B-Align PRESCRIPTION
PATIENT Full name
Email:
Age :
Date: Chief complaint
B-Align PACKAGE : Tiny xxx xxx xxx
TREATED ARCHES Upper Only Lower Only Both
3. TOOTH MOVEMENT RESTRICTION
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
Upper
Lower
ADDITIONAL INSTRUCTIONS
