WORLD BOARD OF LINGUAL ORTHODONTISTS APPENDIX 1 CASE PRESENTATION FORMS

1. WORLD BOARD OF LINGUAL ORTHODONTISTS APPENDIX 1 CASE PRESENTATION FORMS 1

2. WORLD BOARD OF LINGUAL ORTHODONTISTS CANDIDATE NUMBER: CASE NUMBER: Year: WBLO 01

3. RÉSUMÉ OF CASE 1 CASE CATEGORY: ADULT MALOCCLUSION NAME: BORN: SEX: PRETREATMENT RECORDS: AGE: DATE: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: AGE: TREATMENT STARTED: DATE: TREATMENT ENDED: AGE: DATE: ACTIVE TREATMENT TIME: POSTTREATMENT RECORDS: a)upper: RETAINERS: DATE: a)lower: RETENTION ENDED: a)upper: DATE: a)lower: RETENTION TIME: (POST-) RETENTION RECORDS: AGE: DATE: TIME OUT OF RETENTION: WBLO 02

4. RÉSUMÉ OF CASE 2 CASE CATEGORY: CLASS I MALOCCLUSION NAME: BORN: SEX: PRETREATMENT RECORDS: AGE: DATE: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: AGE: TREATMENT STARTED: DATE: TREATMENT ENDED: AGE: DATE: ACTIVE TREATMENT TIME: POSTTREATMENT RECORDS: a)upper: RETAINERS: DATE: a)lower: RETENTION ENDED: a)upper: DATE: a)lower: RETENTION TIME: (POST-) RETENTION RECORDS: AGE: DATE: TIME OUT OF RETENTION: WBLO 02

5. RÉSUMÉ OF CASE 3 CASE CATEGORY: CLASS II DIV. 2 MALOCCLUSION NAME: BORN: SEX: PRETREATMENT RECORDS: AGE: DATE: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: AGE: TREATMENT STARTED: DATE: TREATMENT ENDED: AGE: DATE: ACTIVE TREATMENT TIME: POSTTREATMENT RECORDS: a)upper: RETAINERS: DATE: a)lower: RETENTION ENDED: a)upper: DATE: a)lower: RETENTION TIME: (POST-) RETENTION RECORDS: AGE: DATE: TIME OUT OF RETENTION: WBLO 02

6. RÉSUMÉ OF CASE 4 CASE CATEGORY: CLASS II DIVISION 1 MALOCCLUSION HIGH FRANKFORT MANDIBULAR PLANE ANGLE, MINIMUM FM ANGLE OF 30° AND/OR SN TO Go-Gn ANGLE OF 37° NAME: BORN: SEX: PRETREATMENT RECORDS: AGE: DATE: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: AGE: TREATMENT STARTED: DATE: TREATMENT ENDED: AGE: DATE: ACTIVE TREATMENT TIME: POSTTREATMENT RECORDS: a)upper: RETAINERS: DATE: a)lower: RETENTION ENDED: a)upper: DATE: a)lower: RETENTION TIME: (POST-) RETENTION RECORDS: AGE: DATE: TIME OUT OF RETENTION: WBLO 02

7. RÉSUMÉ OF CASE 5 CASE CATEGORY: CLASS II DIVISION 1 MALOCCLUSION 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: PRETREATMENT RECORDS: AGE: DATE: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: AGE: TREATMENT STARTED: DATE: TREATMENT ENDED: AGE: DATE: ACTIVE TREATMENT TIME: POSTTREATMENT RECORDS: a)upper: RETAINERS: DATE: a)lower: RETENTION ENDED: a)upper: DATE: a)lower: RETENTION TIME: (POST-) RETENTION RECORDS: AGE: DATE: TIME OUT OF RETENTION: WBLO 02

8. RÉSUMÉ OF CASE 6 CASE CATEGORY: CLASS III MALOCCLUSION NAME: BORN: SEX: PRETREATMENT RECORDS: AGE: DATE: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: AGE: TREATMENT STARTED: DATE: TREATMENT ENDED: AGE: DATE: ACTIVE TREATMENT TIME: POSTTREATMENT RECORDS: a)upper: RETAINERS: DATE: a)lower: RETENTION ENDED: a)upper: DATE: a)lower: RETENTION TIME: (POST-) RETENTION RECORDS: AGE: DATE: TIME OUT OF RETENTION: WBLO 02

9. RÉSUMÉ OF CASE 7 CASE CATEGORY: A SEVERE SKELETAL DISCREPANCY NAME: BORN: SEX: PRETREATMENT RECORDS: AGE: DATE: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: AGE: TREATMENT STARTED: DATE: TREATMENT ENDED: AGE: DATE: ACTIVE TREATMENT TIME: POSTTREATMENT RECORDS: a)upper: RETAINERS: DATE: a)lower: RETENTION ENDED: a)upper: DATE: a)lower: RETENTION TIME: (POST-) RETENTION RECORDS: AGE: DATE: TIME OUT OF RETENTION: WBLO 02

10. RÉSUMÉ OF CASE 8 CASE CATEGORY: A SIGNIFICANT TRANSVERSE DISCREPANCY NAME: BORN: SEX: PRETREATMENT RECORDS: AGE: DATE: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: AGE: TREATMENT STARTED: DATE: TREATMENT ENDED: AGE: DATE: ACTIVE TREATMENT TIME: POSTTREATMENT RECORDS: a)upper: RETAINERS: DATE: a)lower: RETENTION ENDED: a)upper: DATE: a)lower: RETENTION TIME: (POST-) RETENTION RECORDS: AGE: DATE: TIME OUT OF RETENTION: WBLO 02

11. RÉSUMÉ OF CASE 9 CASE CATEGORY: Replacement Case NAME: BORN: SEX: PRETREATMENT RECORDS: AGE: DATE: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: AGE: TREATMENT STARTED: DATE: TREATMENT ENDED: AGE: DATE: ACTIVE TREATMENT TIME: POSTTREATMENT RECORDS: a)upper: RETAINERS: DATE: a)lower: RETENTION ENDED: a)upper: DATE: a)lower: RETENTION TIME: (POST-) RETENTION RECORDS: AGE: DATE: TIME OUT OF RETENTION: WBLO 02

12. 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: AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 03

13. 45° FRONTAL PROFILE FACIAL PHOTOGRAPHS BEFORE TREATMENT AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 04

14. Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENT AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 05

15. Print on transparent support LATERAL SKULL RADIOGRAPH BEFORE TREATMENT WBLO 06

16. Print on transparent support TRACING OF LATERAL SKULL RADIOGRAPHBEFORE TREATMENT WBLO 07

17. AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 07-1

18. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 08

19. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 08-1

20. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 08-2

21. Print on transparent support PERIAPICAL OR PANORAMIC RADIOGRAPHS BEFORE TREATMENT WBLO 09

22. AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 09-1

23. Print on transparent support ANY OTHER RADIOGRAPHS BEFORE TREATMENT If needed WBLO 10

24. AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 10-1

25. RADIOGRAPHIC ANALYSIS BEFORE TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH B. Interpretation of cephalometric assessment AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 11

26. TREATMENT PLAN AND THE REASON FOR IT AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 12

27. Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 12-1

28. Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 12-2

29. RÉSUMÉ OF THE TREATMENT CARRIED OUT INCLUDING ANY DIFFICULTIES ENCOUNTERED AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 13

30. 45° FRONTAL PROFILE FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 14

31. Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THEOCCLUSION AT COMPLETION OF TREATMENT AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 15

32. Print on transparent support LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT WBLO 16

33. Print on transparent support TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT WBLO 17

34. AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 17-1

35. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 18

36. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 18-1

37. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 18-2

38. Print on transparent support PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENT WBLO 19

39. AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 19-1

40. RADIOGRAPHIC ANALYSIS AT COMPLETION OF TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH B. Interpretation of cephalometric assessment AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 20

41. DESCRIPTION OF THE TREATMENT RESULT AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 21

42. 45° FRONTAL PROFILE FACIAL PHOTOGRAPHS AT RETENTION / POST RETENTION AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 22

43. Right Buccal Left Buccal Center Upper Occlusal Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHSAT RETENTION / POST-RETENTION AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 23

44. Print on transparent support LATERAL SKULL RADIOGRAPH AT RETENTION / POSTRETENTION WBLO 24

45. Print on transparent support TRACING OF LATERAL SKULL RADIOGRAPH AT RETENTION / POST-RETENTION WBLO 25

46. AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 25-1

47. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 26

48. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 26-1

49. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 26-2

50. DESCRIPTION OF RETENTION / POST-RETENTION FINDINGS AGE: CASE NUMBER: DATE: CANDIDATE NUMBER: WBLO 27