“Surgeon’s and clinic reference” CT-SCAN ORDER FOR THE MAXILLA CT-scan center name: Date:………. Dear Colleague, CT-scan order I send you “Patient’s name” to take a CT-scan of: - The Maxilla from the occlusal surface of upper teeth to the upper third of orbits. - The Maxilla from the occlusal surface of upper teeth to the inferior third of the maxilla sinuses. - The full head. The patient will come with a ScannoGuide to place in mouth during the CT-scan take. CT-scan take - ScannoGuide should be stabilized biting on two provided cotton rolls. - Scout view should check the orientation parallel to the occlusal surface of teeth of the considered arch. - Gantry tilt: zero. - Slice 1 mm - Only axial images are required - 512 x 512 matrix and F.O.V. between 14 to 17cm - Format DICOM DICOM data delivery Can you then send DICOM data to the FTP site of ACT with a letter with CT-scan origin, surgeons’s name and patient’s name. Address: ftp.actimplant.com Host: act-dicom Password: dicom Support In case of any problem, please contact email@example.com ACT will process these data and send them directly back to Dr. “Surgeon’s name”. Radiologist name:
Date and Signature
Surgeon’s and clinic reference CONVERSION ORDER FOR THE MAXILLA (To fill and to sent by e-mail to firstname.lastname@example.org or by fax to +971 4 390 4816) Date:…………… Patient’s name:…………… To ACT Master Center service, You will receive the CT-scan data from my CT-scan center……... at a DICOM format. I would like to order a conversion, cleaning, segmentation and transfer to be able to use my data on SimPlant Planner. Would you please perform this order: At the maxilla: • 3D calculation and separate mask of the teeth of the ScannoGuide to be replaced in position: • 3D calculation and a separate mask of the base of the ScannoGuide in case of a denture type. • 3D calculation and a separate and unique mask of teeth to be extracted or studied in position: • 3D calculation and a separate mask of included tooth in position: • 3D calculation and a separate mask of implant in position: Delivery I’ll receive an email of confirmation from ACT and I’ll download the ordered file at the following address. This address will be given one time for all. Address: ftp.actimplant.com Host: act-“surgeon’s name” Password: password Payment. I hereby authorize to debit my account type Visa (or Master Card) Account number: Exp date: for a Dhs1000 to be paid to Accuracy Current technologies FZLLC. Name: Date: Signature:
Surgeon’s and clinic reference Patient information SimPlant Analysis for “Patient’s name” - Why a SimPlant analysis is necessary? Before any implant placement it is very important to evaluate the volume of bone and the quality of residual bone. If a panoramic radiograph is not enough, we need to take a CT-scan : it allows to evaluate the density and the thickness of the bone using very thin reconstruction layers. - Three Steps: • 1 • Before the CT-scan take, and is certain cases, we are going to figure out the shape and the position of missing teeth using a ScannoGuide. This template is realized out of an impression of your mouth or out of a duplicate of your existing denture. This template is used to set up a prosthetic and a surgical project. • 2 • The CT-scan take (fee : Dhs1000 to CT-scan center) is performed with this template in the mouth. The data are then sent to ACT company (fee : Dhs1000 to ACT by Credit card) to be treated. The images are cleaned, segmented and converted to be used on SimPlant software. These data will be then sent to your dental clinic by e-mail. • 3 • The implant planning and the analysis of your case can be done during the next appointment in our office using the SimPlant software. - What profit this approach presents for you? - You take profit of the most accurate and most secure pre-implant diagnosis existing today. - We can together evaluate risks and decrease them by an objective strategy. - You can visualize your surgery and better understand it. - Following cases, we are able to transfer the project to the mouth using a SurgiGuide using the SAFE System. This guide is made in Belgium using a stereolitographic process and will be directly delivered to your dental office. - For the patient, what is the step by step protocol? 1) Impressions (15 mn) at your office Following cases impressions are taken in the mouth or dentures are duplicated. 2) Try in (5 mn) at your office Try in of the ScannoGuide before the CT-scan take. 3) CT-scan (30 mn) at the CT-scan center CT-scan takes is performed. 4) Implant planning and case presentation (30 mn) at your office This appointment takes place one week after the CT-scan take.