Representative diagnosis

Orthodontics

Facial Form

A. Frontal: - Bilateral Symmetry: - Symmetry - Asymmetry

B. Profile: - Straight - Concave - Convex - Protrusive

1) Maxilla: - Normal - Protrusive - Retrusive

2) Mandible: - Normal - Protrusive - Retrusive

C. Vertical: - Face: - Normal - Short - Long

D. Lips: 1) Together in Centric Occlusion when relaxed 2) Apart in Centric Occlusion when relaxed 3) Gummy Smile

Dentition

A. Stage of Dentition: - Primary - Mixed (Early) - Mixed (Late) - Permanent

B. Number of Erupted Adult Teeth: - Incisors: __U, __L - Canines: __U, __L - Premolars: __U, __L - Molars: __U, __L

C. Periodontal Status: - (All adults must have recent periodontal probings) - Abnormal Frenum - Gingival Recession

D. Endodontics:

E. Restorative Status: - Caries - Prosthetic Restorations

Anteroposterior

A. Angle Classification: - Class I - Class II Division 1 - Class II Division 2 - Class III

B. Molar Relationship: - Right Molar: __ - Right Canine: __ - Left Canine: __ - Left Molar: __ - (Choices: II, SI [Super I], I, E, ml) - Edge to Edge - Anterior Crossbite - Incisor Overjet: __mm

Vertical

A. Posterior Openbite: - __mm

B. Overbite: - __%

C. Anterior Openbite: - __mm

Transverse

A. Dental Midlines to Face: - Upper: __mm - Lower: __mm

B. Posterior Crossbite: - Unilateral - Bilateral

C. Intermolar Width Difference: - __mm

D. Scissors Bite

E. Asymmetry in Dental Arches

F. Functional Shifts on Closure: - Anteroposterior - Transverse

Premature Loss of Deciduous Teeth:

Tooth Size/Arch Size: - Excess Space - Adequate Space - Crowding

Radiographic Analysis: - Supernumerary Teeth - Missing Tooth - Impacted Teeth - Root Resorption - Root Dilaceration - Periapical Pathology - Alveolar Bone Height - Other -