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CASE PRESENTATION FORMS
EUROPEAM SOCIETY OF LINGUAL ORTHODONTISTS APPENDIX 1 CASE PRESENTATION FORMS 1
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EUROPEAN SOCIETY OF LINGUAL ORTHODONTISTS CANDIDATE NUMBER:
CASE NUMBER: Year: ESLO 01
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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
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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
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FACIAL PHOTOGRAPHS BEFORE TREATMENT
45° FRONTAL PROFILE FACIAL PHOTOGRAPHS BEFORE TREATMENT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 04
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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
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LATERAL SKULL RADIOGRAPH BEFORE TREATMENT
Print on transparent support LATERAL SKULL RADIOGRAPH BEFORE TREATMENT ESLO 06
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TRACING OF LATERAL SKULL RADIOGRAPH BEFORE TREATMENT
Print on transparent support TRACING OF LATERAL SKULL RADIOGRAPH BEFORE TREATMENT ESLO 07
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CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 07-1
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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
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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
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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
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PERIAPICAL OR PANORAMIC RADIOGRAPHS
Print on transparent support PERIAPICAL OR PANORAMIC RADIOGRAPHS BEFORE TREATMENT ESLO 09
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CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ÊSLO 09-1
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ANY OTHER RADIOGRAPHS BEFORE TREATMENT
Print on transparent support ANY OTHER RADIOGRAPHS BEFORE TREATMENT If needed ESLO 10
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CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 10-1
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RADIOGRAPHIC ANALYSIS BEFORE TREATMENT
A. INTRAORAL / PANORAMIC RADIOGRAPH B. Interpretation of cephalometric assessment CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 11
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TREATMENT PLAN AND THE REASON FOR IT
CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 12
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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
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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
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RÉSUMÉ OF THE TREATMENT CARRIED OUT ANY DIFFICULTIES ENCOUNTERED
INCLUDING ANY DIFFICULTIES ENCOUNTERED CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 13
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FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT
45° FRONTAL PROFILE FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ELO 14
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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
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LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT
Print on transparent support LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT ESLO 16
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TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT
Print on transparent support TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT ESLO 17
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CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 17-1
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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
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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
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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
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PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENT
Print on transparent support PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENT ESLO 19
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CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 19-1
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RADIOGRAPHIC ANALYSIS AT COMPLETION OF TREATMENT
A. INTRAORAL / PANORAMIC RADIOGRAPH B. Interpretation of cephalometric assessment CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 20
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DESCRIPTION OF THE TREATMENT RESULT
CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 21
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FACIAL PHOTOGRAPHS AT RETENTION / POST RETENTION
45° FRONTAL PROFILE FACIAL PHOTOGRAPHS AT RETENTION / POST RETENTION CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 22
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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
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LATERAL SKULL RADIOGRAPH AT RETENTION / POSTRETENTION
Print on transparent support LATERAL SKULL RADIOGRAPH AT RETENTION / POSTRETENTION ESLO 24
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TRACING OF LATERAL SKULL RADIOGRAPH AT RETENTION / POST-RETENTION
Print on transparent support TRACING OF LATERAL SKULL RADIOGRAPH AT RETENTION / POST-RETENTION ESLO 25
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CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 25-1
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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
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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
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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
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DESCRIPTION OF RETENTION / POST-RETENTION FINDINGS
CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 27
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