The Torque and Angulation Lab.

9/72 Bantor Suandokmak, T.Sansailuang, A.Sansai,Chiang Mai 50210 THAILAND Tel:+66 53 491302, Fax:+66 53 491305, Mobile:+66 8 3766 8021 www.torque-angulationlab.com , E-mail : info@torque-angulationlab.com

Order No:

Date sent : ../../..

Date required : ../../..

Time required : ../../.. Male Female

Dentist : Patient : . Age :

Please give the maximum information to complete the " Diagnostic Set-up "
Arch form Upper Lower Ovoid Square Tapered or change to Individualized Archform co-ordination : Expansion Consriction

Specify maximun amount of the above to achieve required OJ Upper : ..mm. Lower : ..mm.

Select your teeth as required for best archform indicators write internaticnal codes 11 41 21 etc 31 Lower : ..mm. Facial midline ( Please add photo ) Arch symmetry Elastics Class III III III

Max Protraction / Retraction : Upper : ..mm. Treat to : Upper midline Lower midline

Achieve midline by :

IPR / Space management Elastics class II

Class : Molar Canine Achieve by : Axial Reference teeth Occlusal Plane ( OP )

I I IPR

II II

distalize / mesializing , specify teeth

Flat Extrude

COS Intrude

Maintain Specify teeth

Upper

Lower

OB :

< 1mm.

1-2mm.

> 2mm.

Special instructions :

Lower