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NP O
RGUS
Pos
tage
PA
ID
Chap
el H
ill, N
CPe
rmit
# 17
7C
ontin
uing
Den
tal E
duca
tion
Cam
pus
Box
745
0C
hape
l Hill
275
99-7
450
www.den
tistry.un
c.ed
u/cd
e/co
urse
sA
dvan
cing
Kno
wle
dge
in D
entis
try
Registration Form **Please make additional copies for each person registering
I am registering for the following activities (please mark all that you are registering for):
Sept. 23, 2016 3D Imaging: The Path to the Future of Dentistry (17DS003)
Nov. 11, 2016 Advanced Cone Beam CT Interpretation (17DS004)
Jan. 20, 2017 Advanced Cone Beam CT Interpretation (17DS005)
Dentist Specialty ________________________________________________________
Team Member: RDH DAII DAI Other ________________________________
Email _______________________________@ ___________________________________All registrants must provide a unique e-mail address ([email protected]) in order to access credit history and be entered into our database. Generic office email addresses that are shared by many individuals ([email protected]) cannot be used.
First Name _____________________ MI ____ Last Name _______________________ Jr. / Sr.
Preferred Name _____________________________________________________________
Male Female Self-identify ______________________________________________
I am an alumnus/alumna of UNC School of Dentistry: DDS RDH DA Post Doc
Employer __________________________________________________________________
Mailing Address _____________________________________________________________
City _____________________ State _______ Zip _________________________________
County in NC _______________________________________________________________
Daytime Phone (_____) _____________________ Fax (______) _____________________
Emergency Contact ________________ Phone Number ______________________________
Please make checks payable to the UNC School of Dentistry.
Register On-line with a Credit Card at www.dentistry.unc.edu/cde/courses
Date Received (office use only) __________________________________________________
I have special dietary needs, please explain: _____________________________________ I have special needs. Please contact me.
ADA STATEMENT
The University of North Carolina at Chapel Hill is committed to equality of educational opportunity and does not discriminate against applicants, students, or employees on the basis of race, color, religion, sex, national origin, age, disability, veteran’s status, or sexual orientation. If you require reasonable accommodations for a disability in order to participate fully in this continuing education activity, please call 919-537-3400 or attach a note to your registration form.
By providing my information, I consent to receive communication via mail, email, fax, and phone from the University of North Carolina Continuing Dental Education office. The Continuing Dental Education office will not share your information with anyone.
The UNC School of Dentistry is an ADA CERP Recognized Provider.
This continuing education program is presented by the University of North Carolina at Chapel Hill School of Dentistry and the Department of Diagnostic Sciences. The UNC Continuing Dental Education program is an ADA CERP Recognized Provider. UNC CDEs term of recognition is May 1, 2015 through June 30, 2019. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/cerp.
Conflict of InterestIn accordance with the ADA CERP Standard V., everyone involved in planning or presenting this educational activity will be required to disclose any relevant financial relationships with commercial interests and this information will be made available to participants at the start of the activity.
As a continuing education provider, UNC School of Dentistry is responsible for ensuring the content, quality and scientific integrity of all continuing dental education activities for which credit is provided. The School is also responsible for taking steps to protect against and/or disclose any conflict of interest of the faculty/instructors presenting those courses.
Dental education institutions have an obligation to disseminate new knowledge related to dental practice. In so doing, some presentations may include controversial materials or commercial references. Sponsorship of a continuing education course by the University of North Carolina does not necessarily imply endorsement of a particular philosophy, procedure, or product by this institution.
