FORMS AND DOWNLOADS
Treatment Plan Instructions (Rx)
The prescription form for clear aligner design, complete it to give the treatment planners your instructions for each case. Download the editable template below.
THE DOCUMENT
The Rx template
One editable form that carries your instructions from your chair to the treatment planners. Download it, keep a copy in your practice, and complete a fresh one for each case.
Comprehensive Treatment Rx
WHAT THE RX COVERS
What the Rx covers
Fill in the treatment plan instructions once your records are ready, before you create the case on the design platform, so the planners work from your goals rather than their best guess. Mark only the sections that apply to the case.
Patient and history
- General and patient information, doctor and patient details, gender, age, medications that may affect treatment, and relevant dental history
- Periodontal status, flag areas of thin gingival attachment or loss of attachment (with tooth number) and whether to minimise movement there
Bite and relationships
- Anterior, posterior relation, maintain or improve the canine and molar relationship (left/right)
- Overjet and overbite, maintain or improve
- Posterior crossbite, maintain, or correct premolars or molars
Alignment and midline
- Levelling the anterior teeth, to the incisal edges or the gingival margins
- Tooth size discrepancy and midline, improve or move (left/right, upper/lower), marked only if needed
Treatment specification
- Align 3-3 (anterior only), 5-5 (2nd premolar to 2nd premolar), or 7-7 (full arch, additional fee; molar movements not allowed)
- Upper/lower esthetic treatment; allow IPR; allow attachments; IPR in the opposite arch; and where to leave spaces open (distal to laterals or canines)
- Additional comments for the planners
The doctor is solely responsible for the completion and interpretation of x-rays and other diagnostic records.
HOW TO SUBMIT
How to submit the Rx
Three steps take your prescription from the template to a plan you can review.
Complete the Rx
Fill in the treatment plan instructions, marking only the sections that apply to the case, so the planners work from your goals rather than their best guess.
Attach it with your records
Include the completed Rx with the patient’s records when you create the case on the design platform, so your instructions travel with the scan or impressions.
Planners build the plan for your review
The treatment planners design the case to your prescription and return a plan for you to review, approve or adjust before manufacture.
Sending physical impressions to the lab? Pair the completed Rx with the impression collection slip so your submission is logged and routed correctly.