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					    BIOMET 3i Graduate Synergy
 Training Program® Registration Form
Enclosed is my payment of $2,000 to secure
my participation in the BIOMET 3i Graduate                                                                                                                  Graduate Synergy
   Synergy Training Program sponsored by
   Castable Ceramics scheduled to begin
                                                                                                                                                            Training Program®
 September 29, 2011. Upon completion of
  the program, BIOMET 3i will provide the                                                                                                                          A Mini Residency in
  appropriate continuing education credits.                                                                                                                    Restorative Implant Dentistry

Attendee nAme: ___________________________________________

Business nAme: ____________________________________________

Address: __________________________________________________

City: _______________________ stAte: ________ Zip:____________

phone: _____________________ FAx: _________________________

e-mAil: ___________________________________________________


type oF pAyment: ❏ mC                     ❏ VisA           ❏ Amex              ❏ disCoVer            ❏ CheCk*
*If paying by check, please make check payable to Castable Ceramics

Credit CArd #: ____________________________________________
                                                                                                                                                              This program is co-sponsored by:
exp. dAte: _________________________________________________

nAme      As it    AppeArs      on    CArd:
_________________________________________________________


signAture: ________________________________________________



         All forms should be completed and returned to
                                                                                                                                                                                  and
             Castable Ceramics by August 19, 2011
                     to secure participation.

Registration/Cancellation/CE Credits
The number of registrants is limited for each course and registration is accepted on a first-come, first-served basis.
                                                                                                                         Castable Ceramics

                                                                                                                                    Anchorage, AK 99503




Full tuition payment must accompany all registration forms. Registrants unable to attend their course can obtain
                                                                                                                                    502 E. Fireweed Lane




a refund (less a $50 administration fee) by notifying BIOMET 3i in writing, no later than 14 days prior to the
course date. Cancellations past that date will be subject to a no refund policy. BIOMET 3i reserves the right to
cancel a course no later than 14 days prior to the course date. Continuing Education Credits awarded in the U.S.
for participation in the CE activity may not apply towards license renewal in all states. It is the responsibility of                                      YO U R D E N TA L L A B O R AT O R Y S O L U T I O N
each participant to verify the requirements of his/her state licensing board.

BIOMET 3i is an recognized provider. ADA CERP is a service of the American Dental Association to assist dental
professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or
endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
BIOMET 3i designates this activity for 28 continuing education credits.
       Graduate Synergy                                         ProGram outline                                                stP leaders
       Training Program®
                                                              Breakfast & Lunch provided on course dates
                                                                                                               Curtis E. Jansen, DDS
                                                             Session 1 - September 29, 2011                    Dr. Jansen completed his dental de-
A Mini Residency in Restorative Implant Dentistry
                                                                      8:00 am to 4:30 pm                       gree as well as his Prosthodontic edu-
                                                      ❏ Treatment planning the patient transitioning from      cation at the University of Southern
  The Graduate STP® is a continuum of the Syn-          teeth to dental implants.                              California School of Dentistry. Dr.
ergy Training Program®. This is a four-session        ❏ Treatment planning for complex situations in the       Jansen is an Associate member of the
course which is most effectively held on a quar-        anterior aesthetic zone                                American College of Pros-thodon-
                                                           ❍ Multiple implants                                 tics, a Fellow of the American Col-
terly basis. The STP will have a heavy emphasis
                                                           ❍ Dealing with different biotypes                   lege of Dentists and an active mem-
on treatment planning of dental implants, practice         ❍ Immediate provisional, non-occlusal loading       ber of the Academy of Osseointegration. After practicing
growth and development. Participants will be en-               restorations                                    in Westwood, California he accepted a full time teaching
couraged to bring cases to each session for treat-    ❏ Treatment planning new patients for the GSTP           position at the University of Southern, California School
ment planning. The requirement for treatment          ❏ Troubleshooting treatment plans from the               of Dentistry.
planning at least one case is highly recommended.       first course
                                                                                                               He was later appointed as Director of Implant Dentistry
In order for everyone to learn as much as possible,            Session 2 - December 8, 2011                    in the Department of Restorative Dentistry. Dr. Jansen
a definite hands-on approach is needed.                                                                        has presented lectures on various subjects emphasizing
                                                                     8:00 am to 4:30 pm
                                                                                                               Restorative, Aesthetic, and Implant dentistry to groups
                                                      ❏ New Technologies for implant dentistry
Goals & objectives:                                                                                            of specialists, dental associations and study clubs. He has
                                                          ❍ Cad/Cam procedures
                                                                                                               lectured throughout the United States as well as Africa,
                                                          ❍ Bar overdentures
• To increase proficiency in identifying dental                                                                Asia, Australia, Europe and South America.
                                                          ❍ CT Guidance
  implant patients                                    ❏ Treatment planning session
                                                                                                               Dr. Jansen has extensive experience involving research
• To increase proficiency in treatment planning           ❍ Participants to bring cases for treatment plan-
                                                                                                               and design in implant dentistry. He has a number of pa-
  dental implant patients                                    ning.
                                                                                                               tients for implant restorative components, some of which
• To learn to transition patients from teeth to                  Session 3 - March 8, 2012                     are being used by major manufacturers.
  dental implants                                                      8:00 am to 4:30 pm                      Dr. Jansen has a full time prosthetic dentistry practice and
• To keep up to date with new technologies            ❏ Transitioning patients from teeth to dental implants   a dental laboratory in Monterey, California.
                                                          ❍ Temporization options
  and techniques                                          ❍ Immediate occlusal loading of dental implants
                                                            ♦ Maxillae                                                          Program will be held at:
    the Graduate stP® ProGram includes:                     ♦ Mandible
                                                          ❍ Case design considerations
•   Four (4) sessions                                 ❏ Treatment planning session
•   Twenty eight (28) hours of CE upon                    ❍ Group treatment planning participation

     completion (7 Participation, 21 Lecture)                     Session 4 - June 1, 2012
•   Model                                                              8:00 am to 4:30 pm
•   Only 18 Participants                              ❏ Occlusion
                                                      ❏ The re-restoration of the existing implant patient              109 W. International Airport Road
                                                          ❍ Long term complications and maintenance
                                                                                                                             Anchorage, AK 99518
                                                      ❏ Update on cases
                                                      ❏ Treatment planning session                                      For hotel reservations, please call:
                                                                                                                                 (907) 433-4100

				
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