The University of North Carolina School of Dentistry cautions continuing dental education participants that there are potential risks of using limited knowledge when incorporating new techniques and procedures into the practice of dentistry, especially when the continuing education course has not provided supervised clinical experience and/or competency tests in the techniques or procedures. &
3D
Im
agin
g:T
he
Pat
h t
o th
e F
utu
re o
f D
enti
stry
Ad
van
ced
Con
e B
eam
CT
In
terp
reta
tion
3D Imaging:
The Pathto the Future of Dentistry
& Sponsored by
the University of North CarolinaDepartment of Diagnostic Sciences
AdvancedCone Beam CT Interpretation
LOCATION:
UNC SCHOOL OF DENTISTRY
March
3, 2
017
Radiolo
gy Inter
pretation
Prin
ciples
for the
Dental
Hygien
ist
Activity Description3D imaging with cone beam computed tomography (CBCT) and other 3D modalities is the path to the future of dentistry for major improvements in radiographic diagnosis, treatment planning and digital dentistry. Ample research has shown that 2D imaging has reached the end of the road in terms of potential for improvements. CBCT technology has provided a low dose and relatively low cost means of providing 3D imaging of the maxillofacial region for dentistry and has the potential to become an essential component of a modern dental practice. This introductory course is designed to familiarize each participant with the fundamentals of cone beam computed tomography technology and its many applications to dentistry. Course faculty will present an overview of the CBCT anatomy of the maxillofacial region and overview clinical applications in implantology, endodontics, surgery, orthodontics, periodontology, and pathology with numerous case examples. A demonstration on use of the software for interpretation and integration with digital dentistry will be followed by a discussion on the role of an oral and maxillofacial radiologist as a partner in the future of dental practice.
Educational ObjectivesAt the completion of this activity, participants should be able to:
• Explain the basic technology of cone beam CT imaging and associated radiation risks• Compare and contrast the various attributes of CBCT units in the market place • Ask the right questions when considering a CBCT unit for private practice• Recognize and describe the anatomy of the maxillofacial region as presented in CBCT
images and correlate specific structures with their appearance in panoramic radiographs• Demonstrate how to use the software to construct images of the maxillofacial region to
use CBCT volumes for advances in digital dentistry• Discuss the many applications of CBCT to dentistry• Recognize the radiographic signs of abnormalities and disease in CBCT images of the
maxillofacial region• Appreciate the role of an oral and maxillofacial radiologist in the practice of modern dentistry
Activity DirectorDonald A. Tyndall, DDS, MSPH, PhD - Professor and Director of Radiology, Department of Diagnostic Sciences
FacultyAngela Broome, DDS - Clinical Associate Professor, Department of Diagnostic Sciences
Heidi Kohltfarbfer, DDS, MS - Assistant Professor, Loma Linda University and Visiting Scholar at UNC School of Dentistry
Andre Mol, DDS, MS, PhD - Clinical Associate Professor and Director of Radiology Graduate Program, Department of Diagnostic Sciences
Enrique Platin, RTR, MS, EdD - Clinical Professor, Department of Diagnostic Sciences
Agenda - September 23, 2016
8:30 – 9:00 am Registration & Continental Breakfast
9:00 – 9:45 am Cone Beam Computed Tomography Basics
9:45 – 10:30 am Overview of CBCT Systems
10:30 – 10:45 am Morning Break
10:45 – 11:45 am CBCT Anatomy and use of CBCT software
11:45 – 12:30 pm Clinical Applications of CBCT
12:30 – 1:15 pm Lunch
1:15 – 2:45 pm CBCT Interpretation: Radiographic Signs
2:45 – 3:00 pm Afternoon Break
3:00 – 3:45 pm Case Demonstrations
3:45 – 4:30 pm Incidental findings
4:30 pm Adjourn
The UNC School of Dentistry designates this activity for up to 6.25 hours of continuing education credits.
Registration and FeesThe registration fee is $425 for Dentists and $225 for Team Members and includes course materials, CE credit and all meals listed in the agenda. All registrations must be received by September 16, 2016.UNC CDE recommends that you do not make air travel arrangements prior to receiving a receipt of payment or confirmation. UNC CDE is not responsible for any travel-related costs.
Cancellations and Refunds A registration refund, less a $50 fee, will be issued for cancellations received by September 16, 2016. Cancellations must be received in writing either by fax 919-537-3098 or email to [email protected]. The cancellation request must include: the name of the activity, name of the person registered, name of the person requesting the cancellation, and the reason for the cancellation. No refunds will be issued after September 16, 2016. The UNC School of Dentistry Continuing Dental Education Program cannot be responsible for the refund of any part of the registration fee as a result of emergencies, unforeseen circumstances, or events beyond its control after the cancellation date.The University reserves the right to cancel or postpone any course due to unforeseen circumstances. In the event of cancellation or postponement, the University will fully refund registration fees but is not responsible for any related costs or expenses to participants, including cancellation fees assessed by hotels, airlines, rental car or travel agencies.Special dietary requirements will be honored whenever possible. Please be sure to notify our office in writing of your special need no later than September 16, 2016.
