In order to begin the process the first step is completion of the following IMR Intake Referral form by the referring dentist.
Once complete please scan and e-mail or fax along with your current x-rays.
After the completed form and current x-rays are reviewed by Dr. Mastrovich, our office will contact you with next steps.
Completed by Patient’s Dentist
Please read our “Protocol For Referral Acceptance” and understand full disclosure will be required of what treatment has already been attempted.
Our team makes every effort to maximize your benefit from your appointment with Dr. Mastrovich. Before we schedule IMR appointments, we gather (1) the most current x-ray of the broken situation (with focus and saturation quality to reveal the internal aspects of the implant), (2) the completed Intake/Referral form with the implant specifications and (3) very importantly, the details of every attempt to retrieve the broken pieces by other doctors (including the patient’s description of each of those attempts). These three areas of information are necessary for Dr. Mastrovich to evaluate the specific circumstances and decide whether those circumstances necessitate further research and/or design and machining of new customized high-precision tooling or are within the parameters of his existing custom high-precision tools.
Many patients ask whether they will need to be sedated, and therefore require a driver. The answer to that is, “no”, because the IMR procedure is a surprisingly comfortable procedure. We repeatedly hear from patients, “that was a relief, it was so much more comfortable than prior attempts”. Because our bodies are amazing and can quite quickly grow tissue over the implant when a restoration has been displaced, the most that Dr. Mastrovich will need to do is administer a tiny amount of anesthetic, similar to that used for a tiny ‘filling’, to be sure of comfort when he removes any tissue that has encroached over the opening of the implant.
At your appointment, you will be able to see everything Dr. Mastrovich is viewing inside the implant with the 25 power microscope, as it will be on the big screen on the wall of the treatment room. There is nothing disturbing in the view, as it is the inside of the implant, so the patient is viewing the metal as Dr. Mastrovich answers the two most common patient questions: (1) “How /why did this happen?”, and (2) “No offense, Dr. Mastrovich, but what needs to be done so I don’t have to return for the same thing in the future?”. The good news is that Dr. Mastrovich is a teacher at heart and enjoys training other dentists on this information, as well as helping patients understand their situation and so they can make decisions from the basis of factual information.
Thank you for referring your patient to Dr. Mastrovich for his Specialty Implant services. Click the button below to download the Intake form for completion and emailing back. Any insights you can give us in the last section would be greatly appreciated, as Dr. Mastrovich finds it important to know the details of prior attempts at retrieval. As soon as we have this referral/intake, along with a current x-ray, we will be able to review with Dr. Mastrovich whether any additional information is required before calling your patient to schedule.
Important Protocols to Note:
Understand there is a waiting list of patients needing to be scheduled for appointments. Patience will be a virtue and flexibility with your personal schedule will be key.
Before a patient is actually referred, and before we proceed into retrieval, the referring doctor and Dr. Mastrovich have to understand what happened and whether retrieval is the best option. Full disclosure of what treatment has already been attempted on the case is needed in order to fully evaluate and plan for success.
Dr. Mastrovich frequently finds it necessary to mechanically engineer and fabricate customized tooling to safely retrieve broken parts. This takes time.
Fees for this service are billed at time and materials, due by credit card at the time of the appointment.
IMR Intake Form and radiographs need to be in our office in advance of the patient being placed on the waiting list for an appointment, in order to allow Dr. Mastrovich the time he needs to optimize the potential for success.
Referring doctors and their patients need to read Dr. Mastrovich’s protocols /view his lectures here on his website to better understand the scope and nature of the referral.
Responsible party for payment of fees will be established before treatment can be scheduled.
Completed by Patient’s Dentist