eslo case presentation forms

1

EUROPEAN SOCIETY

OF LINGUAL

ORTHODONTICS

APPENDIX 1

CASE PRESENTATION FORMS

EUROPEANSOCIETY

OF LINGUALORTHODONTICS

CANDIDATE NUMBER:

CASE NUMBER:

Year:

WBLO 01

RÉSUMÉ OF CASE 1RÉSUMÉ 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


CLASS I MALOCCLUSIONCASE CATEGORY:

NAME:

BORN:

SEX:


CLASSIFICATION:


APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:



RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:



DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02


CLASS II DIV. 2 MALOCCLUSIONCASE CATEGORY:

NAME:

BORN:

SEX:


CLASSIFICATION:


APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED :



RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:



DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02


CLASS II DIVISION 1 MALOCCLUSIONCASE CATEGORY:

HIGH FRANKFORT MANDIBULAR PLANE ANGLE, MINIMUM

FM ANGLE OF 30° AND/OR SN TO Go-Gn ANGLE OF 37°

NAME:

BORN:

SEX:


CLASSIFICATION:


APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:



RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:



DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02


CLASS II DIVISION 1 MALOCCLUSIONCASE 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:


CLASSIFICATION:


APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:



RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:



DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02


CLASS III MALOCCLUSIONCASE CATEGORY:

NAME:

BORN:

SEX:


CLASSIFICATION:


APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:



RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:



DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02


A SEVERE SKELETAL DISCREPANCYCASE CATEGORY:

NAME:

BORN:

SEX:


CLASSIFICATION:


APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:



RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:



DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02


A SIGNIFICANT TRANSVERSE DISCREPANCY

CASE CATEGORY:

NAME:

BORN:

SEX:


CLASSIFICATION:


APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:



RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:



DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02


REPLACEMENT CASECASE CATEGORY:

NAME:

BORN:

SEX:


CLASSIFICATION:


APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:



RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:



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

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


Right Buccal Left Buccal

CenterUpper Occlusal Lower Occlusal

WBLO 05

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENT


WBLO 06

LATERAL SKULL RADIOGRAPH BEFORE TREATMENT


WBLO 07

TRACING OF LATERAL SKULL RADIOGRAPHBEFORE TREATMENT


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


ASSESSMENT 1

WBLO 08


Pretreatment Mean SD

Sagittal Skeletal Relations

Maxillary PositionS-N-A

82º ± 3.5º

Mandibular PositionS-N-Pg

80º ± 3.5º

Sagittal Jaw RelationA-N-Pg

2º ± 2.5º

Vertical Skeletal Relations

Maxillary InclinationS-N / ANS-PNS

8º ± 3.0º

Mandibular InclinationS-N / Go-Gn

33º ± 2.5º

Vertical Jaw RelationANS-PNS / Go-Gn

25º ± 6.0º

Dento-Basal Relations

Maxillary Incisor Inclination1 - ANS-PNS

110º ± 6.0º

Mandibular Incisor Inclination1 - Go-Gn

94º ± 7.0º

Mandibular Incisor Compensation1 - A-Pg (mm)

2 ± 2.0

Dental Relations

Overjet (mm) 3.5 ± 2.5

Overbite (mm) 2 ± 2.5

Interincisal Angle1 / 1

132º ± 6.0º

PERIAPICAL OR PANORAMIC RADIOGRAPHS

BEFORE TREATMENT

WBLO 09


ANY OTHER RADIOGRAPHS BEFORE TREATMENT

WBLO 10

If needed


RADIOGRAPHIC ANALYSIS

BEFORE TREATMENT

RADIOGRAPHIC ANALYSIS

BEFORE TREATMENT

A. INTRAORAL / PANORAMIC RADIOGRAPH

B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT

WBLO 11


TREATMENT PLAN

AND THE REASON FOR IT

TREATMENT PLAN

AND THE REASON FOR IT

WBLO 12


TREATMENT STEPS INTRA-ORAL OCCLUSAL VIEW COLOUR PHOTOGRAPHS

UPPER ARCH

WBLO 12-1


WBLO 12-2


TREATMENT STEPS INTRA-ORAL OCCLUSAL VIEW COLOUR PHOTOGRAPHS

LOWER ARCH

RÉSUMÉ OF THE TREATMENT CARRIED OUT

INCLUDING

ANY DIFFICULTIES ENCOUNTERED

RÉSUMÉ OF THE TREATMENT CARRIED OUT

INCLUDING

ANY DIFFICULTIES ENCOUNTERED

WBLO 13


FRONTALSMILING

PROFILE

WBLO 14

FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT




INTRA-ORAL COLOUR PHOTOGRAPHS OF THEOCCLUSION AT COMPLETION OF TREATMENT

WBLO 15


LATERAL SKULL RADIOGRAPH

AT COMPLETION OF TREATMENT

WBLO 16


TRACING OF LATERAL SKULL RADIOGRAPH


WBLO 17

THIS TRACING SHOULD BE IN THE COLOR RED.






ASSESSMENT 2


ASSESSMENT 2

WBLO 18


Pretreatment Posttreatment Mean SD



82º ± 3.5º


80º ± 3.5º


2º ± 2.5º



8º ± 3.0º


33º ± 2.5º


25º ± 6.0º



110º ± 6.0º


94º ± 7.0º


2 ± 2.0

Dental Relations




132º ± 6.0º

PERIAPICAL OR PANORAMIC RADIOGRAPHS


WBLO 19


RADIOGRAPHIC ANALYSIS AT

COMPLETION OF TREATMENT

RADIOGRAPHIC ANALYSIS AT

COMPLETION OF TREATMENT

A. INTRAORAL / PANORAMIC RADIOGRAPH

B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT

WBLO 20


DESCRIPTION OF THE

TREATMENT RESULT

DESCRIPTION OF THE

TREATMENT RESULT

WBLO 21


DESCRIPTION OF THE

POST-TREATMENT EVALUATION

OF RETENTION

DESCRIPTION OF THE

POST-TREATMENT EVALUATION

OF RETENTION

WBLO 21-1


FRONTALSMILING

PROFILE

WBLO 22

FACIAL PHOTOGRAPHS AT RETENTION / POST RETENTIONCANDIDATE NUMBER: DATE: AGE:CASE NUMBER:



INTRA-ORAL COLOUR PHOTOGRAPHSAT RETENTION / POST-RETENTION

WBLO 23


LATERAL SKULL RADIOGRAPH AT RETENTION / POST-RETENTION

WBLO 24


TRACING OF LATERAL SKULL RADIOGRAPH

AT RETENTION / POST-RETENTION

WBLO 25


THIS TRACING SHOULD BE IN THE COLOR GREEN.





ASSESSMENT 3


ASSESSMENT 3

WBLO 26


Pretreatment Posttreatment Retention/Postretention

Mean SD



82º ± 3.5º


80º ± 3.5º


2º ± 2.5º



8º ± 3.0º


33º ± 2.5º


25º ± 6.0º



110º ± 6.0º


94º ± 7.0º


2 ± 2.0

Dental Relations




132º ± 6.0º

DESCRIPTION OF RETENTION /

POST-RETENTION FINDINGS

DESCRIPTION OF RETENTION /

POST-RETENTION FINDINGS

CANDIDATE NUMBER: DATE: AGE:

WBLO 27

CASE NUMBER:

eslo case presentation forms

Documents

posttreatment records

treatment plan

retention time

active treatment time

post retention records

treatment candidate

pretreatment records

malocclusion case category