Course is limited to only 25 participants. REGISTER TODAY TO SECURE YOUR SPOT!
Two opportunities to participate:Friday, November 11, 2016
Dentists: $750 on or before Oct. 14, 2016 $850 after Oct. 14, 2016
Friday, January 20, 2017Dentists: $750 on or before Dec. 14, 2016 $850 after Dec. 14, 2016
Activity DescriptionWith the adoption of cone beam CT imaging the productivity and efficiency of a dental practice increases along with career satisfaction. However with such technology the dental practitioner is required to manage significantly more anatomical information than with 2D imaging. A more comprehensive understanding of interpreting CBCT anatomy and pathoses will be a significant aid in the clinician’s ability to review a CBCT volume for significant findings. This advanced course is case based and designed to prepare the dental practitioner to systematically review a CBCT volume, recognize and categorize signs of abnormalities and how to manage the resultant findings and partner with an oral and maxillofacial radiologist. Learning will be accomplished through a computer lab based approach using CBCT cases from the UNC oral and maxillofacial radiology teaching files. Legal and ethical considerations will be covered as well as the role of the oral and maxillofacial radiologist in providing an advanced CBCT reading service to aid the clinician for those cases where abnormalities are recognized but not completely understood. This course requires moderate proficiency in computer use. Experience using proprietary software packages is also advantageous for the practitioner.
Educational ObjectivesAt the completion of this activity, participants should be able to:• Develop a working knowledge of the
maxilla and mandible and associated structures
• Systematically review a CBCT volume and recognize signs of pathological changes or abnormalities
• Categorize CBCT findings into disease categories
• Develop ways to partner with an oral and maxillofacial radiologist for radiology reporting and case management
Activity DirectorDonald A. Tyndall, DDS, MSPH, PhD - Professor and Director of Radiology, Department of Diagnostic Sciences
FacultyAngela Broome, DDS - Clinical Associate Professor, Department of Diagnostic SciencesHeidi Kohltfarbfer, DDS, MS - Assistant Professor, Loma Linda University and Visiting Scholar at UNC School of Dentistry
Agenda - November 11, 2016 & January 20, 2017
7:30 – 8:00 am Registration and Continental Breakfast
8:00 – 8:15 am Course Introduction
8:15 – 10:00 am Overview of CBCT principles, Viewing Software and 3D Anatomy review
10:00 – 10:15 am Morning Break
10:15 – 12:00 pm Case based studies: congenital, trauma, inflammation
12:00 – 12:45 pm Lunch
12:45 – 2:30 pm Case based studies: Benign tumors and cysts, malignant lesions
2:30 – 2:45 pm Afternoon Break
2:45 – 3:30 pm Case based studies: Fibro-osseous lesions, lesions of bone, systemic disease
3:30 – 5:00 pm Unknowns and Incidental findings
The UNC School of Dentistry designates this activity for up to 7.75 hours of continuing education credits.
Registration and FeesThe registration fee includes course materials, CE credit and all meals listed in the agenda. All registrations must be received by November 4, 2016 for the November 11th activity and by January 13, 2017 for the January 20th activity.
Cancellations and Refunds A registration refund, less a $50 fee, will be issued for cancellations received by November 4, 2016/January 13, 2017. Cancellations must be received in writing either by fax 919-537-3098 or email to [email protected]. The cancellation request must include: the name of the activity, name of the person registered, name of the person requesting the cancellation, and the reason for the cancellation. No refunds will be issued after the dates listed above. The UNC School of Dentistry Continuing Dental Education Program cannot be responsible for the refund of any part of the registration fee as a result of emergencies, unforeseen circumstances, or events beyond its control after the cancellation date.
