* A 0 grade indicates no impact on surgical success of implant placement. A 4 grade indicates no chance of successful implant placement.
COMPLEXITY INDEX: _______
| CIS | |
COMMENTS | FEE |
| 1 | MULTIPLE UNIT - FREESTANDING | _ | _ |
| 3 | SINGLE TOOTH | _ | _ |
| 5 | UTILIZING NATURAL TOOTH ABUTMENTS | _ | _ |
| |
|||
| 1 | ANTERIOR MANDIBLE | _ | _ |
| 2 | ANTERIOR MAXILLA | _ | _ |
| 4 | POSTERIOR MANDIBLE | _ | _ |
| 5 | POSTERIOR MAXILLA | _ | _ |
| |
|||
| _ | AVAILABLE BONE VOLUME | _ | _ |
| _ | BONE DENSITY | _ | _ |
| _ | ANATOMICAL LANDMARKS | _ | _ |
| _ | GENERAL MEDICAL CONDITION | _ | _ |
| _ | IMMEDIATE IMPLANTS | _ | _ |
| |
_ | _ | |
| 1 | AGE | _ | _ |
| 1 | OCCLUSAL FACTORS | _ | _ |
| 1 | ORAL HYGIENE | _ | _ |
| 1 | PSYCHOLOGICAL TYPE | _ | _ |
* A 0 grade indicates no impact on surgical success of implant placement. A 4 grade indicates no chance of successful implant placement.
COMPLEXITY INDEX: _______