Project Description

During an Orthodontic Exam, dentists complete a form like this one to determine the malocclusion and develop a treatment plan. Computers are also used to check a side view X-ray like the one pictured. This type of X-ray is called a cephalometric X-ray.

ORTHODONTIC EXAMINATION
Patient’s Name: __________________________________________________________________ Chart No.: ___________________
Date of Birth: _________________________ Sex: ‰ M ‰ F
Patient Motivation: ____________________________________________________________________________________________
1. History Chief Complaint Medical History Dental History Referring Dentist
2. Extra Oral Examination
a. Facial Type: ‰ normocephalic ‰ brachycephalic ‰ dolychocephalic
b. Facial Symmetry: „ symmetrical face „ asymmetrical face „ upper dental midline „ upper midline: deviated ______ mm to the ______________________________ „ lower mandibular midline: deviated ______ mm to the ______________________________ „ lower dental midline: deviated ______ mm to the ______________________________
c. Facial Proportions: ‰ normal facial proportions ‰ increased lower face height ‰ decreased lower face height
Comments_________________________________________________________________________________ __________________________________________________________________________________________
d. Facial Profile: „ normal „ convex: ‰ slight ‰ moderate ‰ severe „ concave: ‰ slight ‰ moderate ‰ severe
Etiology _________________________________________________________________________________________________
e. Lips
„ upper lip length: ‰ normal ‰ short
PATIENT’S NAME: ________________________________________________________________________________ CHART NO.: ___________________
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„ at rest: ‰ normal ‰ strained ‰ deficient lip seal „ upper incisor showing (at rest): ‰ 0mm ‰ 2mm ‰ 4mm ‰ 6mm
3. Neuromuscular Examination
a. Tongue at rest: ‰ normal ‰ anterior tongue posture b. Swallowing pattern: ‰ normal ‰ infantile (tongue thrust)
4. Temporomandibular Examination
a. Muscles of Mastication „ masseter ____________________________________________________________________ „ temporalis____________________________________________________________________ „ pterygoid_____________________________________________________________________ „ insertion of posterior neck muscles _____________________________________________
a. Articular Capsule
„palpation_______________________________________________________________________ ________________________________________________________________________________
b. Mandibular Range of Motion
5. Intra-Oral Examination
1. Teeth Present: ( see Diagram ) 2. Missing Teeth _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3. Molar Classification. Right side 4. Molar Classification. Left side ‰ Cl I Cl I ‰ Cl II Cl II ‰ Cl III Cl III
5. Canine Class. Right side 6. Canine class. Left side
PATIENT’S NAME: _____ __ ___________________________________________________________________ CHART NO.: ___________________
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_ _____
‰ Cl Cl I ‰ Cl II Cl II ‰ Cl III Cl III 7. Overbite ‰ negative ‰ 0% ‰ 10% ‰ 25% ‰ 50% ‰ 75% ‰ 100% 8. Overjet ‰ negative (in centric relation) ‰ end-to-end ‰2mm ‰4mm ‰6mm ‰8mm ‰10mm 9. Dental Midline (refer to Facial Examination) 10. Soft Tissue Assessment
Oral Hygiene ‰ Good ‰ Fair ‰ Poor
Periodontal Assessment a. Normal b. Gingivitis Moderate – Severe c. Attached gingival: Adequate – Inadequate Teeth involved: _____________________ d. Probing: 16 —- 26 —— 36 —– 46 —– Lower incisors ——————- Upper incisors ——————-
e. Crossbite 1. Teeth involved ___________________________ 2. Functional ‰ yes ‰ no
f. Arch Shape Shape UPPER LOWER normal ‰ ‰ tapered ‰ ‰ square ‰ ‰
1. Normal Upper Lower 2. Tapered Upper Lower 3. Square Upper Lower
g. Amount of Crowding Quadrant NORMAL MILD MODERATE SEVERE UR ‰ ‰ ‰ ‰ UL ‰ ‰ ‰ ‰ LR ‰ ‰ ‰ ‰ LL ‰ ‰ ‰ ‰
6. Panoramic Radiograph Analysis Number of Teeth Upper Canine Angulation Upper Molar Angulation Suspected Dental Decay Abnormal Sequence of Eruption Bone Pathology Condyles
PATIENT’S NAME: ________________________________________________________________________________ CHART NO.: ___________________
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7. Dental Casts Analysis (validation of the clinical findings)
1. Molar Rotation ‰ normal ‰ Mesially rotated ( moderately, severely )
2. Angle Classification
‰ Cl I ‰ Cl II ‰ Cl III ____________________________________________________________ 3. Overbite 4. Overjet 5. Midlines
6. Tooth Positioning
abnormal tip _______________________ abnormal torque ______________________ rotation 7. Arch Length Analysis Insert Page 3 front of old design retyped.
Bolton Analysis a. Σ 43, 42, 41, 31, 32, 33 = = Σ LA b. Σ 13, 12, 11, 21, 22, 23 = = Σ UA c. Σ LA/Σ UA = (norm = 77%) Interpretation __________________________________________________________________________________________
8. Cephalometric Analysis
CEPHALOMETRIC ANALYSIS
Measurement Value
Nor mal
Standard Deviation
Skeletal
SNA 81 3 SNB 78 3 ANB 3 2 FACIAL ANGLE 88 4 WITTS 2 2 MAND. PLANE ANGLE 33 3 Y AXIS 60 4 Dento-Alveolar UPPER INC. TO NA 23 6 LOWER INC. TO NB 27.5 5 UPPER INC./ LOWER INC 130 7 LOWER INC. TO MAND. PLANE 91.4 4
PATIENT’S NAME: ________________________________________________________________________________ CHART NO.: ___________________
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Interpretation of Results
Position of the maxilla in relation to the cranial base:
Position of the mandible in relation to cranial base:
Position of the upper incisor in relation to the maxilla
Position of the mandible in relation to the mandible
Growth direction predictions
Vertical component (facial proportions)
PATIENT’S NAME: ________________________________________________________________________________ CHART NO.: ___________________
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