3D Imaging: The Path to the Future of Dentistry Advanced Cone Beam CT Interpretation
Activity Description3D imaging with cone beam computed tomography (CBCT) and other 3D modalities is the path to the future of dentistry for major improvements in radiographic diagnosis, treatment planning and digital dentistry. Ample research has shown that 2D imaging has reached the end of the road in terms of potential for improvements. CBCT technology has provided a low dose and relatively low cost means of providing 3D imaging of the maxillofacial region for dentistry and has the potential to become an essential component of a modern dental practice. This introductory course is designed to familiarize each participant with the fundamentals of cone beam computed tomography technology and its many applications to dentistry. Course faculty will present an overview of the CBCT anatomy of the maxillofacial region and overview clinical applications in implantology, endodontics, surgery, orthodontics, periodontology, and pathology with numerous case examples. A demonstration on use of the software for interpretation and integration with digital dentistry will be followed by a discussion on the role of an oral and maxillofacial radiologist as a partner in the future of dental practice.
Educational ObjectivesAt the completion of this activity, participants should be able to:
• Explain the basic technology of cone beam CT imaging and associated radiation risks• Compare and contrast the various attributes of CBCT units in the market place • Ask the right questions when considering a CBCT unit for private practice• Recognize and describe the anatomy of the maxillofacial region as presented in CBCT
images and correlate specific structures with their appearance in panoramic radiographs• Demonstrate how to use the software to construct images of the maxillofacial region to
use CBCT volumes for advances in digital dentistry• Discuss the many applications of CBCT to dentistry• Recognize the radiographic signs of abnormalities and disease in CBCT images of the
maxillofacial region• Appreciate the role of an oral and maxillofacial radiologist in the practice of modern dentistry
Activity DirectorDonald A. Tyndall, DDS, MSPH, PhD - Professor and Director of Radiology, Department of Diagnostic Sciences
FacultyAngela Broome, DDS - Clinical Associate Professor, Department of Diagnostic Sciences
Heidi Kohltfarbfer, DDS, MS - Assistant Professor, Loma Linda University and Visiting Scholar at UNC School of Dentistry
Andre Mol, DDS, MS, PhD - Clinical Associate Professor and Director of Radiology Graduate Program, Department of Diagnostic Sciences
Enrique Platin, RTR, MS, EdD - Clinical Professor, Department of Diagnostic Sciences
Agenda - September 23, 2016
8:30 – 9:00 am Registration & Continental Breakfast
9:00 – 9:45 am Cone Beam Computed Tomography Basics
9:45 – 10:30 am Overview of CBCT Systems
10:30 – 10:45 am Morning Break
10:45 – 11:45 am CBCT Anatomy and use of CBCT software
11:45 – 12:30 pm Clinical Applications of CBCT
12:30 – 1:15 pm Lunch
1:15 – 2:45 pm CBCT Interpretation: Radiographic Signs
2:45 – 3:00 pm Afternoon Break
3:00 – 3:45 pm Case Demonstrations
3:45 – 4:30 pm Incidental findings
4:30 pm Adjourn
The UNC School of Dentistry designates this activity for up to 6.25 hours of continuing education credits.
Registration and FeesThe registration fee is $425 for Dentists and $225 for Team Members and includes course materials, CE credit and all meals listed in the agenda. All registrations must be received by September 16, 2016.UNC CDE recommends that you do not make air travel arrangements prior to receiving a receipt of payment or confirmation. UNC CDE is not responsible for any travel-related costs.
Cancellations and Refunds A registration refund, less a $50 fee, will be issued for cancellations received by September 16, 2016. Cancellations must be received in writing either by fax 919-537-3098 or email to [email protected]. The cancellation request must include: the name of the activity, name of the person registered, name of the person requesting the cancellation, and the reason for the cancellation. No refunds will be issued after September 16, 2016. The UNC School of Dentistry Continuing Dental Education Program cannot be responsible for the refund of any part of the registration fee as a result of emergencies, unforeseen circumstances, or events beyond its control after the cancellation date.The University reserves the right to cancel or postpone any course due to unforeseen circumstances. In the event of cancellation or postponement, the University will fully refund registration fees but is not responsible for any related costs or expenses to participants, including cancellation fees assessed by hotels, airlines, rental car or travel agencies.Special dietary requirements will be honored whenever possible. Please be sure to notify our office in writing of your special need no later than September 16, 2016.
