Student name:	Date:

Patient:

Born:

Age: years months

History and Etiology:

Medical Hx:

•

Dental:

•

Chief Complaint:

•

Etiology of Malocclusion:

•

Diagnosis/Problem List:

Facial Pattern:

• Profile:

•

• Growth issues?:

Antero-Posterior:

•

• Overjet: mm

•

•

Transverse:

• Midlines

•

•

Vertical:

• Overbite: by mm

• Curve of Spee:

•

Arch Perimeter/Dentition:

• Caries risk:

• Maxillary space assessment: by mm

• Mandibular space assessment: by mm

• Tooth size discrepancy (Bolton)?:

• Missing teeth?:

• Occlusal shifts or problems?:

Specific Goals of Treatment:

Facial Pattern/Esthetics:

• Profile:

•

Skeletal Goals:

• Maxilla skeletal goals:

• Mandible skeletal goals:

• Growth goals:

Dentition:

• Antero-Posterior:

• Transverse:

• Vertical:

• Arch Perimeter:

Functional Goals (Occlusion):

•

Other Goals (hygiene, periodontal tissue concerns, etc.):

•

Treatment Plan:

Pretreatment Records:	Date Taken:

Overall Diagnosis from Diagnostic Summary Sheet:

•

•

Treatment:

• Extractions:

• Appliance:

1. Initiated	Date:	Extractions (if done)

Appliance placed

2. Active Treatment Time to date	months

Treatment Plan:

Treatment Progress:

Results Achieved

Facial Pattern/Esthetics:

• Profile:

•

Facial Skeleton:

• Maxilla:

• Mandible:

• Growth:

Dentition:

• Antero-Posterior:

• Transverse:

• Vertical:

• Arch Perimeter:

Functional Objectives (Occlusion):

•

Retention (Planned or Completed):

• Maxillary:

• Mandibular:

Final Evaluation:

•

Cephalometric Summary

Area of Study

Measurements

Mean (s.d.

Patient

Maxilla to	SNA	(p.18)	82 ( 3

Position of Maxilla is:
Cranial Base	NA - FH	90 ( 4
Mandible to	SNB	(p.20)	79 ( 3

Position of Mandible is:
Cranial Base	SN - Pg	80 ( 3
NPg - FH	87 ( 4
Maxilla to Mandible	ANB	(p.28)	3 ( 2	Skeletal:	Class
SN - MP	(p.22)	32 ( 5

Mandibular Plane Angle:
FH - MP	24 ( 3
Vertical	Y axis - SN	66 ( 3

Mandibular growth direction:
Relations	Y axis - FH	59 ( 3
UAFH (N-ANS) mm

Lower Anterior Face Height:
LAFH (ANS-Me) mm
UAFH/LAFH Ratio	0.8
Chin	Pog - NB (mm)	(p.52)	3 ( 2	Chin:
Maxillary	U1 to SN (deg.)	(p.44)	(p.44)	103 ( 6

Position of Maxillary Incisors is:
Incisors	U1 to NA (deg.)	22 ( 6
U1 to NA (mm)	(p.44)	(p.44)	3 ( 2
Mandibular	L1 to NB (deg.)	25 (7

Position of Mandibular Incisors is:
Incisors	L1 to NB (mm)	(p.48)	3 (2
L1 - MP (deg)	(p.46)	90 (5
Max. to Mand.	Interincisal Angle	(p.32)	135 (11

Inter-incisal Relations:
Incisors	Overjet (mm)	(p.34)	2 (2	Overjet:

Overbite:
Overbite (mm)	(p.36)	3 (2

Orthodontics 631 Patient Observation Exercise

RESUME

Orthodontics

2006-09-05

Geoffrey M. Greenlee

U of W