CASE PRESENTATION FORMS EUROPEAM SOCIETY OF LINGUAL ORTHODONTISTS APPENDIX 1 CASE PRESENTATION FORMS 1
EUROPEAN SOCIETY OF LINGUAL ORTHODONTISTS CANDIDATE NUMBER: CASE NUMBER: Year: ESLO 01
RÉSUMÉ OF CASE 2 CLASS I MALOCCLUSION CASE CATEGORY: NAME: BORN: SEX: PRETREATMENT RECORDS: AGE: DATE: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: TREATMENT STARTED: AGE: DATE: TREATMENT ENDED: AGE: DATE: ACTIVE TREATMENT TIME: POSTTREATMENT RECORDS: RETAINERS: a)upper: DATE: a)lower: RETENTION ENDED: a)upper: DATE: a)lower: RETENTION TIME: (POST-) RETENTION RECORDS: AGE: DATE: TIME OUT OF RETENTION: ESLO 02
DIAGNOSTIC DESCRIPTION OF THE MALOCCLUSION A. SUMMARY B. Examination of head and face C. Functional examination D. Intraoral examination E. Dental casts Mandibular arch: Maxillary arch: Occlusion Sagittal: Occlusion Vertical: Occlusion Transversal: CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 03
FACIAL PHOTOGRAPHS BEFORE TREATMENT 45° FRONTAL PROFILE FACIAL PHOTOGRAPHS BEFORE TREATMENT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 04
INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENT Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 05
LATERAL SKULL RADIOGRAPH BEFORE TREATMENT Print on transparent support LATERAL SKULL RADIOGRAPH BEFORE TREATMENT ESLO 06
TRACING OF LATERAL SKULL RADIOGRAPH BEFORE TREATMENT Print on transparent support TRACING OF LATERAL SKULL RADIOGRAPH BEFORE TREATMENT ESLO 07
CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 07-1
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 Pre-treatment Mean SD Sagittal Skeleatal Maxillary Position S-N-A 82º ±3.5º Mandibular Position S-N-Pg 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N/ANS-PNS 8º ± 3.0º Mandibular Inlination S-N/Go-Gn 33º ± 2.5º CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 08
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 Pre-treatment Mean SD Vertical Jaw Relation ANS-PNS/Go-Gn 25º ± 6.0º Dento-Basal Relations Maxillary Incisor Inclination 1-ANS-PNS 110º ± 6.0º Mandibular Incisor Inclination 1-Go-Gn 94º ± 7.0º CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 08-1
CEPHALOMETRIC MORPHOLOGICAL Mandibular Incisor Compensation ASSESSMENT 1 Mandibular Incisor Compensation 1 –A-Pg (mm) 2 ± 2.0 Dental Relations Overjet (mm) 2º ± 2.0 Overbite (mm) 2 ± 2.5 Interincisal Angle 1/1 132º ± 6.0º CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 08-2
PERIAPICAL OR PANORAMIC RADIOGRAPHS Print on transparent support PERIAPICAL OR PANORAMIC RADIOGRAPHS BEFORE TREATMENT ESLO 09
CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ÊSLO 09-1
ANY OTHER RADIOGRAPHS BEFORE TREATMENT Print on transparent support ANY OTHER RADIOGRAPHS BEFORE TREATMENT If needed ESLO 10
CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 10-1
RADIOGRAPHIC ANALYSIS BEFORE TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH B. Interpretation of cephalometric assessment CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 11
TREATMENT PLAN AND THE REASON FOR IT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 12
INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 12-1
INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 12-2
RÉSUMÉ OF THE TREATMENT CARRIED OUT ANY DIFFICULTIES ENCOUNTERED INCLUDING ANY DIFFICULTIES ENCOUNTERED CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 13
FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT 45° FRONTAL PROFILE FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ELO 14
Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION AT COMPLETION OF TREATMENT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 15
LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT Print on transparent support LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT ESLO 16
TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT Print on transparent support TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT ESLO 17
CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 17-1
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 Pre-treatment Mean SD Sagittal Skeleatal Maxillary Position S-N-A 82º ±3.5º Mandibular Position S-N-Pg 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N/ANS-PNS 8º ± 3.0º Mandibular Inlination S-N/Go-Gn 33º ± 2.5º CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 18
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 Pre-treatment Mean SD Vertical Jaw Relation ANS-PNS/Go-Gn 25º ± 6.0º Dento-Basal Relations Maxillary Incisor Inclination 1-ANS-PNS 110º ± 6.0º Mandibular Incisor Inclination 1-Go-Gn 94º ± 7.0º CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 18-1
CEPHALOMETRIC MORPHOLOGICAL Mandibular Incisor Compensation ASSESSMENT 2 Mandibular Incisor Compensation 1 –A-Pg (mm) 2 ± 2.0 Dental Relations Overjet (mm) 2º ± 2.0 Overbite (mm) 2 ± 2.5 Interincisal Angle 1/1 132º ± 6.0º CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 18-2
PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENT Print on transparent support PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENT ESLO 19
CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 19-1
RADIOGRAPHIC ANALYSIS AT COMPLETION OF TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH B. Interpretation of cephalometric assessment CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 20
DESCRIPTION OF THE TREATMENT RESULT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 21
FACIAL PHOTOGRAPHS AT RETENTION / POST RETENTION 45° FRONTAL PROFILE FACIAL PHOTOGRAPHS AT RETENTION / POST RETENTION CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 22
INTRA-ORAL COLOUR PHOTOGRAPHS AT RETENTION / POST-RETENTION Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS AT RETENTION / POST-RETENTION CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 23
LATERAL SKULL RADIOGRAPH AT RETENTION / POSTRETENTION Print on transparent support LATERAL SKULL RADIOGRAPH AT RETENTION / POSTRETENTION ESLO 24
TRACING OF LATERAL SKULL RADIOGRAPH AT RETENTION / POST-RETENTION Print on transparent support TRACING OF LATERAL SKULL RADIOGRAPH AT RETENTION / POST-RETENTION ESLO 25
CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 25-1
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 Pre-treatment Mean SD Sagittal Skeleatal Maxillary Position S-N-A 82º ±3.5º Mandibular Position S-N-Pg 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N/ANS-PNS 8º ± 3.0º Mandibular Inlination S-N/Go-Gn 33º ± 2.5º CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 26
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 Pre-treatment Mean SD Vertical Jaw Relation ANS-PNS/Go-Gn 25º ± 6.0º Dento-Basal Relations Maxillary Incisor Inclination 1-ANS-PNS 110º ± 6.0º Mandibular Incisor Inclination 1-Go-Gn 94º ± 7.0º CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 26-1
CEPHALOMETRIC MORPHOLOGICAL Mandibular Incisor Compensation ASSESSMENT 3 Mandibular Incisor Compensation 1 –A-Pg (mm) 2 ± 2.0 Dental Relations Overjet (mm) 2º ± 2.0 Overbite (mm) 2 ± 2.5 Interincisal Angle 1/1 132º ± 6.0º CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 26-2
DESCRIPTION OF RETENTION / POST-RETENTION FINDINGS CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 27