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Invisalign Start Form
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了解详情
* 表示必填
电子邮件地址
*
您的电子邮件
Patient Name
*
您的回答
Date Scanned
年
/
月
/
日
Clinical Conditions
*
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
其他:
必填
General Notes
您的回答
Patient Type
*
选择
Adult
Teen
Child
Product Type
Invisalign Clear Aligners
Invisalign Assist Clear Aligners
Vivera Retainers
Invisalign FIRST Clear Aligners (For Child)
Treatment Options
Comprehensive
Lite
Express 10
Express (7)
Express 5
Unlimited Stages
1. Arches to Treat
BOTH
UPPER
LOWER
Nothing on Opposite Arch
Diagnostic Model Opposite Arch
Passive Aligners Opposite Arch
2. Teeth To Treat
Full Arch
Anterior Only
3. Tooth Movement Restrictions
None
These specific teeth should NOT be moved RIGHT SIDE
8
7
6
5
4
3
2
1
Upper Right
Lower Right
8
7
6
5
4
3
2
1
Upper Right
Lower Right
These specific teeth should NOT be moved LEFT SIDE
1
2
3
4
5
6
7
8
Upper Left
Lower Left
1
2
3
4
5
6
7
8
Upper Left
Lower Left
4. Attachments
Place attachments as needed
Do NOT place attachments on these teeth RIGHT SIDE
8
7
6
5
4
3
2
1
Upper Right
Lower Right
8
7
6
5
4
3
2
1
Upper Right
Lower Right
Do NOT place attachments on these teeth LEFT SIDE
1
2
3
4
5
6
7
8
Upper Left
Lower Left
1
2
3
4
5
6
7
8
Upper Left
Lower Left
5. Anterior-Posterior (A-P) Relationship
R
L
Maintain
Improve Canine Relationship Only
Improve Canine & Molar Relationship
Correction to Class I (Canine & Molar)
R
L
Maintain
Improve Canine Relationship Only
Improve Canine & Molar Relationship
Correction to Class I (Canine & Molar)
Tooth Movement Options
Posterior IPR
Yes
No
Class II/III Correction Simulation (elastics required) - Precision Cuts
Yes
No
Sequential Distalization
Yes
No
Orthognathic Surgical Simulation
Yes
No
6. Overjet
Show Resulting Overjet After Alignment
Maintain Initial Overjet (May Require IPR)
Improve Resulting Overjet with IPR
清除所选内容
7. Overbite
Options for Overbite
Show Resulting Overbite After Alignment
Maintain Initial Overbite (may require IPR)
Correct Open Bite
Upper
Lower
Extrude Anterior Teeth Only
Extrude Anterior Teeth & Intrude Posterior Teeth
Upper
Lower
Extrude Anterior Teeth Only
Extrude Anterior Teeth & Intrude Posterior Teeth
Other (Eg. Surgical Simulation)
Yes
No
清除所选内容
Correct Deep Bite
Upper
Lower
Intrude Anterior Teeth Only
Intrude Anterior Teeth and Extrude Premolars
Upper
Lower
Intrude Anterior Teeth Only
Intrude Anterior Teeth and Extrude Premolars
Other (Eg. Surgical Simulation)
Yes
No
清除所选内容
8. Bite Ramps
Options for Bite Ramps
None
Place bite ramps on lingual of these upper teeth - Incisors
Central Incisors
Lateral Incisors
Canines
Yes
No
9. Midline
Options for Midline
Show Resulting Midline After Alignment
Maintain Initial Midline
Improve Midline with IPR
To Patient Right
To Patients Left
Upper
Lower
To Patient Right
To Patients Left
Upper
Lower
10. Posterior Crossbite (if present)
Do Not Correct
Correct
清除所选内容
11. Spacing
Close All Spaces
Close all spaces
Leave Specific Spaces
您的回答
Crowding (Resolve Upper)
Primarily
As Needed
Expand
Procline
IPR Anterior
IPR Posterior Right
IPR Posterior Left
Primarily
As Needed
Expand
Procline
IPR Anterior
IPR Posterior Right
IPR Posterior Left
Crowding (Resolve Lower)
Primarily
As Needed
Expand
Procline
IPR Anterior
IPR Posterior Right
IPR Posterior Left
Primarily
As Needed
Expand
Procline
IPR Anterior
IPR Posterior Right
IPR Posterior Left
Extractions
None
Extract These Teeth RIGHT SIDE
8
7
6
5
4
3
2
1
Upper Right
Lower Right
8
7
6
5
4
3
2
1
Upper Right
Lower Right
Extract These Teeth LEFT SIDE
1
2
3
4
5
6
7
8
Upper Left
Lower Left
1
2
3
4
5
6
7
8
Upper Left
Lower Left
12. Special Instructions
您的回答
提交
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