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

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

3. NAME: BORN: SEX: PRETREATMENT RECORDS: CLASSIFICATION: TEETH MISSING BEFORE TREATMENT: APPLIANCE: TREATMENT STARTED: TREATMENT ENDED: ACTIVE TREATMENT TIME: POSTTREATMENT 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: AGE:DATE: ESLO 02 RÉSUMÉ OF CASE 6 CLASS III MALOCCLUSION CASE CATEGORY :

4. 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: CANDIDATE NUMBER: CASE NUMBER: DATE:AGE: ESLO 03

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

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

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

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

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

10. Pre- treatment Mean SD Sagittal Skeleatal Maxillary Position S-N-A 82º ±3.5º Mandibular Position S-N-Pg 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N/ANS- PNS 8º ± 3.0º Mandibular Inlination S-N/Go-Gn 33º ± 2.5º CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 ESLO 08 CANDIDATE NUMBER: CASE NUMBER: DATE:AGE:

11. Pre- treatment Mean SD Vertical Jaw Relation ANS- PNS/Go-Gn 25º ± 6.0º Dento- Basal Relations Maxillary Incisor Inclination 1-ANS-PNS 110º ± 6.0º Mandibular Incisor Inclination 1-Go-Gn 94º ± 7.0º CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 ESLO 08-1 CANDIDATE NUMBER: CASE NUMBER: DATE:AGE:

12. Mandibular Incisor Compensati on 1 –A-Pg (mm) 2 ± 2.0 Dental Relations Overjet (mm) 2º ± 2.0 Overbite (mm) 2 ± 2.5 Interincisal Angle 1/1 132º ± 6.0º CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 ESLO 08-2 CANDIDATE NUMBER: CASE NUMBER: DATE:AGE:

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

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

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

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

17. RADIOGRAPHIC ANALYSIS BEFORE TREATMENT 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 TREATMENT PLAN AND THE REASON FOR IT CANDIDATE NUMBER: CASE NUMBER: DATE:AGE: ESLO 12

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

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

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

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

23. Right BuccalLeft Buccal Center Upper OcclusalLower Occlusal CANDIDATE NUMBER: CASE NUMBER: DATE:AGE: INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION AT COMPLETION OF TREATMENT ESLO 15

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

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

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

27. Pre- treatment Mean SD Sagittal Skeleatal Maxillary Position S-N-A 82º ±3.5º Mandibular Position S-N-Pg 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N/ANS- PNS 8º ± 3.0º Mandibular Inlination S-N/Go-Gn 33º ± 2.5º CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 CANDIDATE NUMBER: CASE NUMBER: DATE:AGE: ESLO 18

28. Pre- treatment Mean SD Vertical Jaw Relation ANS- PNS/Go-Gn 25º ± 6.0º Dento- Basal Relations Maxillary Incisor Inclination 1-ANS-PNS 110º ± 6.0º Mandibular Incisor Inclination 1-Go-Gn 94º ± 7.0º CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 CANDIDATE NUMBER: CASE NUMBER: DATE:AGE: ESLO 18-1

29. Mandibular Incisor Compensati on 1 –A-Pg (mm) 2 ± 2.0 Dental Relations Overjet (mm) 2º ± 2.0 Overbite (mm) 2 ± 2.5 Interincisal Angle 1/1 132º ± 6.0º CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 CANDIDATE NUMBER: CASE NUMBER: DATE:AGE: ESLO 18-2

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

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

32. RADIOGRAPHIC ANALYSIS AT COMPLETION OF TREATMENT 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 DESCRIPTION OF THE TREATMENT RESULT CANDIDATE NUMBER: CASE NUMBER: DATE:AGE: ESLO 21

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

35. Right BuccalLeft Buccal Center Upper OcclusalLower Occlusal CANDIDATE NUMBER: CASE NUMBER: DATE:AGE: INTRA-ORAL COLOUR PHOTOGRAPHS AT RETENTION / POST-RETENTION ESLO 23

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

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

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

39. Pre- treatment Mean SD Sagittal Skeleatal Maxillary Position S-N-A 82º ±3.5º Mandibular Position S-N-Pg 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N/ANS- PNS 8º ± 3.0º Mandibular Inlination S-N/Go-Gn 33º ± 2.5º CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 CANDIDATE NUMBER: CASE NUMBER: DATE:AGE: ESLO 26

40. Pre- treatment Mean SD Vertical Jaw Relation ANS- PNS/Go-Gn 25º ± 6.0º Dento- Basal Relations Maxillary Incisor Inclination 1-ANS-PNS 110º ± 6.0º Mandibular Incisor Inclination 1-Go-Gn 94º ± 7.0º CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 CANDIDATE NUMBER: CASE NUMBER: DATE:AGE: ESLO 26-1

41. Mandibular Incisor Compensati on 1 –A-Pg (mm) 2 ± 2.0 Dental Relations Overjet (mm) 2º ± 2.0 Overbite (mm) 2 ± 2.5 Interincisal Angle 1/1 132º ± 6.0º CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 CANDIDATE NUMBER: CASE NUMBER: DATE:AGE: ESLO 26-2

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