New Questionnaire FormQuestion 1. Patient Name:*Question 2. Patient Age:*Kid < 10 years (Minimum 2 years away from full tx)Kid > 10 yearsAdultQuestion 3. Current AP Relationship:*Class 1Class 2Class 3Sub selection for Class 2*Mild (1/4 cusp)Moderate (1/2 cusp)Severe (>1/2 cusp)Sub selection for Class 3*Mild (1/4 cusp)Moderate (1/2 cusp)Severe (>1/2 cusp)Question 4. Class 2, Division ?*Div 1Div 2Question 5. How much AP correction was promised to the patient?*None / Maintain (0%)Marginal (0-25%)Partial (25-50%)Full (100%)Question 6. Correct AP with:*Elastics (up to 1/4 cusp correction in adults, up to 1/2 cusp correction in kids)Sequential distalization (>1/4 cusp correction in adults, >1/2 cusp correction in kids)Sequential mesializationExtractionsMAFSurgerySub selection for Q6 Sequential distalization option*UpperLowerSub Selection for Q6 Upper option*Q1Q2Are upper 8s present that could interfere sequential distalization?*YesNoWARNING: Please reconsider if sequential distalization is how you want to correct the AP as it may not work with upper 8s present.Sub selection for Q6 Lower option*Q3Q4Are lower 8s present that could interfere sequential distalization?*YesNoWARNING: Please reconsider if sequential distalization is how you want to correct the AP as it may not work with lower 8s present.Where do you want to burn the anchorage?* Q1 Q2 Q3 Q4Please specify which teeth to extract*Please specify what upper and lower jaw surgeries*Hidden Q6 optionsYesNoQuestion 7. Current Vertical Relationship:*Normal (10-20% overbite)Minimal Overbite (0-10% overbite)Deep BiteOpen BiteSub selection for Q7 Deep Bite*Mild (20-40%)Moderate (40-70%)Severe (70%+)Sub selection for Q7d Open Bite*TIP: Use occlusogram on the scan to see what teeth are truly in contact.Anterior to 4sDistal to 4sQuestion 8. Is there a posterior crossbite?*No posterior crossbiteYes, but maintain posterior crossbiteYes, and correct posterior crossbiteSub selection for Q8c Yes, and correct posterior crossbite*Partial correctionFull correctionPlease specify where to correct the posterior crossbite and where to maintain the posterior crossbite if applicable (ie. correct distal to 14, maintain distal to 24)*Question 9. Expansion of upper and lower arch forms:*TIP: Expansion will help open the bite. Maintain and coordinate arch forms Expand arch formsSub Selection Q9b option*Mild (1mm per side at premolars miniml at molars) - default for adultModerate (2mm per side at premolar) - default for kidSignificant (>2mm per side, including molars for very narrow arches)Extreme (>3mm, Phase 1 only)Question 10. IPR:*A. Please use IPR for the following reasons: Significant crowding (beyond whatever expansion and proclination is possible) Reduce overjet Reduce proclination Recession concern Black triangles Bolton discrepancy Pt strongly declines IPR No obvious reasons for IPRSub Selection for Q10 "Recession concern" option*UpperLowerBothPlease specify location of black triangle (ie. 11/21, 31/41)*B. What arch do you want IPR:* Upper IPR: Lower IPR:Sub selection for Q10 Upper IPR option*Mild (1-2 mm)Moderate (2-4 mm)Significant (>4mm from U6-6)Sub selection for Q10 Lower IPR option*Mild (1-2 mm)Moderate (2-4 mm)Significant (>4mm from U6-6)Question: Do you feel L2-2 is very small and IPR should be shifted to the posteriors?*YesNoQuestion 11. "Extractions:"*NoneExtract premolarsExtract lower incisorOtherSub selection for Q11 "Extract premolars"* 15 14 24 25 45 44 34 35Sub selection for Q11 "Extract lower incisor"*TIP: Extraction of lower centrals are preferable as they are smaller than laterals so less of a Bolton discrepancy is created. 42 41 31 32Sub selection for Q11 "Other" option*Question. 11-1 "Is there a large midline shift?"*YesNoQuestion 13. "Is there an alternate plan that we need to simulate?*YesNoSub selection for Q13 "Yes" Option*Please make the alternate plan the less complicated plan biomechanically."No extractions, significant IPR insteadAlternate extraction planNo AP correctionOtherSub selection for Q11 Other option*Question 14: Will any auxillaries be used?* None Propel Buttons and powerchain for derotation Partial braces to correct root tip Elastics for extrusion of a single tooth or general posterior bite settlingWhere*Sub selection for Q14c option* When WhereSub selection for Q14c option* During active trays During passive trays at endWhere*Sub selection for Q14d option* When WhereSub selection for Q14d option* During active trays During passive trays at endWhere*Sub selection for Q14e option* When WhereSub selection for Q14e option* During active trays During passive trays at endWhere*Hidden question 143 passive trays10 passive traysQuestion 15. Other situations that are present:* Transitioning from Carriere Simultaneous Carriere with Invisalign Anterior crossbite (single tooth or complete) Single tooth posterior crossbite (dental crossbite) Diastema > 1mm Ectopic canine(s) Lingually displaced tooth Signficant space closure required that is not due to extractions from this tx plan (>7mm) Maintain space Mesially tipped lower molars Add torque to upright upper incisors Excessively proclined lower incisors (>120 degrees) None of the above applySub selection for Q15 "Transitioning from Carriere" option*Class 2Class 3Sub selection for Q15 "Simultaneous Carriere with Invisalign" option*Class 2Class 3Sub Selection for Q15 "Single tooth posterior crossbite (dental crossbite)"*Sub selection for Q15 "Diastema > 1mm" option*Complete closureLeave space at diastemaSub selection for Q15e "Leave space at diastema" option*Sub selection for Q15 "Ectopic canine(s)" option* 13 23 43 33Sub selection for Q15 "Lingually displaced tooth" option*Sub selection for Q15h option* Retract anteriors to close space Reciprocal space closureRetract anteriors to close space* Q1 Q2 Q3 Q4Reciprocal space closure* Q1 Q2 Q3 Q4Sub selection for Q15i "Maintain space" option* Missing tooth / implant Restorative buildups OtherSub selection for Q15i option 1*Sub selection for Q15i option 2*Sub selection for Q15i option 3*Sub selection for Q15j option* Do not upright Upright minimally (5 degrees) Upright fullyDo not upright* 18 17 16 26 27 28 48 47 46 36 37 38Upright minimally (5 degrees)* 18 17 16 26 27 28 48 47 46 36 37 38Upright fully* 18 17 16 26 27 28 48 47 46 36 37 38Sub selection for Q15l option*YesNoQuestion 16. 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