ࡱ > , bjbj . p~_p~_ F F 8 $! ! , 8 # $ $ $ $ 6 6 6 "8 $8 $8 $8 $8 $8 $8 $ : == p H8 6 5 " 6 6 6 H8 $ $ ]8 B7 B7 B7 6 R $ $ "8 B7 6 "8 B7 B7 B7 fu- j6 @ B7 8 s8 0 8 B7 = 6 L = B7 = B7 6 6 B7 6 6 6 6 6 H8 H8 6 L 6 6 6 8 6 6 6 6 = 6 6 6 6 6 6 6 6 6 F X : BI-COLLEGIATE MEMBERSHIP IN ORTHODONTICS A joint initiative between The Royal College of Physicians and Surgeons of Glasgow and The Royal College of Surgeons of England. Case Presentation Candidate Number: Patients Initials: Patients Date of Birth: Pre-Treatment Assessment Patients Initials: Sex: Date of Birth: Age at pre-treatment assessment: Age at start of treatment: Age at completion of active treatment: Patients complaint(s) Relevant Medical History Extra-Oral Assessment Skeletal assessment Soft tissue assessment TMJ Assessment Intra-Oral Examination Oral Hygiene and Dental Health Soft Tissue Assessment Erupted Teeth SHAPE \* MERGEFORMAT Arch Alignment and Space Assessment Maxillary Arch Mandibular Arch Occlusal relationships Incisor classificationOverjet (mm)OverbiteCentrelinesBuccal segment relationship Canine Molar Left Left Right RightCrossbitesDisplacementsOther features of note Pre-treatment IOTN dental health component: Extra-Oral Photographs (please include full face; full face smiling (if possible); right profile) Intra-Oral Photographs (Please include anterior view, plus left and right buccal views of teeth in occlusion AND occlusal views) Images (5) of digital models or physical study models (OPTIONAL) (Please include anterior view, plus left and right buccal views of teeth in occlusion AND occlusal views) Special Investigations Pre-treatment Radiographs (please include copies of radiographs) Views taken Unerupted teeth Absent teeth Pathology Other relevant radiographic findings Other special investigations and results Pre-treatment Cephalometric Tracing (Please include hand-drawn or digital cephalometric tracing- in BLACK) Pre-treatment Cephalometric Analysis Sagittal skeletal relationships Pre-treatment Normal (SD)* SNA 81 +/- 3 SNB 78 +/- 3 ANB 3 +/- 2 Vertical skeletal relationships Pre-treatment Normal (SD)* Maxillary inclination S-N/ANS-PNS 8 +/- 3 MMPA 27 +/- 3 LFH % 55 +/- 2 Dento-basal relationships Pre-treatment Normal (SD)* Upper incisor to maxillary plane 109 +/- 6 Lower incisor to mandibular plane 93 +/- 6 Lower incisor to A-Po line 0-2 mm +/- 2 mm Inter-incisal angle 133 +/- 10 (*Values given are for Caucasians, if patient of other ethnic group please insert correct means for that population) Summary of Cephalometric analysis Aetiology of Presenting Malocclusion Aims of Treatment (Please list) Treatment Plan (Please list details of extractions, appliances, any adjunctive treatment / surgery, retention regime) Rationale (Please briefly justify treatment chosen) Prognosis for stability (Briefly state) Additional Information for Inter-disciplinary cases (Surgical predictions and restorative details can be included here) Sequence of Treatment (Please include (5 - 10) key stages of treatment with date and treatment details) Mid-Treatment Photographs (Please include intra-oral views of appliances here) At or near end of active treatment radiographs (Please include copies of all relevant radiographs) At or near end of treatment cephalometric radiographs (Please include hand-drawn or digital cephalometric tracing- in RED. Use GREEN for post-functional tracings) Pre and end of treatment superimpositions (Overall superimposition on Sella-Nasion line at Sella with pre-treatment BLACK and near end of treatment RED. Post-functional tracings in GREEN font.) Maxillary superimposition (On malar buttress, palatal vault or other appropriate structure) Mandibular superimposition (On stable structures) At or near end of treatment Cephalometric analysis Sagittal skeletal relationships End of treatment Change during treatment SNA SNB ANB Vertical skeletal relationships End of treatment Change during treatment Maxillary inclination S-N/ANS-PNS MMPA LFH % Dento-basal relationships End of treatment Change during treatment Upper incisor to maxillary plane Lower incisor to mandibular plane Lower incisor to A-Po line Inter-incisal angle Summary of treatment changes (Briefly) End of active treatment extra-oral photographs (Please include full face, full face smiling (if possible); right profile) End of active treatment intra-oral photographs (Please include anterior view, plus left and right buccal views of teeth in occlusion) End of active treatment images of digital models or physical study models (OPTIONAL) (Please include anterior view, plus left and right buccal views of teeth in occlusion AND occlusal views) Assessment of outcome of treatment Pre- treatment PAR score: Post-treatment PAR score: Percentage reduction in PAR score: Post treatment evaluation (Should include discussion of treatment prognosis) ) * + , 6 7 K P ` Ź hO9 h2) CJ \^J aJ *h