PerioChip

Universal case study

Internatiobal case study form for recording PerioChip global success stories

Dental Professional Identification Data

* Name

* GDC (license #)

* Country

City

Address

* E-mail

* Phone

Patient personal data

* Name (initials)

* Age

* Gender

Female Male

Patient data

* Number of Pockets/patient >= 5mm

* Periodontal disease diagnosis

* Treatment provided prior to chip placement

* Treatment provided at same visit as chip placement

Pocket data (for each pocket treated with PerioChip – 4 pockets per tooth possible – Mesial Distal Buccal & Lingual)

* Bleeding on probing (BOP)

* Probing pocket depth (PPD) - mm

* Recession - mm

* Plaque

* Tooth mobility

* Apical involvement

Post treatment data

Adverse events (if any)

Pocket data at 3 months post treatment

* Bleeding on probing (BOP)

* Probing pocket depth (PPD) - mm

* Recession - mm

* Plaque

* Tooth mobility

* Apical Involvement

Pocket data at 6 months post treatment

* Bleeding on probing (BOP)

* Probing pocket depth (PPD) - mm

* Recession - mm

* Plaque

* Tooth mobility

* Apical Involvement

Pocket data at 9 months post treatment

* Bleeding on probing (BOP)

* Probing pocket depth (PPD) - mm

* Recession - mm

* Plaque

* Tooth mobility

* Apical Involvement

Comments

Comments

Patient satisfaction level
(10 is very happy):

1	2	3	4	5	6	7	8	9	10

Homepage

Tell a Friend

Web Building