Annual Review AuDentes® Review Protocol Date of Review Dentist Name Dentist Email Patient Name Arch Maxilla Mandible Both Length of Appointment Number of Surviving Implants Number of Failed Implants Failure Location/s Prosthesis Survival Yes No Prosthesis Success Yes No Cleaning the bridge use of water pick floss brushing Bridge removed for cleaning? Yes No Bridge reline? Yes No Comments, Complications and Notes Comfort (1 = low, 5 = high) 5 4 3 2 1 Aesthetics (1 = low, 5 = high) 5 4 3 2 1 Function (1 = low, 5 = high) 5 4 3 2 1 Overall happiness with treatment decision (1 = low, 5 = high) 5 4 3 2 1 Upload the following files OPG Extra-oral photograph - smiling front Intra-oral photograph - biting front Intra-oral photograph - biting left Intra-oral photograph - biting right Intra-oral photograph - open front Intra-oral photograph - maxilla occlusal Intra-oral photograph - mandible occlusal Submit Review