Course is limited to only 25 participants. REGISTER TODAY TO SECURE YOUR SPOT!
Two opportunities to participate:Friday, November 11, 2016
Dentists: $750 on or before Oct. 14, 2016 $850 after Oct. 14, 2016
Friday, January 20, 2017Dentists: $750 on or before Dec. 14, 2016 $850 after Dec. 14, 2016
Activity DescriptionWith the adoption of cone beam CT imaging the productivity and efficiency of a dental practice increases along with career satisfaction. However with such technology the dental practitioner is required to manage significantly more anatomical information than with 2D imaging. A more comprehensive understanding of interpreting CBCT anatomy and pathoses will be a significant aid in the clinician’s ability to review a CBCT volume for significant findings. This advanced course is case based and designed to prepare the dental practitioner to systematically review a CBCT volume, recognize and categorize signs of abnormalities and how to manage the resultant findings and partner with an oral and maxillofacial radiologist. Learning will be accomplished through a computer lab based approach using CBCT cases from the UNC oral and maxillofacial radiology teaching files. Legal and ethical considerations will be covered as well as the role of the oral and maxillofacial radiologist in providing an advanced CBCT reading service to aid the clinician for those cases where abnormalities are recognized but not completely understood. This course requires moderate proficiency in computer use. Experience using proprietary software packages is also advantageous for the practitioner.
Educational ObjectivesAt the completion of this activity, participants should be able to:• Develop a working knowledge of the
maxilla and mandible and associated structures
• Systematically review a CBCT volume and recognize signs of pathological changes or abnormalities
• Categorize CBCT findings into disease categories
• Develop ways to partner with an oral and maxillofacial radiologist for radiology reporting and case management
Activity DirectorDonald A. Tyndall, DDS, MSPH, PhD - Professor and Director of Radiology, Department of Diagnostic Sciences
FacultyAngela Broome, DDS - Clinical Associate Professor, Department of Diagnostic SciencesHeidi Kohltfarbfer, DDS, MS - Assistant Professor, Loma Linda University and Visiting Scholar at UNC School of Dentistry
Agenda - November 11, 2016 & January 20, 2017
7:30 – 8:00 am Registration and Continental Breakfast
8:00 – 8:15 am Course Introduction
8:15 – 10:00 am Overview of CBCT principles, Viewing Software and 3D Anatomy review
10:00 – 10:15 am Morning Break
10:15 – 12:00 pm Case based studies: congenital, trauma, inflammation
12:00 – 12:45 pm Lunch
12:45 – 2:30 pm Case based studies: Benign tumors and cysts, malignant lesions
2:30 – 2:45 pm Afternoon Break
2:45 – 3:30 pm Case based studies: Fibro-osseous lesions, lesions of bone, systemic disease
3:30 – 5:00 pm Unknowns and Incidental findings
The UNC School of Dentistry designates this activity for up to 7.75 hours of continuing education credits.
Registration and FeesThe registration fee includes course materials, CE credit and all meals listed in the agenda. All registrations must be received by November 4, 2016 for the November 11th activity and by January 13, 2017 for the January 20th activity.
Cancellations and Refunds A registration refund, less a $50 fee, will be issued for cancellations received by November 4, 2016/January 13, 2017. Cancellations must be received in writing either by fax 919-537-3098 or email to [email protected]. The cancellation request must include: the name of the activity, name of the person registered, name of the person requesting the cancellation, and the reason for the cancellation. No refunds will be issued after the dates listed above. The UNC School of Dentistry Continuing Dental Education Program cannot be responsible for the refund of any part of the registration fee as a result of emergencies, unforeseen circumstances, or events beyond its control after the cancellation date.
