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

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

3. RÉSUMÉ OF CASE 2 CLASS I MALOCCLUSION CASE CATEGORY: NAME: BORN: SEX:
PRETREATMENT RECORDS:
AGE:
DATE:
CLASSIFICATION:
TEETH MISSING BEFORE TREATMENT:
APPLIANCE:
TREATMENT STARTED:
AGE:
DATE:
TREATMENT ENDED:
AGE:
DATE:
ACTIVE TREATMENT TIME:
POSTTREATMENT RECORDS:
RETAINERS:
a)upper:
DATE:
a)lower:
RETENTION ENDED:
a)upper:
DATE:
a)lower:
RETENTION TIME:
(POST-) RETENTION RECORDS:
AGE:
DATE:
TIME OUT OF RETENTION:
ESLO 02

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

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

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

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

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

10. CEPHALOMETRIC MORPHOLOGICAL
ASSESSMENT 1
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
CANDIDATE NUMBER:
CASE NUMBER:
DATE:
AGE:
ESLO 08

11. CEPHALOMETRIC MORPHOLOGICAL
ASSESSMENT 1
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
CANDIDATE NUMBER:
CASE NUMBER:
DATE:
AGE:
ESLO 08-1

12. CEPHALOMETRIC MORPHOLOGICAL Mandibular Incisor Compensation
ASSESSMENT 1
Mandibular Incisor Compensation
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
CANDIDATE NUMBER:
CASE NUMBER:
DATE:
AGE:
ESLO 08-2

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

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

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

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

17. 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
CANDIDATE NUMBER:
CASE NUMBER:
DATE:
AGE:
ESLO 12

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

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

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

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

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

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

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

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

27. CEPHALOMETRIC MORPHOLOGICAL
ASSESSMENT 2
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
CANDIDATE NUMBER:
CASE NUMBER:
DATE:
AGE:
ESLO 18

28. CEPHALOMETRIC MORPHOLOGICAL
ASSESSMENT 2
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
CANDIDATE NUMBER:
CASE NUMBER:
DATE:
AGE:
ESLO 18-1

29. CEPHALOMETRIC MORPHOLOGICAL Mandibular Incisor Compensation
ASSESSMENT 2
Mandibular Incisor Compensation
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
CANDIDATE NUMBER:
CASE NUMBER:
DATE:
AGE:
ESLO 18-2

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

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

32. 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
CANDIDATE NUMBER:
CASE NUMBER:
DATE:
AGE:
ESLO 21

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

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

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

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

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

39. CEPHALOMETRIC MORPHOLOGICAL
ASSESSMENT 3
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
CANDIDATE NUMBER:
CASE NUMBER:
DATE:
AGE:
ESLO 26

40. CEPHALOMETRIC MORPHOLOGICAL
ASSESSMENT 3
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
CANDIDATE NUMBER:
CASE NUMBER:
DATE:
AGE:
ESLO 26-1

41. CEPHALOMETRIC MORPHOLOGICAL Mandibular Incisor Compensation
ASSESSMENT 3
Mandibular Incisor Compensation
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
CANDIDATE NUMBER:
CASE NUMBER:
DATE:
AGE:
ESLO 26-2

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