ESLO CASE PRESENTATION FORMS
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ESLO CASE PRESENTATION FORMS ESLO CASE PRESENTATION FORMS Document Transcript

  • 1 EUROPEAN SOCIETY OF LINGUAL ORTHODONTICS APPENDIX 1 CASE PRESENTATION FORMS
  • EUROPEAN SOCIETY OF LINGUAL ORTHODONTICS CANDIDATE NUMBER: CASE NUMBER: Year: WBLO 01
  • RÉSUMÉ OF CASE 1 ADULT MALOCCLUSION NAME: BORN: SEX: PRE-TREATMENT RECORDS: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: TREATMENT STARTED: TREATMENT FINISHED: ACTIVE TREATMENT TIME: POST-TREATMENT RECORDS: RETAINERS: RETENTION ENDED: AGE: RETENTION TIME: (POST-) RETENTION RECORDS: TIME OUT OF RETENTION: DATE: AGE: DATE: AGE: DATE: a)upper: a)lower: a)upper: a)lower: DATE: DATE: AGE: DATE: CASE CATEGORY : WBLO 02 TREATMENT PLAN: AGE: DATE:
  • WBLO 02 RÉSUMÉ OF CASE 2 CLASS I MALOCCLUSION CASE CATEGORY : NAME: BORN: SEX: PRE-TREATMENT RECORDS: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: TREATMENT STARTED: TREATMENT FINISHED: ACTIVE TREATMENT TIME: POST-TREATMENT RECORDS: RETAINERS: RETENTION ENDED: AGE: RETENTION TIME: (POST-) RETENTION RECORDS: TIME OUT OF RETENTION: DATE: AGE: DATE: AGE: DATE: a)upper: a)lower: a)upper: a)lower: DATE: DATE: AGE: DATE: TREATMENT PLAN: AGE: DATE:
  • WBLO 02 RÉSUMÉ OF CASE 3 CLASS II DIV. 2 MALOCCLUSION CASE CATEGORY : NAME: BORN: SEX: PRE-TREATMENT RECORDS: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: TREATMENT STARTED: TREATMENT FINISHED : ACTIVE TREATMENT TIME: POST-TREATMENT RECORDS: RETAINERS: RETENTION ENDED: AGE: RETENTION TIME: (POST-) RETENTION RECORDS: TIME OUT OF RETENTION: DATE: AGE: DATE: AGE: DATE: a)upper: a)lower: a)upper: a)lower: DATE: DATE: AGE: DATE: TREATMENT PLAN: AGE: DATE:
  • WBLO 02 RÉSUMÉ OF CASE 4 CLASS II DIVISION 1 MALOCCLUSION CASE CATEGORY : HIGH FRANKFORT MANDIBULAR PLANE ANGLE, MINIMUM FM ANGLE OF 30° AND/OR SN TO Go-Gn ANGLE OF 37° NAME: BORN: SEX: PRE-TREATMENT RECORDS: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: TREATMENT STARTED: TREATMENT FINISHED: ACTIVE TREATMENT TIME: POST-TREATMENT RECORDS: RETAINERS: RETENTION ENDED: AGE: RETENTION TIME: (POST-) RETENTION RECORDS: TIME OUT OF RETENTION: DATE: AGE: DATE: AGE: DATE: a)upper: a)lower: a)upper: a)lower: DATE: DATE: AGE: DATE: TREATMENT PLAN: AGE: DATE:
  • WBLO 02 RÉSUMÉ OF CASE 5 CLASS II DIVISION 1 MALOCCLUSION CASE CATEGORY : A MALOCCLUSION WITH SIGNIFICANT MANDIBULAR ARCH LENGTH DEFICIENCY In at least one of the two Class II 1 cases the treatment must involve extractions in both dental arches ° NAME: BORN: SEX: PRE-TREATMENT RECORDS: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: TREATMENT STARTED: TREATMENT FINISHED: ACTIVE TREATMENT TIME: POST-TREATMENT RECORDS: RETAINERS: RETENTION ENDED: AGE: RETENTION TIME: (POST-) RETENTION RECORDS: TIME OUT OF RETENTION: DATE: AGE: DATE: AGE: DATE: a)upper: a)lower: a)upper: a)lower: DATE: DATE: AGE: DATE: TREATMENT PLAN: AGE: DATE:
  • WBLO 02 RÉSUMÉ OF CASE 6 CLASS III MALOCCLUSION CASE CATEGORY : NAME: BORN: SEX: PRE-TREATMENT RECORDS: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: TREATMENT STARTED: TREATMENT FINISHED: ACTIVE TREATMENT TIME: POST-TREATMENT RECORDS: RETAINERS: RETENTION ENDED: AGE: RETENTION TIME: (POST-) RETENTION RECORDS: TIME OUT OF RETENTION: DATE: AGE: DATE: AGE: DATE: a)upper: a)lower: a)upper: a)lower: DATE: DATE: AGE: DATE: TREATMENT PLAN: AGE: DATE:
  • WBLO 02 RÉSUMÉ OF CASE 7 A SEVERE SKELETAL DISCREPANCY CASE CATEGORY : NAME: BORN: SEX: PRE-TREATMENT RECORDS: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: TREATMENT STARTED: TREATMENT FINISHED: ACTIVE TREATMENT TIME: POST-TREATMENT RECORDS: RETAINERS: RETENTION ENDED: AGE: RETENTION TIME: (POST-) RETENTION RECORDS: TIME OUT OF RETENTION: DATE: AGE: DATE: AGE: DATE: a)upper: a)lower: a)upper: a)lower: DATE: DATE: AGE: DATE: TREATMENT PLAN: AGE: DATE:
  • WBLO 02 RÉSUMÉ OF CASE 8 A SIGNIFICANT TRANSVERSE DISCREPANCY CASE CATEGORY : NAME: BORN: SEX: PRE-TREATMENT RECORDS: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: TREATMENT STARTED: TREATMENT FINISHED: ACTIVE TREATMENT TIME: POST-TREATMENT RECORDS: RETAINERS: RETENTION ENDED: AGE: RETENTION TIME: (POST-) RETENTION RECORDS: TIME OUT OF RETENTION: DATE: AGE: DATE: AGE: DATE: a)upper: a)lower: a)upper: a)lower: DATE: DATE: AGE: DATE: TREATMENT PLAN: AGE: DATE:
  • WBLO 02 RÉSUMÉ OF CASE 9 REPLACEMENT CASE CASE CATEGORY : NAME: BORN: SEX: PRE-TREATMENT RECORDS: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: TREATMENT STARTED: TREATMENT FINISHED: ACTIVE TREATMENT TIME: POST-TREATMENT RECORDS: RETAINERS: RETENTION ENDED: AGE: RETENTION TIME: (POST-) RETENTION RECORDS: TIME OUT OF RETENTION: DATE: AGE: DATE: AGE: DATE: a)upper: a)lower: a)upper: a)lower: DATE: DATE: AGE: DATE: TREATMENT PLAN: AGE: DATE:
  • 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: WBLO 03 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • FRONTAL SMILING PROFILE WBLO 04   FACIAL PHOTOGRAPHS BEFORE TREATMENT CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal WBLO 05 INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENT CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • WBLO 06 LATERAL SKULL RADIOGRAPH BEFORE TREATMENT CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • WBLO 07 TRACING OF LATERAL SKULL RADIOGRAPH BEFORE TREATMENT CANDIDATE NUMBER: DATE: AGE: CASE NUMBER: THIS TRACING SHOULD BE IN THE COLOR BLACK. REMOVE THIS PART AND PLACE ONLY THE LOWER PART WITH THE TEXT BELOW THE CUT OFF LINE AT THE BOTTOM OF THE TRANSPARENT COVER; THEN PLACE THE TRACING IN THE TRANSPARENT COVER. IN THIS WAY THE TRACING CAN BE EASILY INSPECTED. HAND TRACING SHOULD FACE TO THE RIGHT. COPIES ON TRANSPARENT MATERIAL ARE NECESSARY TO CONTROL RELIABILITY OF TRACINGS.
  • CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 WBLO 08 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER: Pretreatment Mean SD Sagittal Skeletal Relations 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 Inclination S-N / Go-Gn 33º ± 2.5º 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 Mandibular Incisor Compensation 1 - A-Pg (mm) 2 ± 2.0 Dental Relations Overjet (mm) 3.5 ± 2.5 Overbite (mm) 2 ± 2.5 Interincisal Angle 1 / 1 132º ± 6.0º
  • PERIAPICAL OR PANORAMIC RADIOGRAPHS BEFORE TREATMENT WBLO 09 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • ANY OTHER RADIOGRAPHS BEFORE TREATMENT WBLO 10 If needed CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • RADIOGRAPHIC ANALYSIS BEFORE TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT WBLO 11 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • TREATMENT PLAN AND THE REASON FOR IT WBLO 12 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • TREATMENT STEPS INTRA-ORAL OCCLUSAL VIEW COLOUR PHOTOGRAPHS UPPER ARCH WBLO 12-1 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • WBLO 12-2 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER: TREATMENT STEPS INTRA-ORAL OCCLUSAL VIEW COLOUR PHOTOGRAPHS LOWER ARCH
  • RÉSUMÉ OF THE TREATMENT CARRIED OUT INCLUDING ANY DIFFICULTIES ENCOUNTERED WBLO 13 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • FRONTAL SMILING PROFILE WBLO 14   FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION AT COMPLETION OF TREATMENT WBLO 15 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT WBLO 16 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT WBLO 17 THIS TRACING SHOULD BE IN THE COLOR RED. REMOVE THIS PART AND PLACE ONLY THE LOWER PART WITH THE TEXT BELOW THE CUT OFF LINE AT THE BOTTOM OF THE TRANSPARENT COVER; THEN PLACE THE TRACING IN THE TRANSPARENT COVER. IN THIS WAY THE TRACING CAN BE EASILY INSPECTED. HAND TRACING SHOULD FACE TO THE RIGHT. COPIES ON TRANSPARENT MATERIAL ARE NECESSARY TO CONTROL RELIABILITY OF TRACINGS. CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 WBLO 18 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER: Pretreatment Posttreatment Mean SD Sagittal Skeletal Relations 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 Inclination S-N / Go-Gn 33º ± 2.5º 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 Mandibular Incisor Compensation 1 - A-Pg (mm) 2 ± 2.0 Dental Relations Overjet (mm) 3.5 ± 2.5 Overbite (mm) 2 ± 2.5 Interincisal Angle 1 / 1 132º ± 6.0º
  • PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENT WBLO 19 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • RADIOGRAPHIC ANALYSIS AT COMPLETION OF TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT WBLO 20 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • DESCRIPTION OF THE TREATMENT RESULT WBLO 21 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • DESCRIPTION OF THE POST-TREATMENT EVALUATION OF RETENTION WBLO 21-1 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • FRONTAL SMILING PROFILE WBLO 22 FACIAL PHOTOGRAPHS AT RETENTION / POST RETENTION CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS AT RETENTION / POST-RETENTION WBLO 23 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • LATERAL SKULL RADIOGRAPH AT RETENTION / POST-RETENTION WBLO 24 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:
  • TRACING OF LATERAL SKULL RADIOGRAPH AT RETENTION / POST-RETENTION WBLO 25 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER: THIS TRACING SHOULD BE IN THE COLOR GREEN. REMOVE THIS PART AND PLACE ONLY THE LOWER PART WITH THE TEXT BELOW THE CUT OFF LINE AT THE BOTTOM OF THE TRANSPARENT COVER; THEN PLACE THE TRACING IN THE TRANSPARENT COVER. IN THIS WAY THE TRACING CAN BE EASILY INSPECTED. HAND TRACING SHOULD FACE TO THE RIGHT. COPIES ON TRANSPARENT MATERIAL ARE NECESSARY TO CONTROL RELIABILITY OF TRACINGS.
  • CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 WBLO 26 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER: Pretreatment Posttreatment Retention/ Postretention Mean SD Sagittal Skeletal Relations 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 Inclination S-N / Go-Gn 33º ± 2.5º 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 Mandibular Incisor Compensation 1 - A-Pg (mm) 2 ± 2.0 Dental Relations Overjet (mm) 3.5 ± 2.5 Overbite (mm) 2 ± 2.5 Interincisal Angle 1 / 1 132º ± 6.0º
  • DESCRIPTION OF RETENTION / POST-RETENTION FINDINGS CANDIDATE NUMBER: DATE: AGE: WBLO 27 CASE NUMBER: