Initial Periodontal
Data Base and Recommendations

Organize essential perio tissue
documentation and treatment planning

Use this form to document existing conditions, pathology, and treatment recommendations for periodontal case planning. Use the columns for notations to make data collection and planning quick and accurate. A "little story" can be documented for each and every tooth or tooth area. Electively the tooth diagrams can be used for tissue or bone height. Use the C-103R Comprehensive Periodontal Examination form (C103R) for complete periodontal charting. This form becomes the blue print for your periodontal treatment plan.


  • Present and missing teeth

  • Pathology and recommended treatment

  • Notations in columns

  • Priority of treatment

C-303R Initial Periodontal Data Base and Recommendations
  $18.00 / 200        $34.00 / 400
$64.00 / 800        $120.00 / 1600



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