr. Americo Fernandes Education Director, Canada. 2
Level One Certification Workshop (At least 3 weeks prior to class) - Watch Dr. Christensen s video on the BASIC System. - Read Chapter 1 of the Protocol manual. - Find 1-3 appropriate patients, take records on patients. - Forward records to laboratory for review and discussion. - Complete and return forms on pages 5-8 (2-3 weeks before class) - Read Chapter 2 of the Protocol manual. - Make sure your office is equipped with all necessary armamentarium (See page 4 for list of equipment) and that the necessary supplies are disinfected and packed and ready to be brought to the workshop. (One week before class) - Read Chapters 3, 4, and 5 of the Protocol Manual. - Watch Dr. Christensen s BASIC video again. 1 st Day of Workshop: Intro to Basic Dental Implants Detail of Instruments and Components Detail of Procedure Case Selection Model Tomograph Surgical Stent Place the Implant Protocol Restorative Options Cementation Protocol 2 nd Day of Workshop: Brief review of yesterday s topics, if necessary. Answer questions prior to implant placement. Review Tray Setup Protocol. Operatories will be readied by doctors and assistants. First group placements begin. First group Placements conclude. Assistants will disinfect, and barrier operatories. Half the patients will arrive one hour later for second group placement. Second group placements begin. Second group placements conclude. Assistants will disinfect, and barrier operatories. Attendees will discuss placements. Implementing and marketing implants in your practice. 3
Equipment and Set-up For Implant Placement 1) Placement Handpiece Aseptico** AHP-85 or Equivelant (sterilized) 2) Placement Console Aseptico** AEU 707-Av2 or Equivelant provided(disinfected) a) Motor-cable assembly) provided (disinfected) b) Foot Control/Cable assembly provided (disinfected) c) Internal irrigation assembly: provided (sterilized) 3) Infection Control Materials gloves, masks, and etc. 4) Stainless Steel Tray on mayo stand or disinfected work surface (disinfected) 5) Towel/Drape placed on disinfected stainless tray or work surface. (sterilized) 6) BASIC Omni-Tight Placement Instruments box containing all instruments (sterilized) (Will be shipped to attendees prior to Certification Course) 7) Implant Strip(s) - provided (sterilized) (Will be brought by BASIC to Certification Course) 8) Sterile Water and Saline One 250ml bag 9) Monoject Syringe #412/12cc (sterilized) 10) Mouth Mirrors (sterilized) 11) Aspirating Anesthetic Syringe for anesthetic 12) Anesthetic of choice (1:100,000 epi) 13) 3-D drill guide stent (Cold sterilized/sterile H 2 O washed) (Will be brought by BASIC to Certification Course) 14) Suctions Tips (2) - small tip surgical (sterilized) 15) Spoon Excavator - 4mm diameter, double ended & angled) (sterilized) 16) Mouse-tooth Tissue Tweezer - Small Tip (sterilized) 17) Straight Scissors (sterilized) 18) Syngauze 2 X 2 4-ply (sterilized) 19) Full arch trays (disposable), pre-select to fit your patient 20) Impression material your favorite crown and bridge material 4
Please complete this form as soon as possible and return Call to Esthet your Patterson Representative: Dental Arts more info 800-447-072 293-6373 Credit Card Authorization Please complete form as soon as possible and fax or mail to: Company: Patterson Dental Canada Attn: Fax #: Address: Upon receipt, we will forward the remainder of your materials for the upcoming course including your placement instruments, protocol manual, and a copy of Dr. Christensen s video. We look forward to seeing you there and helping you to incorporate implants into your practice. Level 1 Certification Workshop Name Address Phone Method of payment: Check MasterCard Visa Card Number V-Code (Last three numbers printed in signature line) Expiration Date Cardholder Cardholder Signature Date of Course: Course Fee Includes: Supervised Implant Placement, Surgical Instruments, Model Tomograph, Surgical Stent, Protocol Manual, and Gordon Christensen DVD 5
Please complete this form as soon as possible and return to your Patterson Representative. STUDENT INFORMATION FORM Personal Information: Attendees Full Name: (For certificates and continuing education credits. Include title, if desired.) Nickname: (If applicable, for name tags) License Number: Office Address: Office Phone number: please include area code Office Fax number: please include area code Home Phone number: please include area code Email address: Educational Background: Dental School: Degree: Year: Graduate Residency: How many years have you practiced Dentistry? What are your main concerns about placing Implants? Have you tried any other implant systems? If so which ones? When? 6
Please complete this form as soon as possible and return to your Patterson Representative. LIABILITY FORM Release of Liability and Agreement for Participation I,, am a participant in a continuing dental education program, sponsored by BASIC Dental Implants and taught by on 20. Pursuant to class curriculum, I willingly agree to participate in a clinical situation sponsored by BASIC Dental Implants. I understand and agree that I will be required to conform to policies and procedures during the time I spend in the clinic or classroom. I agree to take direction from the instructor and his/her designees. In consideration of the opportunity to participate in this program, I hereby release BASIC Dental Implants, their officers, directors, employees and agents from any claim, damage or liability for or arising out of an injury of death which could result from my own actions or omissions or the actions or omissions of any employee or agent of BASIC Dental Implants. I also agree that I am responsible for all the follow-up remedial care on my patient for this course. My current liability insurance coverage is with: Name of Insurance Company: Please Print Dr. s Name: Dr. Signature: Date: 20 7
Please have patients, on whom course records are being taken, sign this form. Duplicate as necessary and return forms to your Patterson Representative. PATIENT AGREEMENT AND RELEASE FORM I hereby apply for selection as a patient for dental service to be performed for and upon me by participating dentist(s) in the continuing education course sponsored by BASIC Dental Implants. In consideration therefore, I hereby waive, release and discharge the following from any and all claims for pain, injuries, damages, or otherwise of whatsoever nature which might claim or assert by virtue of performance for and upon me such dental services by the participants themselves and BASIC Dental Implants its faculty, staff and employees. I further recognize that the participating dentist(s) who will perform services for and upon me during the course will do so as independent professional(s), and they will not be performing such services in any way as agents or employees, or for any benefit for BASIC Dental Implants or any employee thereof. It is my understanding that the follow-up/remedial care will be rendered by my assigned participant/practitioner. I have read the above, I verify that I understand the information contained therein, and I grant authority to the continuing education course participants to perform those procedures and treatments deemed necessary for while I am a patient here, and I further Patient's name authorize BASIC Dental Implant staff to use material, including visual aids, pertaining to this case for teaching and printing publications. I also authorize photographs and or slides to be taken of me for educational purposes I understand that they may be shown to other dentists and their staff. Print name of Dentist Adults: Signature of Patient Witness Date Minors and other Dependents Signature Date Signature of Patients Agent or Representative to give consent Relationship to patient or Authority to give consent Address of Agent or Representative Please return as soon as possible 8