3D Imaging: The Path to the Future of Dentistry Advanced Cone Beam CT Interpretation
NP O
RGUS
Pos
tage
PA
ID
Chap
el H
ill, N
CPe
rmit
# 17
7C
ontin
uing
Den
tal E
duca
tion
Cam
pus
Box
745
0C
hape
l Hill
275
99-7
450
www.den
tistry.un
c.ed
u/cd
e/co
urse
sA
dvan
cing
Kno
wle
dge
in D
entis
try
Registration Form **Please make additional copies for each person registering
I am registering for the following activities (please mark all that you are registering for):
Sept. 23, 2016 3D Imaging: The Path to the Future of Dentistry (17DS003)
Nov. 11, 2016 Advanced Cone Beam CT Interpretation (17DS004)
Jan. 20, 2017 Advanced Cone Beam CT Interpretation (17DS005)
Dentist Specialty ________________________________________________________
Team Member: RDH DAII DAI Other ________________________________
Email _______________________________@ ___________________________________All registrants must provide a unique e-mail address ([email protected]) in order to access credit history and be entered into our database. Generic office email addresses that are shared by many individuals ([email protected]) cannot be used.
First Name _____________________ MI ____ Last Name _______________________ Jr. / Sr.
Preferred Name _____________________________________________________________
Male Female Self-identify ______________________________________________
I am an alumnus/alumna of UNC School of Dentistry: DDS RDH DA Post Doc
Employer __________________________________________________________________
Mailing Address _____________________________________________________________
City _____________________ State _______ Zip _________________________________
County in NC _______________________________________________________________
Daytime Phone (_____) _____________________ Fax (______) _____________________
Emergency Contact ________________ Phone Number ______________________________
Please make checks payable to the UNC School of Dentistry.
Register On-line with a Credit Card at www.dentistry.unc.edu/cde/courses
Date Received (office use only) __________________________________________________
I have special dietary needs, please explain: _____________________________________ I have special needs. Please contact me.
ADA STATEMENT
The University of North Carolina at Chapel Hill is committed to equality of educational opportunity and does not discriminate against applicants, students, or employees on the basis of race, color, religion, sex, national origin, age, disability, veteran’s status, or sexual orientation. If you require reasonable accommodations for a disability in order to participate fully in this continuing education activity, please call 919-537-3400 or attach a note to your registration form.
By providing my information, I consent to receive communication via mail, email, fax, and phone from the University of North Carolina Continuing Dental Education office. The Continuing Dental Education office will not share your information with anyone.
The UNC School of Dentistry is an ADA CERP Recognized Provider.
This continuing education program is presented by the University of North Carolina at Chapel Hill School of Dentistry and the Department of Diagnostic Sciences. The UNC Continuing Dental Education program is an ADA CERP Recognized Provider. UNC CDEs term of recognition is May 1, 2015 through June 30, 2019. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/cerp.
Conflict of InterestIn accordance with the ADA CERP Standard V., everyone involved in planning or presenting this educational activity will be required to disclose any relevant financial relationships with commercial interests and this information will be made available to participants at the start of the activity.
As a continuing education provider, UNC School of Dentistry is responsible for ensuring the content, quality and scientific integrity of all continuing dental education activities for which credit is provided. The School is also responsible for taking steps to protect against and/or disclose any conflict of interest of the faculty/instructors presenting those courses.
Dental education institutions have an obligation to disseminate new knowledge related to dental practice. In so doing, some presentations may include controversial materials or commercial references. Sponsorship of a continuing education course by the University of North Carolina does not necessarily imply endorsement of a particular philosophy, procedure, or product by this institution.
