EUROPEAM SOCIETY OF LINGUAL ORTHODONTISTS APPENDIX 1 CASE PRESENTATION FORMS

1. EUROPEAM SOCIETY OF LINGUAL ORTHODONTISTS APPENDIX 1 CASE PRESENTATION FORMS 1

2. EUROPEAN SOCIETY OF LINGUAL ORTHODONTISTS CANDIDATE NUMBER: CASE NUMBER: Year: ESLO 01

3. 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: ESLO 02

4. 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

5. 45° FRONTAL PROFILE FACIAL PHOTOGRAPHS BEFORE TREATMENT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 04

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

7. Print on transparent support LATERAL SKULL RADIOGRAPH BEFORE TREATMENT ESLO 06

8. Print on transparent support TRACING OF LATERAL SKULL RADIOGRAPHBEFORE TREATMENT ESLO 07

9. CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 07-1

10. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 08

11. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 08-1

12. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 08-2

13. Print on transparent support PERIAPICAL OR PANORAMIC RADIOGRAPHS BEFORE TREATMENT ESLO 09

14. CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ÊSLO 09-1

15. Print on transparent support ANY OTHER RADIOGRAPHS BEFORE TREATMENT If needed ESLO 10

16. CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 10-1

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

18. TREATMENT PLAN AND THE REASON FOR IT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 12

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

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

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

22. 45° FRONTAL PROFILE FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ELO 14

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

24. Print on transparent support LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT ESLO 16

25. Print on transparent support TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT ESLO 17

26. CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 17-1

27. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 18

28. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 18-1

29. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 18-2

30. Print on transparent support PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENT ESLO 19

31. CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 19-1

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

33. DESCRIPTION OF THE TREATMENT RESULT CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 21

34. 45° FRONTAL PROFILE FACIAL PHOTOGRAPHS AT RETENTION / POST RETENTION CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 22

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

36. Print on transparent support LATERAL SKULL RADIOGRAPH AT RETENTION / POSTRETENTION ESLO 24

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

38. CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 25-1

39. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 26

40. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 26-1

41. CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 26-2

42. DESCRIPTION OF RETENTION / POST-RETENTION FINDINGS CANDIDATE NUMBER: CASE NUMBER: DATE: AGE: ESLO 27