1

EUROPEAN SOCIETY

OF LINGUAL

ORTHODONTICS

APPENDIX 1

CASE PRESENTATION FORMS

EUROPEANSOCIETY

OF LINGUALORTHODONTICS

CANDIDATE NUMBER:

CASE NUMBER:

Year:

WBLO 01

RÉSUMÉ OF CASE 1RÉSUMÉ OF CASE 1

ADULT MALOCCLUSION

NAME:

BORN:

SEX:

PRE-TREATMENT RECORDS:

CLASSIFICATION:

TEETH MISSING BEFORE TREATMENT:

APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:

ACTIVE TREATMENT TIME:

POST-TREATMENT RECORDS:

RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:

(POST-) RETENTION RECORDS:

TIME OUT OF RETENTION:

DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

CASE CATEGORY:

WBLO 02

TREATMENT PLAN:

AGE: DATE:

WBLO 02

RÉSUMÉ OF CASE 2RÉSUMÉ OF CASE 2

CLASS I MALOCCLUSIONCASE CATEGORY:

NAME:

BORN:

SEX:

PRE-TREATMENT RECORDS:

CLASSIFICATION:

TEETH MISSING BEFORE TREATMENT:

APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:

ACTIVE TREATMENT TIME:

POST-TREATMENT RECORDS:

RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:

(POST-) RETENTION RECORDS:

TIME OUT OF RETENTION:

DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02

RÉSUMÉ OF CASE 3RÉSUMÉ OF CASE 3

CLASS II DIV. 2 MALOCCLUSIONCASE CATEGORY:

NAME:

BORN:

SEX:

PRE-TREATMENT RECORDS:

CLASSIFICATION:

TEETH MISSING BEFORE TREATMENT:

APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED :

ACTIVE TREATMENT TIME:

POST-TREATMENT RECORDS:

RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:

(POST-) RETENTION RECORDS:

TIME OUT OF RETENTION:

DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02

RÉSUMÉ OF CASE 4RÉSUMÉ OF CASE 4

CLASS II DIVISION 1 MALOCCLUSIONCASE CATEGORY:

HIGH FRANKFORT MANDIBULAR PLANE ANGLE, MINIMUM

FM ANGLE OF 30° AND/OR SN TO Go-Gn ANGLE OF 37°

NAME:

BORN:

SEX:

PRE-TREATMENT RECORDS:

CLASSIFICATION:

TEETH MISSING BEFORE TREATMENT:

APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:

ACTIVE TREATMENT TIME:

POST-TREATMENT RECORDS:

RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:

(POST-) RETENTION RECORDS:

TIME OUT OF RETENTION:

DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02

RÉSUMÉ OF CASE 5RÉSUMÉ OF CASE 5

CLASS II DIVISION 1 MALOCCLUSIONCASE CATEGORY:

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:

PRE-TREATMENT RECORDS:

CLASSIFICATION:

TEETH MISSING BEFORE TREATMENT:

APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:

ACTIVE TREATMENT TIME:

POST-TREATMENT RECORDS:

RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:

(POST-) RETENTION RECORDS:

TIME OUT OF RETENTION:

DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02

RÉSUMÉ OF CASE 6RÉSUMÉ OF CASE 6

CLASS III MALOCCLUSIONCASE CATEGORY:

NAME:

BORN:

SEX:

PRE-TREATMENT RECORDS:

CLASSIFICATION:

TEETH MISSING BEFORE TREATMENT:

APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:

ACTIVE TREATMENT TIME:

POST-TREATMENT RECORDS:

RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:

(POST-) RETENTION RECORDS:

TIME OUT OF RETENTION:

DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02

RÉSUMÉ OF CASE 7RÉSUMÉ OF CASE 7

A SEVERE SKELETAL DISCREPANCYCASE CATEGORY:

NAME:

BORN:

SEX:

PRE-TREATMENT RECORDS:

CLASSIFICATION:

TEETH MISSING BEFORE TREATMENT:

APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:

ACTIVE TREATMENT TIME:

POST-TREATMENT RECORDS:

RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:

(POST-) RETENTION RECORDS:

TIME OUT OF RETENTION:

DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02

RÉSUMÉ OF CASE 8RÉSUMÉ OF CASE 8

A SIGNIFICANT TRANSVERSE DISCREPANCY

CASE CATEGORY:

NAME:

BORN:

SEX:

PRE-TREATMENT RECORDS:

CLASSIFICATION:

TEETH MISSING BEFORE TREATMENT:

APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:

ACTIVE TREATMENT TIME:

POST-TREATMENT RECORDS:

RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:

(POST-) RETENTION RECORDS:

TIME OUT OF RETENTION:

DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

WBLO 02

RÉSUMÉ OF CASE 9RÉSUMÉ OF CASE 9

REPLACEMENT CASECASE CATEGORY:

