Case Submission Form for Innmetec

Case Submission Form

Create a new patient-specific case in just a few minutes
Step 1 — Basic Case Information
Patient Name
Surgeon Name
Company
In case of distributor
Estimated Surgery Date

MonthDayYear
Country
Solutions Required

Other
Step 2 — Image and File Uploads
Medical Images (compressed)

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DICOM link (if provided externally)
Filling information (when link needed)
Dental Information Final occlusion (STL when needed)

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Patient photos (optional)

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Contact Email
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Notes / Special Requests
- Step 3 — Cranial System Clinical Questionnaire
- Material
- Is an osteotomy with surgical guide required?
- Are there any plates/mesh/implants that will be removed during the procedure? If yes, could you please specify which ones?
- Are Fenestrations required? (Perforations in the Implant)
- Definition of Fixation Points
- Which Fixation System will be used?
  
  Other
- Step 3 — Orthognathics Clinical Questionnaire
- Please confirm that the following required information and files are included in this submission.
- Surgery Plan
- Surgery at Le Fort
  
  Other
- Number of segments
  When Multi-piece Le Fort I
- Mandibular Surgery
  
  Other
- Left condylectomy _______mm
  mm
- Right condylectomy _______mm
  mm
- Orthognathic: Previous Surgery
- Surgical Sequence
- Required solution
  
  Other
- Splints Details
- Would you like to use tooth-supported Le Fort surgical guides?
- Would you like to use tooth-supported Genioplasty surgical guides?
- Would you like to use tooth-supported BSSO surgical guides?
- Which Fixation System will be used?
  
  Other
- Step 3 — CMF Reconstruction Clinical Questionnaire
- Maxillofacial Reconstruction: Defect Location
  
  Other
- Defect Laterality
- Defect Type
  
  Other
- Surgical Approach -Mandible
  
  Other
- Surgical Approach -Midface
  
  Other
- Material
- Graft to be used (When needed)
  
  Other
- Graft Laterality (when needed)
- Suggested Number of Segments
- Desired Plate Thickness (mm)
- If Oral Rehabilitation is expected, write the number of implants needed
- Which Fixation System will be used?
  
  Other
- Please confirm that the following required information and files are included in this submission.
- Step 3 — TMJ Replacement Clinical Questionnaire
- Please confirm that the following required information and files are included in this submission.
- Defect Laterality
- Is There an Ankylosis?
- Current Mouth Opening (mm)
- TMJ Reconstruction: Previous TMJ Surgery
- Is there a change In Bite, or Mandibular Alignment Required?
- Surgical Approach
  
  Other
- Step 3 — Subperiosteal Implants Clinical Questionnaire
- Please confirm that the following required information and files are included in this submission.
- Defect Location
- Number of desired Pillars
  
  Other
- Dental implant brand
  Ex straumann - Neodent
- Fixation system
  Brand
- Which Fixation System will be used?
  
  Other
- Step 3 — Facial implants Clinical Questionnaire
- Defect location:
- Are there any plates/mesh/implants that will be removed during the procedure? If yes, could you please specify which ones?
- Affected Areas
  
  Other
- Implant Material
- Desired Implant Thickness (mm)
  Required for aesthetic facial implants (Malar, chin, mandibular angles)
- Desired Projection (mm)
  Required for aesthetic facial implants (Malar, chin, mandibular angles)
- Step 3 — Orthopedics -Clinical Questionnaire
- What is the primary clinical indication for this case?
  
  Other
- Which solution are you requesting?
- Which anatomical region is involved? Lower Limb
- Which anatomical region is involved? Upper Limb
- What is the main surgical objective?
Should be Empty:

Case Submission Form

Step 1 — Basic Case Information

Step 2 — Image and File Uploads

Step 3 — Cranial System Clinical Questionnaire

Step 3 — Orthognathics Clinical Questionnaire

Step 3 — CMF Reconstruction Clinical Questionnaire

Step 3 — TMJ Replacement Clinical Questionnaire

Step 3 — Subperiosteal Implants Clinical Questionnaire

Step 3 — Facial implants Clinical Questionnaire

Step 3 — Orthopedics -Clinical Questionnaire