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How to Complete A Digital Prescription Rx Sheet

Rx Forms

Section 1 - Contact Information

The Specialty Appliances Indirect Bonding prescription form should include the doctor’s name and address, the patient’s name, the date shipped and the anticipated date for appliance placement. On the diagram of the teeth, please indicate which teeth are to be bonded, banded, extracted or not treated. Detailed bracket placement information can also be specified, as well as instructions for fabricating and sectioning the transfer trays.

Section 2 - Case Information

The first section of the Specialty Appliances Indirect Bonding prescription form deals with basic case information. Included is the doctor's name and address, the patient's name, the date shipped to Specialty Appliances, and the date requested for appliance placement. On the diagram of the teeth, please indicate which teeth are to be bonded, banded, extracted, or not treated. Also indicate if you have enclosed the brackets, or if they are to be supplied by Specialty Appliances. We will place any manufacturers’ brackets you send with the case; as an option, we have a complete inventory of brackets from American Orthodontics, including the TIME self-ligating and ceramic brackets.

Section 3 - Transfer Tray Information and Options

Our standard transfer trays used with the "custom base" consist of a clear two-part design. The standard for the "clean base" transfer tray is a single silicone tray. Unless otherwise specified, we deliver the transfer trays to your practice with no sectioning or splitting. However, some offices prefer to have the trays sectioned at the dental midlines or even in three pieces per arch when the molars are bonded – they report that sectioning the trays helps in maintaining the isolation and dry field. When we have a request to cut the trays, the inner and outer trays are always sectioned in the same manner. In other words, if there is a mid-line split it will be on both the inner and outer trays.

Section 4 - Lingual Archwires

N/A - Applies to the Lingual IB cases only. For more information, please go to Lingual Archwire.

Section 5 - Bracket Placement

On our prescription form, there is a section where detailed instructions may be provided regarding bracket placement. Many practices have provided us with standard guidelines for their typical vertical heights, and provide additional instructions on a per case basis when indicated. For example, when the upper canines are extremely pointed and some contouring is anticipated after orthodontic treatment, the doctor’s special instructions may be to place the brackets 1/2 mm more gingival to allow for the anticipated contouring. We strongly encourage each practice to establish a computerized special instructions file that details their exact bracket positioning guidelines. These instructions are then followed on all cases unless otherwise indicated on the prescription form

Section 6 - Special Instructions

This section is for the doctor to communicate special instructions.