Contact information:

3Shape Implant Studio

Surgical Report

Order Details APPROVED

Patient Name: Nontarit Samart

Client Order Reference: 739712_20190110_0917_03 (1)

Creation Date: 14/1/2562 10:31:26

Approved by tech01
(bfa3cbc2-1883-4f20-bad4-629cfacf3e82)

Lower Jaw

Implant information
Implant position (FDI) 36
Manufacturer Neobiotech
Type Neobiotech IS III Active 5.0 x 11.5
Order number IS35011A
Length, mm 11.5
Diameter (Ø), mm 5
Color Green

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) 36

Manufacturer Neobiotech

Type Neobiotech IS III Active 5.0 x 11.5

Order number IS35011A

Length, mm 11.5

Diameter (Ø), mm 5

Color Green

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.