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Patient details
Presenting complaint
Dental examination
Treatment aims
Aligner system
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Patient details
PMS ID
First name initial*
Surname initial*
Date of birth*
Sex*
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Presenting complaint
Describe complaint*:
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Dental examination:
BPE score*:
Teeth of poor prognosis*:
Traumatised teeth*:
Root-filled teeth*:
Crowns*:
Bridges*:
Implants*:
Missing teeth*:
Radiological findings*:
Additional observations:
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Treatment aims:
You must select a minimum of 1 aim.*
Additional aims:
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Yes
No
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Aligner system to be used:
Doctor site username*:
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Upload files:
Drag and drop all relevant clinical images up to 10 MB per file and DPT images if available. We recommend you upload up to 5 images.
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Upload DPT here:
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Patient details
Patient initials:
J.
D.
Date of birth:
22
Sex:
Male
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Complaint:
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Dental examination:
BPE score:
1
1
1
1
1
1
Teeth of poor prognosis:
1
Traumatised teeth:
1
Root-filled teeth:
1
Crowns:
1
Bridges:
1
Implants:
1
Missing teeth:
1
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Radiological findings:
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Additional observations:
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Ideal treatment aims:
Align teeth
Reduce excessive overjet
Reduce deep overbite
Close open bite
Correct crossbites
Close spaces
Correct molar relationship
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Additional aims:
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Aligner system to be used:
Spark Aligner
Risks of aligner treatment explained to patient
Consented to aligner treatment
Aligner Intelligence added as a 'staff member' on relevant aligner system
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Uploaded files:
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Uploaded photos:
Uploaded DPT:
Periodontal examination completed and recorded
Appropriate radiographs taken and reported
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