Contact information:
3Shape Implant Studio
Surgical Report
Order Details APPROVED
Patient Name: 008 Chor Vanna
Client Order Reference: 06188_20241217_1137_18_334 (1)
Creation Date: 12/17/2024 2:05:12 PM
Approved by Default user
(f5c322e6-3c9d-4710-8d34-b5b9631e1311)
Upper Jaw
Implant information
Implant position (FDI) 11
Manufacturer Osstem
Type TSIII Mini 3.5x13.0
Order number TS3M3513S
Length, mm 13
Diameter (Ø), mm 3.5
Color Yellow
Limitation of Liability: Page 1
This instruction incorporates a custom document that is based on a surgical plan proposed by the surgeon before operation. The surgeon,
therefore, takes full medical responsibility for the design and the application of the surgical guide, the intended used surgical tray kit, implants and
sleeves – all as specified on the order form received by the supplier. The custom document shall be considered as an addition to all other
documents sent with and pertaining to the case, and it does not replace any of those other documents.
Implant Information
Implant position (FDI) 11
Manufacturer Osstem
Type TSIII Mini 3.5x13.0
Order number TS3M3513S
Length, mm 13
Diameter (Ø), mm 3.5
Color Yellow
Safety zone - apical distance 2.0
Safety zone - radial distance 1.5
Buccal Mesial Lingual Distal
M D
Limitation of Liability: Page 2
This instruction incorporates a custom document that is based on a surgical plan proposed by the surgeon before operation. The surgeon,
therefore, takes full medical responsibility for the design and the application of the surgical guide, the intended used surgical tray kit, implants and
sleeves – all as specified on the order form received by the supplier. The custom document shall be considered as an addition to all other
documents sent with and pertaining to the case, and it does not replace any of those other documents.
