 |
|
Section 1 - Identification Information
Please complete the entire Identification Section including practice name, the name of the doctor who is ordering the case, address, contact numbers and email address. Note patient's first and last name and their placement/appointment date and time for aligner delivery. Please allow 7-10 working days from the day your case arrives at Specialty for fabrication of Clear Image Appliances.
Section 2 - Aligners Requested
Series 1 to 3 Aligners - for very minor anterior corrections such as minor orthodontic treatment relapse.
Series 4 to 5 Aligners - for more comprehensive anterior corrections which may include cuspids and first bicuspids.
Refinement or Continuation of Treatment Aligners - for additional tooth movement. If a second series of 1 to 5 aligners is required-new work models/impressions need to be submitted at the end of the first series.
Specialty uses proven aligner materials that exhibit optimal tooth moving properties while maintaining a clear appearance. We can also fabricate a final retainer type aligner from either .035 or .040mm material.
Section 3 - Interproximal Reduction (IPR)
Indicate the contacts and amounts of IPR required. IPR can be determined in the laboratory as the teeth are repositioned. The places and amounts are charted and sent back with the appliances.
Section 4 - Special Instructions
Use this section to indicate the patient's chief concern and both your expectations concerning-specific teeth, black triangles, rotations, etc. Also note if treatment goal includes positioning for future restorative/cosmetic enhancements. If referring to certain teeth please note tooth numbering system -Palmer or Universal.
|
|
|
|
|
More Information
Clear Image Aligner Rx Form
Download a Clear Image Aligner Rx Form.
Case Shipping Information
Need a rush case or a specific return date? Review "the date needed" section for details.
Retention Options
Specialty offers several retention options.
Types of Tooth Movement
Types of tooth movements that respond well to Specialty Clear Image Aligners ...examples and illustrations.
|
|
|
