LASTNAME, FIRSTNAME

XX yrs. X mos. File #Xxxxxx

Chief Complaint: “A little crooked"

Health History:
• WNL

Facial Pattern:
• Profile: • Muscle Strain:
–Nasolabial Angle:
• Frontal Symmetry:
–Labiomental fold:
• Mx. Incisor Display at Rest:
• Chin:
• Mx. Incisor Display at Smile:
• Lips:
• Gingival Display on Smile:
Teeth Present:

R L

Antero-Posterior Relationship:
• Angle’s Classification:
• Overjet:
• Arch Symmetry:
–Maxilla:
–Mandible:

• Anterior Crossbites:
R L

–Functional Shift:

Vertical Relationship:
• Overbite:
• Curve of Spee:
• Mandibular Plane Angle:
• Open Bite:

Transverse Relationship:
• Midlines: • Posterior Crossbites:
–Maxilla:
R L
–Mandible:
Arch Perimeter/Dentition:
• Space Assesment:
–Maxilla:
–Mandible:
• Arch Shape:
–Maxilla:
–Mandible:

• Missing:

R L

• Spaces:

R L

• Rotated:

R L

• Caries: (clinical or radiographic)

R L

• Ankylosed:

R L

• Bolton Analysis:
Occlusion:
• CR/CO Discrepancy:
• Shift:
–A/P:
–Vertical:
–Transverse:

Growth Expected:
•

Soft Tissue/Hygiene:
• Hygiene:
• Frenum Problems:
• Attached Gingiva:
• Spot Probings:

Temporomandibular Joint:
• History of Pain/Trauma:
• Deviations:
• Sounds:
• Range of Motion:
–Max. Opening:
–Lateral Excursions:
-Right:
-Left:
–Protrusive:

Habits:
• Thumb/Finger Sucking:
• Bruxism/Clenching:

Behavior:
•
 CEPHALOMETRIC ANALYSIS

ANB: ° (2)

SNA: ° (81)
SNB: ° (79)
%NH: % (43) 1 NA: ° (22) 1 NA: mm (4)
YSN: °(67) 1 NB: ° (25) 1 NB: mm (4)
1–1: ° (135) OJ: mm (2)
OB: mm (3)
MPSN: ° (32) PgNB: mm (3)

MPFH: ° (24)

1 MP: ° (91)

• Harvold Analysis: female

Measured Mean (12 yr) Mean (16 yr)
Maxillary Unit (mm) 90 (SD=4.07) 93 (SD=3.45)

Mandibular Unit (mm) 113 (SD=5.2) 119 (SD=4.44)

LFH (mm) 62 (SD=4.36) 65 (SD=4.67)

Unit Difference (mm) 23 (16<X<36) 26 (19<X<39)

• Wits Analysis : (AO – BO = 0 ± 1.75) =

Radiographic/Cephalometric Findings:
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 Cephalometric Analysis

Area of Study Range Mean Patient

Measurements
Maxilla to SNA 75–87 81
Position of Maxilla is:
Cranial Base NA – FH 84–96 90 Protrusive Normal Retrusive
Mandible to SNB 72–87 79
Position of Mandible is:
Cranial Base SN – Pg 72–88 80 PrognathicNormal Retrogn
FH–NPg (Facial 82–95 87
angle)
Maxilla – ANB -1–5 2 Skeletal: Class I II III
Mandible
SN – MP 22–42 32
Mandibular Plane Angle:
FH – MP 18–30 24 High Normal Low
Vertical Y axis – SN 61–72 67
Mand growth direction:
Relations Y axis – FH 53–66 59 Vertical Normal Horizontal
UAFH (N–pal pl) mm Lower Anterior Face Height:
Total FH (N–Me) mm Short Normal Long
% nasal height UAFH/ total FH Ratio 40–46% 43%
Chin Pog - NB (mm) 2–5 3mm Prominent Normal
Recessive
Maxillary U1 to SN (deg.) 92–114 103 Pos'n of Max Incisors is:
Incisors U1 to NA (deg.) 3–31 22 Proclined Normal
U1 to NA (mm) -2–6 4mm Upright Retroclined
Mandibular L1 to NB (deg.) 8–40 25 7
Pos'n of Mand Incisors is:
Incisors L1 to NB (mm) 1–10 4mm
Proclined Normal
L1 - MP (deg) 81–97 91 Upright Retroclined
Max. to Mand. Interincisal Angle 130–150 135
Inter-incisal Relationship:
Incisors Overjet (mm) 1–4 2
Open Normal Deep
Overbite (mm) 1–6 3 Edge–Edge Neg Overjet
Facial Pattern Upper lip – E-plane 4 Lips:
Lower lip – E-plane 2
Retrusive Norm Protrusive