1. ACAD Case Presentations ACAD Academy of Cosmetic and Adhesive Dentistry Case Presentations Date Dr. Name City Years in Practice

2. Patient Information Name:____(Get Release)___ Age:____ Sex ___ Chief Complaint. (In the Patients words, what motivated the patient to seek Treatment) What are Their Expectations? How Would they Like to Look? Medical Health History. Allergies. Financial Limitations.

3. Dental History Dental History:________________________ Periodontal Prognosis:__________________ Endodontic Concerns: __________________ Orthodontic History:____________________ Dental Materials Allergies:_______________ Dental Plan Considerations:______________

4. Dental Charting _____________________________________

5. Preoperative - Full Face ACAD Founded 1984 Date/Image/Taken

6. Preoperative - Incisal Show ACAD Founded 1984

7. Preoperative - Half Smile ACAD Founded 1984

8. Preoperative - Full Smile ACAD Founded 1984

9. Preoperative - Retracted Smile ACAD Founded 1984

10. Preoperative - Upper Arch Mirror ACAD Founded 1984

11. Preoperative - Lower Arch Mirror ACAD Founded 1984

12. Preoperative - Left Occlusion ACAD Founded 1984

13. Preoperative - Right Occlusion ACAD Founded 1984

14. Esthetic Analysis Face Classification: Square Oval Tapering, etc Occlusion Class: I, II, III Lip Length, Tooth Exposure:______________ Smile Line: __________________ Incisal Silhouette:____________________ Gingival Outline:______________________ Diastemas:___________________________ Inclinations:_____________ Rotations:_________________ Color of Teeth, Discolorations: Wear and Parafunctions:________

15. Dental Treat Planning Smile Analysis:________________________ Vertical Dimension:_________________ Endodontic Concerns: __________________ Orthodontic History:____________________ Dental Plan Considerations:______________

16. Panographic Film ACAD Founded 1984 Date/Image/Taken

17. Full Mouth Radiographic Series ACAD Founded 1984 Date/Image/Taken

18. Study Models - Facial View ACAD Founded 1984 Date/Image/Taken

19. Study Models - Lingual View ACAD Founded 1984 Date/Image/Taken

20. Treatment ACAD Founded 1984 Date/Image/Taken

21. Treatment ACAD Founded 1984 Date/Image/Taken

22. Treatment ACAD Founded 1984 Date/Image/Taken

23. Treatment ACAD Founded 1984 Date/Image/Taken

24. Complications ACAD Founded 1984 Date/Image/Taken

25. Postoperative - Full Face ACAD Founded 1984 Date/Image/Taken

26. Postoperative - Smile ACAD Founded 1984

27. Postoperative - Retracted Smile ACAD Founded 1984

28. Postoperative - Upper Arch Mirror ACAD Founded 1984

29. Postoperative - Lower Arch Mirror ACAD Founded 1984

30. Postoperative - Left Occlusion ACAD Founded 1984

31. Postoperative - Right Occlusion ACAD Founded 1984

32. Before - After Smile ACAD Founded 1984 Date/Image/Taken

33. Before - After ACAD Founded 1984 Date/Image/Taken

34. 1 Month Before - After ACAD Founded 1984 Date/Image/Taken

35. 1 Month Before - After ACAD Founded 1984 Date/Image/Taken

36. 3 Months Before - After ACAD Founded 1984 Date/Image/Taken

37. 3 Month Before - After ACAD Founded 1984 Date/Image/Taken

38. 6 Months Before - After ACAD Founded 1984 Date/Image/Taken

39. 6 Month Before - After ACAD Founded 1984 Date/Image/Taken

40. 12 Months Before - After ACAD Founded 1984 Date/Image/Taken

41. 12 Month Before - After ACAD Founded 1984 Date/Image/Taken

42. QUESTIONS E-Mail Address Address Phone