NAME:

BORN:

SEX:

PRE-TREATMENT RECORDS:

CLASSIFICATION:

TEETH MISSING BEFORE TREATMENT:

APPLIANCE:

TREATMENT STARTED:

TREATMENT FINISHED:

ACTIVE TREATMENT TIME:

POST-TREATMENT RECORDS:

RETAINERS:

RETENTION ENDED:

AGE:

RETENTION TIME:

(POST-) RETENTION RECORDS:

TIME OUT OF RETENTION:

DATE:

AGE: DATE:

AGE: DATE:

a)upper:

a)lower:

a)upper:

a)lower:

DATE:

DATE:

AGE: DATE:

TREATMENT PLAN:

AGE: DATE:

DIAGNOSTIC DESCRIPTION

OF THE MALOCCLUSION

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:

WBLO 03

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

FRONTAL SMILING

PROFILE

WBLO 04

 

FACIAL PHOTOGRAPHS BEFORE TREATMENT

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

Right Buccal Left Buccal

CenterUpper Occlusal Lower Occlusal

WBLO 05

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENT

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

WBLO 06

LATERAL SKULL RADIOGRAPH BEFORE TREATMENT

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

WBLO 07

TRACING OF LATERAL SKULL RADIOGRAPHBEFORE TREATMENT

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

THIS TRACING SHOULD BE IN THE COLOR BLACK.

REMOVE THIS PART AND PLACE ONLY THE LOWER PART WITH THE TEXT BELOW THE CUT OFF LINE AT THE BOTTOM OF THE TRANSPARENT COVER; THEN PLACE THE TRACING IN THE TRANSPARENT COVER. IN THIS WAY THE TRACING CAN BE EASILY INSPECTED.

HAND TRACING SHOULD FACE TO THE RIGHT.

COPIES ON TRANSPARENT MATERIAL ARE NECESSARY TO CONTROL RELIABILITY OF TRACINGS.

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 1

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 1

WBLO 08

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

Pretreatment Mean SD

Sagittal Skeletal Relations

Maxillary PositionS-N-A

82º ± 3.5º

Mandibular PositionS-N-Pg

80º ± 3.5º

Sagittal Jaw RelationA-N-Pg

2º ± 2.5º

Vertical Skeletal Relations

Maxillary InclinationS-N / ANS-PNS

8º ± 3.0º

Mandibular InclinationS-N / Go-Gn

33º ± 2.5º

Vertical Jaw RelationANS-PNS / Go-Gn

25º ± 6.0º

Dento-Basal Relations

Maxillary Incisor Inclination1 - ANS-PNS

110º ± 6.0º

Mandibular Incisor Inclination1 - Go-Gn

94º ± 7.0º

Mandibular Incisor Compensation1 - A-Pg (mm)

2 ± 2.0

Dental Relations

Overjet (mm) 3.5 ± 2.5

Overbite (mm) 2 ± 2.5

Interincisal Angle1 / 1

132º ± 6.0º

PERIAPICAL OR PANORAMIC RADIOGRAPHS

BEFORE TREATMENT

WBLO 09

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

ANY OTHER RADIOGRAPHS BEFORE TREATMENT

WBLO 10

If needed

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

RADIOGRAPHIC ANALYSIS

BEFORE TREATMENT

RADIOGRAPHIC ANALYSIS

BEFORE TREATMENT

A. INTRAORAL / PANORAMIC RADIOGRAPH

B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT

WBLO 11

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

TREATMENT PLAN

AND THE REASON FOR IT

TREATMENT PLAN

AND THE REASON FOR IT

WBLO 12

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

TREATMENT STEPS INTRA-ORAL OCCLUSAL VIEW COLOUR PHOTOGRAPHS

UPPER ARCH

WBLO 12-1

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

WBLO 12-2

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

TREATMENT STEPS INTRA-ORAL OCCLUSAL VIEW COLOUR PHOTOGRAPHS

LOWER ARCH

RÉSUMÉ OF THE TREATMENT CARRIED OUT

INCLUDING

ANY DIFFICULTIES ENCOUNTERED

RÉSUMÉ OF THE TREATMENT CARRIED OUT

INCLUDING

ANY DIFFICULTIES ENCOUNTERED

WBLO 13

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

FRONTALSMILING

PROFILE

WBLO 14

 

FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

Right Buccal Left Buccal

CenterUpper Occlusal Lower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THEOCCLUSION AT COMPLETION OF TREATMENT

WBLO 15

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

LATERAL SKULL RADIOGRAPH

AT COMPLETION OF TREATMENT

WBLO 16

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

TRACING OF LATERAL SKULL RADIOGRAPH

AT COMPLETION OF TREATMENT

WBLO 17

THIS TRACING SHOULD BE IN THE COLOR RED.

