1. 1 WORLD BOARD OF LINGUAL ORTHODONTISTS APPENDIX 1 CASE PRESENTATION FORMS

2. WORLD BOARD OF LINGUAL ORTHODONTISTS CANDIDATE NUMBER: CASE NUMBER: Year: WBLO 01

3. RÉSUMÉ OF CASE 1 ADULT MALOCCLUSION 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: CASE CATEGORY : WBLO 02

4. 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: WBLO 02 RÉSUMÉ OF CASE 2 CLASS I MALOCCLUSION CASE CATEGORY :

5. 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: WBLO 02 RÉSUMÉ OF CASE 3 CLASS II DIV. 2 MALOCCLUSION CASE CATEGORY :

6. 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: WBLO 02 RÉSUMÉ OF CASE 4 CLASS II DIVISION 1 MALOCCLUSION CASE CATEGORY : HIGH FRANKFORT MANDIBULAR PLANE ANGLE, MINIMUM FM ANGLE OF 30° AND/OR SN TO Go-Gn ANGLE OF 37°

7. 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: WBLO 02 RÉSUMÉ OF CASE 5 CLASS II DIVISION 1 MALOCCLUSION CASE CATEGORY : A MALOCCLUSION WITH SIGNIFICANT MANDIBULAR ARCH LENGTH DEFICIENCY In at least one of the two Class II 1 cases the treatment must involve extractions in both dental arches °

8. 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: WBLO 02 RÉSUMÉ OF CASE 6 CLASS III MALOCCLUSION CASE CATEGORY :

9. 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: WBLO 02 RÉSUMÉ OF CASE 7 A SEVERE SKELETAL DISCREPANCY CASE CATEGORY :

10. 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: WBLO 02 RÉSUMÉ OF CASE 8 A SIGNIFICANT TRANSVERSE DISCREPANCY CASE CATEGORY :

11. 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: WBLO 02 RÉSUMÉ OF CASE 9 REPLACEMENT CASE CASE CATEGORY :

12. 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: WBLO 03 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

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

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

15. WBLO 06 LATERAL SKULL RADIOGRAPH BEFORE TREATMENT Print on transparent support

16. WBLO 07 TRACING OF LATERAL SKULL RADIOGRAPH BEFORE TREATMENT Print on transparent support

17. WBLO 07-1 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

18. 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 WBLO 08 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

19. 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 WBLO 08-1 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

20. 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 WBLO 08-2 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

21. PERIAPICAL OR PANORAMIC RADIOGRAPHS BEFORE TREATMENT WBLO 09 Print on transparent support

22. WBLO 09-1 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

23. ANY OTHER RADIOGRAPHS BEFORE TREATMENT WBLO 10 If needed Print on transparent support

24. WBLO 10-1 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

25. RADIOGRAPHIC ANALYSIS BEFORE TREATMENT RADIOGRAPHIC ANALYSIS BEFORE TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT WBLO 11 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

26. TREATMENT PLAN AND THE REASON FOR IT TREATMENT PLAN AND THE REASON FOR IT WBLO 12 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

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

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

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

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

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

32. LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT WBLO 16 Print on transparent support

33. TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT WBLO 17 Print on transparent support

34. WBLO 17-1 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

35. 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 WBLO 18 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

36. 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 WBLO 18-1 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

37. 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 WBLO 18-2 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

38. PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENT WBLO 19 Print on transparent support

39. WBLO 19-1 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

40. RADIOGRAPHIC ANALYSIS AT COMPLETION OF TREATMENT RADIOGRAPHIC ANALYSIS AT COMPLETION OF TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT WBLO 20 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

41. DESCRIPTION OF THE TREATMENT RESULT DESCRIPTION OF THE TREATMENT RESULT WBLO 21 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

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

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

44. LATERAL SKULL RADIOGRAPH AT RETENTION / POSTRETENTION WBLO 24 Print on transparent support

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

46. WBLO 25-1 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

47. 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 WBLO 26 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

48. 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 WBLO 26-1 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

49. 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 WBLO 26-2 CANDIDATE NUMBER: DATE: AGE: CASE NUMBER:

50. DESCRIPTION OF RETENTION / POST-RETENTION FINDINGS DESCRIPTION OF RETENTION / POST-RETENTION FINDINGS CANDIDATE NUMBER: DATE: AGE: WBLO 27 CASE NUMBER: