B-Align PRESCRIPTION
PATIENT Full name
Email:
Age :
Date: Chief complaint
4. DO NOT PLACE ATTACHMENTS ON THESE TEETH
5. ANTERIOR - POSTERIOR (A-P) RELATIONSHIP : Maintain Improve canine relationship only Improve canine & molar relationship up to 4 mm Correction to Class I (canine & molar) Distalisation (up to 2 mm, without elastics)
Central incisors Lateral incisors Note: Placement of Bite Ramps will take the place of the upper anterior Canines
Upper
Lower
11. CROWDING RESOLUTION
Procline: Primarily As needed None Expand: Primarily As needed None IPR Anterior: Primarily As needed None IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None Lower Procline: Primarily As needed None Expand: Primarily As needed None IPR Anterior: Primarily As needed None IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None 12. COMPLIANCE INDICATOR Yes (fee applies) No Free additional aligners within Treatment Expiration Date (1 for Express Package, 2 for Lite Package and unnlimited for Moderate and Comprehensive Packages). ADDITIONAL INSTRUCTION plz type english STL File 1plz insert STL Scan file Upload another Browse... حداکثر سایز 20 MB Jpeg filepiz insert jpeg file Upload another Browse... حداکثر سایز 10 MB This field should be left blank Send Please wait...
Expand: Primarily As needed None IPR Anterior: Primarily As needed None IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None Lower Procline: Primarily As needed None Expand: Primarily As needed None IPR Anterior: Primarily As needed None IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None 12. COMPLIANCE INDICATOR Yes (fee applies) No Free additional aligners within Treatment Expiration Date (1 for Express Package, 2 for Lite Package and unnlimited for Moderate and Comprehensive Packages). ADDITIONAL INSTRUCTION plz type english STL File 1plz insert STL Scan file Upload another Browse... حداکثر سایز 20 MB Jpeg filepiz insert jpeg file Upload another Browse... حداکثر سایز 10 MB This field should be left blank Send Please wait...
IPR Anterior: Primarily As needed None IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None Lower Procline: Primarily As needed None Expand: Primarily As needed None IPR Anterior: Primarily As needed None IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None 12. COMPLIANCE INDICATOR Yes (fee applies) No Free additional aligners within Treatment Expiration Date (1 for Express Package, 2 for Lite Package and unnlimited for Moderate and Comprehensive Packages). ADDITIONAL INSTRUCTION plz type english STL File 1plz insert STL Scan file Upload another Browse... حداکثر سایز 20 MB Jpeg filepiz insert jpeg file Upload another Browse... حداکثر سایز 10 MB This field should be left blank Send Please wait...
IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None Lower Procline: Primarily As needed None Expand: Primarily As needed None IPR Anterior: Primarily As needed None IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None 12. COMPLIANCE INDICATOR Yes (fee applies) No Free additional aligners within Treatment Expiration Date (1 for Express Package, 2 for Lite Package and unnlimited for Moderate and Comprehensive Packages). ADDITIONAL INSTRUCTION plz type english STL File 1plz insert STL Scan file Upload another Browse... حداکثر سایز 20 MB Jpeg filepiz insert jpeg file Upload another Browse... حداکثر سایز 10 MB This field should be left blank Send Please wait...
IPR Posterior Left: Primarily As needed None Lower Procline: Primarily As needed None Expand: Primarily As needed None IPR Anterior: Primarily As needed None IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None 12. COMPLIANCE INDICATOR Yes (fee applies) No Free additional aligners within Treatment Expiration Date (1 for Express Package, 2 for Lite Package and unnlimited for Moderate and Comprehensive Packages). ADDITIONAL INSTRUCTION plz type english STL File 1plz insert STL Scan file Upload another Browse... حداکثر سایز 20 MB Jpeg filepiz insert jpeg file Upload another Browse... حداکثر سایز 10 MB This field should be left blank Send Please wait...
Procline: Primarily As needed None Expand: Primarily As needed None IPR Anterior: Primarily As needed None IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None 12. COMPLIANCE INDICATOR Yes (fee applies) No Free additional aligners within Treatment Expiration Date (1 for Express Package, 2 for Lite Package and unnlimited for Moderate and Comprehensive Packages). ADDITIONAL INSTRUCTION plz type english STL File 1plz insert STL Scan file Upload another Browse... حداکثر سایز 20 MB Jpeg filepiz insert jpeg file Upload another Browse... حداکثر سایز 10 MB This field should be left blank Send Please wait...
Expand: Primarily As needed None IPR Anterior: Primarily As needed None IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None 12. COMPLIANCE INDICATOR Yes (fee applies) No Free additional aligners within Treatment Expiration Date (1 for Express Package, 2 for Lite Package and unnlimited for Moderate and Comprehensive Packages). ADDITIONAL INSTRUCTION plz type english STL File 1plz insert STL Scan file Upload another Browse... حداکثر سایز 20 MB Jpeg filepiz insert jpeg file Upload another Browse... حداکثر سایز 10 MB This field should be left blank Send Please wait...
IPR Anterior: Primarily As needed None IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None 12. COMPLIANCE INDICATOR Yes (fee applies) No Free additional aligners within Treatment Expiration Date (1 for Express Package, 2 for Lite Package and unnlimited for Moderate and Comprehensive Packages). ADDITIONAL INSTRUCTION plz type english STL File 1plz insert STL Scan file Upload another Browse... حداکثر سایز 20 MB Jpeg filepiz insert jpeg file Upload another Browse... حداکثر سایز 10 MB This field should be left blank Send Please wait...
IPR Posterior Right: Primarily As needed None IPR Posterior Left: Primarily As needed None 12. COMPLIANCE INDICATOR Yes (fee applies) No Free additional aligners within Treatment Expiration Date (1 for Express Package, 2 for Lite Package and unnlimited for Moderate and Comprehensive Packages). ADDITIONAL INSTRUCTION plz type english STL File 1plz insert STL Scan file Upload another Browse... حداکثر سایز 20 MB Jpeg filepiz insert jpeg file Upload another Browse... حداکثر سایز 10 MB This field should be left blank Send Please wait...
IPR Posterior Left: Primarily As needed None 12. COMPLIANCE INDICATOR Yes (fee applies) No Free additional aligners within Treatment Expiration Date (1 for Express Package, 2 for Lite Package and unnlimited for Moderate and Comprehensive Packages). ADDITIONAL INSTRUCTION
12. COMPLIANCE INDICATOR
Free additional aligners within Treatment Expiration Date (1 for Express Package, 2 for Lite Package and unnlimited for Moderate and Comprehensive Packages).
ADDITIONAL INSTRUCTION
حداکثر سایز 20 MB
حداکثر سایز 10 MB