The University of North Carolina School of Dentistry cautions continuing dental education participants that there are potential risks of using limited knowledge when incorporating new techniques and procedures into the practice of dentistry, especially when the continuing education course has not provided supervised clinical experience and/or competency tests in the techniques or procedures. &
3D
Im
agin
g:T
he
Pat
h t
o th
e F
utu
re o
f D
enti
stry
Ad
van
ced
Con
e B
eam
CT
In
terp
reta
tion
3D Imaging:
The Pathto the Future of Dentistry
& Sponsored by
the University of North CarolinaDepartment of Diagnostic Sciences
AdvancedCone Beam CT Interpretation
LOCATION:
UNC SCHOOL OF DENTISTRY
March
3, 2
017
Radiolo
gy Inter
pretation
Prin
ciples
for the
Dental
Hygien
ist
NP O
RGUS
Pos
tage
PA
ID
Chap
el H
ill, N
CPe
rmit
# 17
7C
ontin
uing
Den
tal E
duca
tion
Cam
pus
Box
745
0C
hape
l Hill
275
99-7
450
www.den
tistry.un
c.ed
u/cd
e/co
urse
sA
dvan
cing
Kno
wle
dge
in D
entis
try
Registration Form **Please make additional copies for each person registering
I am registering for the following activities (please mark all that you are registering for):
Sept. 23, 2016 3D Imaging: The Path to the Future of Dentistry (17DS003)
Nov. 11, 2016 Advanced Cone Beam CT Interpretation (17DS004)
Jan. 20, 2017 Advanced Cone Beam CT Interpretation (17DS005)
Dentist Specialty ________________________________________________________
Team Member: RDH DAII DAI Other ________________________________
Email _______________________________@ ___________________________________All registrants must provide a unique e-mail address ([email protected]) in order to access credit history and be entered into our database. Generic office email addresses that are shared by many individuals ([email protected]) cannot be used.
First Name _____________________ MI ____ Last Name _______________________ Jr. / Sr.
Preferred Name _____________________________________________________________
Male Female Self-identify ______________________________________________
I am an alumnus/alumna of UNC School of Dentistry: DDS RDH DA Post Doc
Employer __________________________________________________________________
Mailing Address _____________________________________________________________
City _____________________ State _______ Zip _________________________________
County in NC _______________________________________________________________
Daytime Phone (_____) _____________________ Fax (______) _____________________
Emergency Contact ________________ Phone Number ______________________________
Please make checks payable to the UNC School of Dentistry.
Register On-line with a Credit Card at www.dentistry.unc.edu/cde/courses
Date Received (office use only) __________________________________________________
I have special dietary needs, please explain: _____________________________________ I have special needs. Please contact me.
ADA STATEMENT
The University of North Carolina at Chapel Hill is committed to equality of educational opportunity and does not discriminate against applicants, students, or employees on the basis of race, color, religion, sex, national origin, age, disability, veteran’s status, or sexual orientation. If you require reasonable accommodations for a disability in order to participate fully in this continuing education activity, please call 919-537-3400 or attach a note to your registration form.
By providing my information, I consent to receive communication via mail, email, fax, and phone from the University of North Carolina Continuing Dental Education office. The Continuing Dental Education office will not share your information with anyone.
The UNC School of Dentistry is an ADA CERP Recognized Provider.
This continuing education program is presented by the University of North Carolina at Chapel Hill School of Dentistry and the Department of Diagnostic Sciences. The UNC Continuing Dental Education program is an ADA CERP Recognized Provider. UNC CDEs term of recognition is May 1, 2015 through June 30, 2019. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/cerp.
Conflict of InterestIn accordance with the ADA CERP Standard V., everyone involved in planning or presenting this educational activity will be required to disclose any relevant financial relationships with commercial interests and this information will be made available to participants at the start of the activity.
As a continuing education provider, UNC School of Dentistry is responsible for ensuring the content, quality and scientific integrity of all continuing dental education activities for which credit is provided. The School is also responsible for taking steps to protect against and/or disclose any conflict of interest of the faculty/instructors presenting those courses.
Dental education institutions have an obligation to disseminate new knowledge related to dental practice. In so doing, some presentations may include controversial materials or commercial references. Sponsorship of a continuing education course by the University of North Carolina does not necessarily imply endorsement of a particular philosophy, procedure, or product by this institution.
