d> = Tambalan</td>
            <td><span class="fa fa-Goyang fa-2x"></td>
            <td> = Goyang</td>
          </tr>
        </table>
        <br/><br/>        
      </div>
      <div class="row clearfix">
        <div class="form-odontogram">
          <div class="col-md-6">
            <div class="form-group">
              <label for="hasil">Elemen Pemeriksaan</label>
              <select name="gg_xx" id="gg_xx" class="form-control">
                <option value="">------------</option>
          