REMOVE THIS PART AND PLACE ONLY THE LOWER PART WITH THE TEXT BELOW THE CUT OFF LINE AT THE BOTTOM OF THE TRANSPARENT COVER; THEN PLACE THE TRACING IN THE TRANSPARENT COVER. IN THIS WAY THE TRACING CAN BE EASILY INSPECTED.

HAND TRACING SHOULD FACE TO THE RIGHT.

COPIES ON TRANSPARENT MATERIAL ARE NECESSARY TO CONTROL RELIABILITY OF TRACINGS.

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 2

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 2

WBLO 18

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

Pretreatment Posttreatment Mean SD

Sagittal Skeletal Relations

Maxillary PositionS-N-A

82º ± 3.5º

Mandibular PositionS-N-Pg

80º ± 3.5º

Sagittal Jaw RelationA-N-Pg

2º ± 2.5º

Vertical Skeletal Relations

Maxillary InclinationS-N / ANS-PNS

8º ± 3.0º

Mandibular InclinationS-N / Go-Gn

33º ± 2.5º

Vertical Jaw RelationANS-PNS / Go-Gn

25º ± 6.0º

Dento-Basal Relations

Maxillary Incisor Inclination1 - ANS-PNS

110º ± 6.0º

Mandibular Incisor Inclination1 - Go-Gn

94º ± 7.0º

Mandibular Incisor Compensation1 - A-Pg (mm)

2 ± 2.0

Dental Relations

Overjet (mm) 3.5 ± 2.5

Overbite (mm) 2 ± 2.5

Interincisal Angle1 / 1

132º ± 6.0º

PERIAPICAL OR PANORAMIC RADIOGRAPHS

AT COMPLETION OF TREATMENT

WBLO 19

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

RADIOGRAPHIC ANALYSIS AT

COMPLETION OF TREATMENT

RADIOGRAPHIC ANALYSIS AT

COMPLETION OF TREATMENT

A. INTRAORAL / PANORAMIC RADIOGRAPH

B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT

WBLO 20

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

DESCRIPTION OF THE

TREATMENT RESULT

DESCRIPTION OF THE

TREATMENT RESULT

WBLO 21

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

DESCRIPTION OF THE

POST-TREATMENT EVALUATION

OF RETENTION

DESCRIPTION OF THE

POST-TREATMENT EVALUATION

OF RETENTION

WBLO 21-1

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

FRONTALSMILING

PROFILE

WBLO 22

FACIAL PHOTOGRAPHS AT RETENTION / POST RETENTIONCANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

Right Buccal Left Buccal

CenterUpper Occlusal Lower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHSAT RETENTION / POST-RETENTION

WBLO 23

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

LATERAL SKULL RADIOGRAPH AT RETENTION / POST-RETENTION

WBLO 24

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

TRACING OF LATERAL SKULL RADIOGRAPH

AT RETENTION / POST-RETENTION

WBLO 25

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

THIS TRACING SHOULD BE IN THE COLOR GREEN.

REMOVE THIS PART AND PLACE ONLY THE LOWER PART WITH THE TEXT BELOW THE CUT OFF LINE AT THE BOTTOM OF THE TRANSPARENT COVER; THEN PLACE THE TRACING IN THE TRANSPARENT COVER. IN THIS WAY THE TRACING CAN BE EASILY INSPECTED.

HAND TRACING SHOULD FACE TO THE RIGHT.

COPIES ON TRANSPARENT MATERIAL ARE NECESSARY TO CONTROL RELIABILITY OF TRACINGS.

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 3

CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 3

WBLO 26

CANDIDATE NUMBER: DATE: AGE:CASE NUMBER:

Pretreatment Posttreatment Retention/Postretention

Mean SD

Sagittal Skeletal Relations

Maxillary PositionS-N-A

82º ± 3.5º

Mandibular PositionS-N-Pg

80º ± 3.5º

Sagittal Jaw RelationA-N-Pg

2º ± 2.5º

Vertical Skeletal Relations

Maxillary InclinationS-N / ANS-PNS

8º ± 3.0º

Mandibular InclinationS-N / Go-Gn

33º ± 2.5º

Vertical Jaw RelationANS-PNS / Go-Gn

25º ± 6.0º

Dento-Basal Relations

Maxillary Incisor Inclination1 - ANS-PNS

110º ± 6.0º

Mandibular Incisor Inclination1 - Go-Gn

94º ± 7.0º

Mandibular Incisor Compensation1 - A-Pg (mm)

2 ± 2.0

Dental Relations

Overjet (mm) 3.5 ± 2.5

Overbite (mm) 2 ± 2.5

Interincisal Angle1 / 1

132º ± 6.0º

DESCRIPTION OF RETENTION /

POST-RETENTION FINDINGS

DESCRIPTION OF RETENTION /

POST-RETENTION FINDINGS

CANDIDATE NUMBER: DATE: AGE:

WBLO 27

CASE NUMBER: