1

EUROPEAM SOCIETYOF LINGUAL

ORTHODONTISTS

APPENDIX 1CASE PRESENTATION FORMS

EUROPEAN SOCIETYOF LINGUAL

ORTHODONTISTS

CANDIDATE NUMBER:

CASE NUMBER:

Year:

ESLO 01

NAME:

BORN:

SEX:

PRETREATMENT RECORDS:

CLASSIFICATION:

TEETH MISSING BEFORE TREATMENT:

APPLIANCE:

TREATMENT STARTED:

TREATMENT ENDED:

ACTIVE TREATMENT TIME:

POSTTREATMENT 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:

ESLO 02

RÉSUMÉ OF CASE 8

A SIGNIFICANT TRANSVERSE DISCREPANCY

CASE CATEGORY:

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

FRONTAL 45°

PROFILE

ESLO 04

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

FACIAL PHOTOGRAPHS BEFORE TREATMENT

Right Buccal Left Buccal

CenterUpper Occlusal Lower Occlusal

ESLO 05

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENT

ESLO 06

LATERAL SKULL RADIOGRAPH BEFORE TREATMENT

Print on transparent support

ESLO 07

TRACING OF LATERAL SKULL RADIOGRAPHBEFORE TREATMENT

Print on transparent support

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ESLO 07-1

Pre-treatment

Mean SD

Sagittal Skeleatal

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 Inlination

S-N/Go-Gn

33º ± 2.5º

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 1

ESLO 08

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

Pre-treatment

Mean SD

Vertical Jaw Relation

ANS-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

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 1

ESLO 08-1

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

Mandibular Incisor

Compensation

1 –A-Pg (mm)

2 ± 2.0

Dental Relations

Overjet (mm) 2º ± 2.0

Overbite (mm)

2 ± 2.5

Interincisal Angle

1/1132º ± 6.0º

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 1

ESLO 08-2

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

PERIAPICAL OR PANORAMIC RADIOGRAPHS

BEFORE TREATMENT

ESLO 09

Print on transparent support

ÊSLO 09-1

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ANY OTHER RADIOGRAPHS BEFORE TREATMENT

ESLO 10

If needed

Print on transparent support

ESLO 10-1

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

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

Right Buccal Left Buccal

CenterUpper Occlusal Lower Occlusal

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT

ESLO 12-1

Right Buccal Left Buccal

CenterUpper Occlusal Lower Occlusal

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT

ESLO 12-2

RÉSUMÉ OF THE TREATMENT CARRIED OUT

INCLUDING

ANY DIFFICULTIES ENCOUNTERED

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ESLO 13

FRONTAL 45°

PROFILE

ELO 14

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

 

FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT

Right Buccal Left Buccal

CenterUpper Occlusal Lower Occlusal

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

INTRA-ORAL COLOUR PHOTOGRAPHS OF THEOCCLUSION AT COMPLETION OF TREATMENT

ESLO 15

LATERAL SKULL RADIOGRAPH

AT COMPLETION OF TREATMENT

ESLO 16

Print on transparent support

TRACING OF LATERAL SKULL RADIOGRAPH

AT COMPLETION OF TREATMENT

ESLO 17

Print on transparent support

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ESLO 17-1

Pre-treatment

Mean SD

Sagittal Skeleatal

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 Inlination

S-N/Go-Gn

33º ± 2.5º

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 2

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ESLO 18

Pre-treatment

Mean SD

Vertical Jaw Relation

ANS-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

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 2

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ESLO 18-1

Mandibular Incisor

Compensation

1 –A-Pg (mm)

2 ± 2.0

Dental Relations

Overjet (mm) 2º ± 2.0

Overbite (mm)

2 ± 2.5

Interincisal Angle

1/1132º ± 6.0º

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 2

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ESLO 18-2

PERIAPICAL OR PANORAMIC RADIOGRAPHS

AT COMPLETION OF TREATMENT

ESLO 19

Print on transparent support

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

FRONTAL 45°

PROFILE

ESLO 22

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

FACIAL PHOTOGRAPHS AT RETENTION / POST RETENTION

Right Buccal Left Buccal

CenterUpper Occlusal Lower Occlusal

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

INTRA-ORAL COLOUR PHOTOGRAPHSAT RETENTION / POST-RETENTION

ESLO 23

LATERAL SKULL RADIOGRAPH AT RETENTION / POSTRETENTION

ESLO 24

Print on transparent support

TRACING OF LATERAL SKULL RADIOGRAPH

AT RETENTION / POST-RETENTION

ESLO 25

Print on transparent support

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ESLO 25-1

Pre-treatment

Mean SD

Sagittal Skeleatal

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 Inlination

S-N/Go-Gn

33º ± 2.5º

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 3

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ESLO 26

Pre-treatment

Mean SD

Vertical Jaw Relation

ANS-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

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 3

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ESLO 26-1

Mandibular Incisor

Compensation

1 –A-Pg (mm)

2 ± 2.0

Dental Relations

Overjet (mm) 2º ± 2.0

Overbite (mm)

2 ± 2.5

Interincisal Angle

1/1132º ± 6.0º

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 3

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ESLO 26-2

DESCRIPTION OF RETENTION /

POST-RETENTION FINDINGS

CANDIDATE NUMBER:

CASE NUMBER:DATE: AGE:

ESLO 27