Patient information:

• Male
  Female

Patient anamnesis:

Case type:

Teeth impression type:

Analog

Digital (STL file)

Arch to treat:

Upper

Lower

Both

Tooth movements restrictions (bridges, ankylosed teeth, implants, etc.):

None (move all teeth)

Teeth...

Dental formula:

1.81.71.61.51.41.31.21.12.12.22.32.42.52.62.72.8

4.84.74.64.54.44.34.24.13.13.23.33.43.53.63.73.8

Patient anamnesis:

Clinical part:

Main complaint:

Crowding

Spacing

Class II div 1

Class II div 2

Class III

Open bite

Anterior crossbite

Posterior crossbite

Deep bite

Narrow arch

Flared teeth

Overjet

Uneven smile

Misshapen teeth

Other

Patient anamnesis:

Clinical part:

Parafunctions:

Bruxism

Infantile type of swallowing

Mouth breathing

Signs of leukoplakia (directly related to pathological occlusion)

Bad habits ( biting something, propping up with one hand, biting lips / cheeks)

TMJ dysfunction:

None

Yes

Deviation of the path of opening the mouth:

Yes

No

Injuries to the maxillofacial area in the past:

Yes

No

Doctor’s prescription:

Anterior-posterior (A-P) relationship:

Maintain current:

R

L

Improve canine relationship only:

R

L

Improve canine and molars relationship:

R

L

Correction to class I:

R

L

Using of elastics:

Yes

No

Using of IPR in the posterior area:

Yes

No

Overjet:

Maintain initial (Overjet may be with use of IPR)

Overjet should NOT be

Overjet should be

Doctor’s prescription:

Overbite:

Maintain initial overbite

Correct open biteUpper jaw

Intrusion of anterior teethExtrusion of posterior teeth

Lower jaw

Intrusion of anterior teethExtrusion of posterior teeth

Correct a deep biteUpper jaw

Intrusion of anterior teethExtrusion of posterior teeth

Lower jaw

Intrusion of anterior teethExtrusion of posterior teeth

Using the “Bite Stop” system to correct overbite?:

Yes

No

If needed

Doctor’s prescription:

Midline:

Correct if needed

Maintain initial midline (may require IPR)

Improve your midline with IPRUpper

to patient’s rightto patient’s left

Lower

to patient’s rightto patient’s left

Cross-bite (if present):

Do not correct

Correct

Doctor’s prescription:

Spacing (Tremes / Diastemas):
Close all spaces
Leave spaces
Crowding:
Resolve upper:
Expand:
Primarely
As needed
None
Procline:
Primarely
As needed
None
IPR – Anterior:
Primarely
As needed
None
IPR – Posterior right:
Primarely
As needed
None
IPR – Posterior left:
Primarely
As needed
None
Resolve lower:
Expand:
Primarely
As needed
None
Procline:
Primarely
As needed
None
IPR – Anterior:
Primarely
As needed
None
IPR – Posterior right:
Primarely
As needed
None
IPR – Posterior left:
Primarely
As needed
None

Doctor’s prescription:

Extractions (for orthodontic indications):

None

Extract...

Dental formula:

1.81.71.61.51.41.31.21.12.12.22.32.42.52.62.72.8

4.84.74.64.54.44.34.24.13.13.23.33.43.53.63.73.8

Doctor’s prescription:

Other instructions:

Upload STL files:

Upper
Lower
• Occlusion (optional):

Patient photos:

X-RAY images:

Summary:

• Patient information:

  First name:  
  Last name:  
  Phone number:  
  Gender:  
  Delivery address:  

  Patient anamnesis:

  Case type:
  Teeth impression type:  
  Arch to treat:  
  Tooth movements restrictions:  
  Dental formula:  
  Clinical part:
  Main complaint:  
  Other complaint:  
  Parafunctions:  
  Other parafunctions:  
  TMJ dysfunction:  
  Type TMJ dysfunction:  
  Deviation of the path of opening the mouth:  
  Injuries to the maxillofacial area in the past:  

  Doctor’s prescription:

  Anterior-posterior (A-P) relationship:
  Maintain current:  
  Improve canine relationship only:  
  Improve canine and molars relationship:  
  Correction to class I:  
  Using of elastics:  
  Using of IPR in the posterior area:  
  Overjet:  
  Overbite:  
  Upper jaw:  
  Lower jaw:  
  Using the “Bite Stop” system to correct overbite?:  
  Midline:  
  Upper:  
  Lower:  
  Cross-bite (if present):  
  Spacing (Tremes / Diastemas):  
  Leave spaces:  
  Crowding: Resolve upper:  
  Expand:  
  Procline:  
  IPR – Anterior:  
  IPR – Posterior right:  
  IPR – Posterior left:  
  Crowding: Resolve lower:  
  Expand:  
  Procline:  
  IPR – Anterior:  
  IPR – Posterior right:  
  IPR – Posterior left:  
  Extractions (for orthodontic indications):  
  Dental formula:  
  Other instructions: