Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)

Date

Dr. Prosthodontist
Address
City, State  Zip

Dear Dr. Prostho:

I have referred John Doe to you for comprehensive evaluation/consultation, and specifically restoration of upper left posterior area.  I am enclosing recent full mouth x-rays; panorex; chart notes from Dr. Oral Surgeon.  Study models from Dr. OtherProsthodontist will be sent soon.

Mr. Doe has been a patient of mine for approximately 10 years; his care has consisted of regular 6-month recalls, and basic restorative treatment.  His periodontal condition has been good; 6mm pocket on #11, and 5mm around 17 and 18.  In the recent years his restorative needs seem to have been maintenance/patching of existing bridgework.

He has a cantilever bridge #11-12, and is missing 13-16.  He has done fine without posterior support on the left side, but recently he developed a fractured root on #11, and is concerned with esthetics and loss of function.  He has extensive crown/bridgework; he has had two removable partial dentures made in the past, but has not been able to wear them.

I have taken impressions for a temporary upper stayplate, and he has an appointment with Dr. OralSurgeon to have #11 extracted and the stayplate inserted.  He has had consultations with Dr. OtherProsthodontist (his study models will be forwarded to you) and Dr. OralSurgeon (letter enclosed) about dental implants to restore the upper left quadrant. 

Would you please evaluate Mr. Doe, and give him your thoughts concerning:

• implants to restore upper left posterior;
• tuberosity reduction upper left;
• removable partial dentures to restore upper left, given past history with two unsuccessful partials;
• full mouth reconstruction;
• maintenance/patchwork of existing bridgework with possibility of eventual full dentures.
• time frame of any treatment (he winters in Florida at least 6 months/year).

Joe, please call me after you have checked Mr. Doe so we can discuss his case.

Sincerely,

Dr. ______