Orthodontic chart

Pacient:__________________________________________ DOB:_____________
Date:______________Referring Doctor:__________________________________
Adress:___________________________________________Tel:______________
E-mail:_____________________________________________________________
CC:________________________________________________________________
Goals for treatment:__________________________________________________
Obstacles for ideal treatment:__________________________________________

Facial type: Brachyfacial Mezzofacial Dolycofacial

Facial symmetry:____________________________________________________
Facial harmony:_____________________________________________________

Profile: Convex Straight Concave

Functions:__________________________________________________________
Vicious
habits:_______________________________________________________
Trauma:____________________________________________________________

1
Posture:____________________________________________________________
Palpation (1-10) Right Left Muscular TMJ Data
Temporalis Right Left
Masseter Opening click
Submandibular Closing click
Pterygoid Crepitation
Occipital Deviation
SCM Max opening
Trapezius Functional shift
Ressistance Yes No Clinical TMJ Data
MI Path CR

Dental data
Lower archform Normal Constricted
Spacing/Crowding None Mild Moderate Severe
Upper archform Normal Constricted
Spacing/Crowding None Mild Moderate Severe
Overbite Ideal Shalow Open Deep %
Overjet Ideal Mild Moderate Severe Negative mm
Crossbite None Unilateral Bilateral Tooth:
Molar class I II div. 1 II div. 2 II sub. R II sub. L III
Canine class I II II sub. R II sub. L III
Wear facets None Anterior Posterior
Right guidance Canine PosteriorG AnteriorGF N W Interferences
Left guidance Canine PosteriorG AnteriorGF N W Interferences
Protrusive guidance Anterior Balancing interferences
Premature contacts Tooth:

Frenum Max labial Mand labial Lingual Bucal

Biotype Normal Thin Thick
Recession None Localised: Generalised
Inflamation Absent Present
Visible Plaque Absent Present
Fremitus Absent Present

2
 Periodontal data
Sagital diagnosis CR Vertical diagnosis CR
Skeletal I / II / III Skeletal Open Normal Deep
Dental I / II / III Dental Open Normal Deep
Maxilla Deficency / Excess Maxilla Deficency / Excess
Mandible Deficency / Excess Mandible Deficency / Excess
Overjet mm Overbite %
Transverse diagnosis
Skeletal CBCT CAC Dental Measured Ideal Gain/Loss
Maxilla 45 WALA ridge 57
Mandible 41 FA 51 53
Difference 4 CF 41 43,5
Ideal 5 5 P 43 43,5
Required 1 FA 57 57

Space requirment
Mandible R Mandible L Maxilla R Maxilla L
Crowding/Spacing -4 -5 -3 -2,5
Incisior inclination +1 +1
Maxillary expansion
Dental expansion +1 +1
Curve of Spee
Tooth size discrepancy
Midline +1 -1
Space requirment -3 -4 -1 -2,5
Extraction / IPR
Lower molar movement
Molar relationship*
Upper molar movement
*CI I Molar = 0 discrepancy; Cl II Molar (cusp to cusp = -3); (full cusp = -5); Cl III Molar (cusp to cusp = +3); (full cusp = +5)

6 – 6 max =96 mm; 6 – 6 mand =87,5 mm; 3 – 3 max =47,5 mm; 3 - 3 mand =38 mm

Bolton anterior: maxillary excess < 77,2% < mandibulary excess – calculat = 80 %; excess: 1,33 mm

Bolton overall: maxillary excess < 91,3% < mandibulary excess – calculat = 91,14 %; excess: mm

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OBIECTIVE TERAPEUTICE
 Chirurgie?
 Merge distalizare arc inf buccal shelf plus stripping?Daca nu alta solutie?
 Retrat 46? cor prov?
 Pot aparea probl in etapa de niv si alin pt 13,12?
 Se poate corecta pozitia 44?
 Angrenajele inverse se pot corecta doar din arc?

PLAN DE TRATAMENT