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Clear Aligner Treatment Plan for Upper Ref. No. Clinician Patient Date General Diagnosis Dental classification Class I Skeletal classification Class I Anteriorocclusion Normal Posteriorocclusion Normal Over Jet 1mm Overbite 2mm Deviation of midline Mandible shifted to the Left1mm Missing teeth UR6 Difficulty of alignment and estimated treatment time in weeks Moderate 10 to 12Clears Additional Requirements to the Clear Aligner Treatment The bite needs to be temporarely opened with composites on occlusion of opposing 6s or 7s during treatment Composite attachments will be needed. A stent will be provided to help make these attachments We recommend patient have fixed bonded retainer andor Essix retainer after treatment Aims of Treatment DistaliseLaterals FurtherNotes De-rotateIncisors Align anterior segment Estimation in changes of tooth Tooth width before IPR position and tooth width Tooth Width Tooth Width 11 8.15 21 8.57 after alignment 12 6.97 22 7.05 13 7.41 23 7.61 Total No. Clears 9 14 24 15 25 No teeth aligned 4 16 26 Are Teeth Mobile No 17 27 Tooth Rotation Angulation Inclination DistMesi ExtInt LabialPalatal Tooth width after IPR 16 0.00 15 0.00 14 0.00 13 7.21 12 -3.0 1.0 0.2 -0.8 6.77 11 -25.0 -7.0 5.0 -1.6 0.5 7.95 21 14.0 3.0 5.0 1.1 0.7 8.22 22 -12.0 1.0 0.1 -0.9 6.65 23 7.31 24 0.00 25 0.00 26 0.00 Please refer to the diagrams below and strip the teeth accordingly to achieve the correct tooth width as indicated on the table previous page IPR Guide per Stage once space is closed move to the next stage Please refer to colour key for Strip 0.08mm StripDisc 0.15mm the IPR StripDisc needed Strip 0.10mm StripDisc 0.20mm Strip 0.12mm 0.20 0.25 0.40 Total amout of IPR per contact 0.30 0.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 More than one appointment may be needed to achieve the required IPR Composite Attachment Placement Start Position Before and After Simulation of tooth Movement More than one appointment may be needed to achieve the required alignment Before After Before After Before After Consent Treatment with Clear Aligners has proven to be very successful but with every form of orthodontics there are certain risks involved which should be seriously consideredbefore undertaking treatment. Please read the below statements and if you understand them and are fully aware of the risks please sign and date at the end. I understand that the result has been predicted before treatment has begun therefore the outcome may not exactly replicate the result discussed beforehand if the advised treatment plan hasnt been followed correctly. I understand that a lack of compliancy poor oral hygiene and missed appointments lengthen treatment time and these are all things I can prevent from happening. 100 cooperation is very important. I understand that the Clear Aligners must be worn full time for at least 16-20 hours a day apart from when eating or brushing teeth. Remember that the longer you wear the Clear Aligner the quicker the results. I understand that teeth have a tendency to return to their original position after treatment relapse and that at the end of treatment retention is required for life in order topreventthis. I accept the treatment plan recommended by Nimrodental and explained to me by my dental practitioner. Name............................................ Date The Clear Aligners Treatment PlanC.A.T.P is intended to be used as a guideonly. All measurements and the treatment time scale are estimates only. At times more than one appointment will be needed to achieve the required stage.The C.A.T.P may have to be modified as the treatment progresses. All responsibility for the results of the treatment for the above patient lies with the Dentist providing the treatment. Nimrodental bear no responsibility for the consequences resulting from using the C.A.T.P. All terms and conditions stated atwww.nimrodental.com apply. Please tick the box or confirm by writing that you would like to proceed with recommended treatmentplan.