The University of North Carolina School of Dentistry cautions continuing dental education participants that there are potential risks of using limited knowledge when incorporating new techniques and procedures into the practice of dentistry, especially when the continuing education course has not provided supervised clinical experience and/or competency tests in the techniques or procedures. &
3D
Im
agin
g:T
he
Pat
h t
o th
e F
utu
re o
f D
enti
stry
Ad
van
ced
Con
e B
eam
CT
In
terp
reta
tion
3D Imaging:
The Pathto the Future of Dentistry
& Sponsored by
the University of North CarolinaDepartment of Diagnostic Sciences
AdvancedCone Beam CT Interpretation
LOCATION:
UNC SCHOOL OF DENTISTRY
March
3, 2
017
Radiolo
gy Inter
pretation
Prin
ciples
for the
Dental
Hygien
ist
NP O
RGUS
Pos
tage
PA
ID
Chap
el H
ill, N
CPe
rmit
# 17
7C
ontin
uing
Den
tal E
duca
tion
Cam
pus
Box
745
0C
hape
l Hill
275
99-7
450
www.den
tistry.un
c.ed
u/cd
e/co
urse
sA
dvan
cing
Kno
wle
dge
in D
entis
try
Registration Form **Please make additional copies for each person registering
I am registering for the following activities (please mark all that you are registering for):
Sept. 23, 2016 3D Imaging: The Path to the Future of Dentistry (17DS003)
Nov. 11, 2016 Advanced Cone Beam CT Interpretation (17DS004)
Jan. 20, 2017 Advanced Cone Beam CT Interpretation (17DS005)
Dentist Specialty ________________________________________________________
Team Member: RDH DAII DAI Other ________________________________
Email _______________________________@ ___________________________________All registrants must provide a unique e-mail address ([email protected]) in order to access credit history and be entered into our database. Generic office email addresses that are shared by many individuals ([email protected]) cannot be used.
First Name _____________________ MI ____ Last Name _______________________ Jr. / Sr.
Preferred Name _____________________________________________________________
Male Female Self-identify ______________________________________________
I am an alumnus/alumna of UNC School of Dentistry: DDS RDH DA Post Doc
Employer __________________________________________________________________
Mailing Address _____________________________________________________________
City _____________________ State _______ Zip _________________________________
County in NC _______________________________________________________________
Daytime Phone (_____) _____________________ Fax (______) _____________________
Emergency Contact ________________ Phone Number ______________________________
Please make checks payable to the UNC School of Dentistry.
Register On-line with a Credit Card at www.dentistry.unc.edu/cde/courses
Date Received (office use only) __________________________________________________
I have special dietary needs, please explain: _____________________________________ I have special needs. Please contact me.
ADA STATEMENT
The University of North Carolina at Chapel Hill is committed to equality of educational opportunity and does not discriminate against applicants, students, or employees on the basis of race, color, religion, sex, national origin, age, disability, veteran’s status, or sexual orientation. If you require reasonable accommodations for a disability in order to participate fully in this continuing education activity, please call 919-537-3400 or attach a note to your registration form.
By providing my information, I consent to receive communication via mail, email, fax, and phone from the University of North Carolina Continuing Dental Education office. The Continuing Dental Education office will not share your information with anyone.
The UNC School of Dentistry is an ADA CERP Recognized Provider.
This continuing education program is presented by the University of North Carolina at Chapel Hill School of Dentistry and the Department of Diagnostic Sciences. The UNC Continuing Dental Education program is an ADA CERP Recognized Provider. UNC CDEs term of recognition is May 1, 2015 through June 30, 2019. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/cerp.
Conflict of InterestIn accordance with the ADA CERP Standard V., everyone involved in planning or presenting this educational activity will be required to disclose any relevant financial relationships with commercial interests and this information will be made available to participants at the start of the activity.
As a continuing education provider, UNC School of Dentistry is responsible for ensuring the content, quality and scientific integrity of all continuing dental education activities for which credit is provided. The School is also responsible for taking steps to protect against and/or disclose any conflict of interest of the faculty/instructors presenting those courses.
Dental education institutions have an obligation to disseminate new knowledge related to dental practice. In so doing, some presentations may include controversial materials or commercial references. Sponsorship of a continuing education course by the University of North Carolina does not necessarily imply endorsement of a particular philosophy, procedure, or product by this institution.
The University of North Carolina School of Dentistry cautions continuing dental education participants that there are potential risks of using limited knowledge when incorporating new techniques and procedures into the practice of dentistry, especially when the continuing education course has not provided supervised clinical experience and/or competency tests in the techniques or procedures. &
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3D Imaging:
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the University of North CarolinaDepartment of Diagnostic Sciences
AdvancedCone Beam CT Interpretation
LOCATION:
UNC SCHOOL OF DENTISTRY
March
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