Title: Chief Complaint
1Chief Complaint
2Identifying Data
3Contributory Medical or Dental History (Ignore
if normal)
- Medical diagnosis and history
- Medications
- Previous orthodontics, splints, surgery, etc.
4Temporomandibular Disorder (Ignore if normal)
5 Clinical Diagnostic Exam
- Dental
- Periodontal
- Neurologic, Muscular, Orthopedic, Neurovascular
- Occlusal Analysis
6 Pre-treatment Facial slides
Frontal Frontal/Smiling
7 Pre-treatment Facial slides
Right 45? Right Profile
8 Pre-treatment X-RaysCephalometric Film
Frontal Lateral
9 Pre-treatment X-RaysPanoramic Film or Full
Mouth X-Rays
10Pre-treatment X-RaysWrist Film (Growing Patients)
11 Pre-treatment X-Rays SMV
12 Pre-treatment TMJ X-Rays Axis Oriented
Tomograms or CBCT
13 Pre-treatment Intraoral Slides
Right Buccal Frontal
Left Buccal
Upper Occlusal Overjet Lower
Occlusal
14Pre-treatment Mounted Models
Right Buccal Frontal
Left Buccal
Right Overjet CPI
Left Overjet
15 Pre-treatment CPI or MPI
16Pre-treatment Axiograph or Axi-path
17 CO-CR Conversion
- Tracing CO in Black
- Tracing CR in Purple
18 Pre-treatment Ricketts CR
19 Pre-treatment Roth-Jarabak CR
20Reason of splint therapy
21Splint Therapy Progress Slides 00
Weeks Later
Right Buccal Frontal
Left Buccal
Overjet
22Splint Therapy Progress Slides 00
Weeks Later
Right Buccal Frontal
Left Buccal
Overjet
23Splint Therapy Progress Slides 00
Weeks Later
Right Buccal Frontal
Left Buccal
Overjet
24Splint Therapy Progress Slides 00
Weeks Later
Right Buccal Frontal
Left Buccal
Overjet
25 CPI Data Sheet Summary
26 Changes in CPI data during splint therapy
Left
Right
Initial
00 weeks
00 weeks
R
L
00 weeks
00 weeks
00 weeks
00 weeks
00 weeks
27 Post Splint Facial slides
Frontal Frontal/Smiling
28 Post Splint Facial slides
Right 45? Right Profile
29 Post Splint X-RaysCephalometric Film
Frontal Lateral
30 Post Splint TMJ X-Rays Axis Oriented Tomograms
or CBCT
31 Post Splint Intraoral Slides
Right Buccal Frontal
Left Buccal
Upper Occlusal Overjet Lower
Occlusal
32Post Splint Mounted Models
Right Buccal Frontal
Left Buccal
Right Overjet
Left Overjet
33Post Splint Split Cast Check
34 Post Splint Ricketts CR
35 Post Splint Roth-Jarabak CR
36Pre Splint VS Post Splint Full Superimposition
- Tracing Pre Splint in Black
- Tracing Post Splint in Green
37Pre Splint VS Post Splint 5 Point
Superimposition
- Tracing Pre Splint in Black
- Tracing Post Splint in Green
38Post Splint Axiograph or Axi-path
39Post Splint Mounted Models 3-D Check
Right Buccal Frontal
Left Buccal
Right Overjet
Left Overjet
40Problem List After Splint Therapy
41Treatment Plan
42Mechanics
43Post Splint VS VTO Full Superimposition
- Tracing Post Splint in Green
- Tracing VTO in Red
44Post Splint VS VTO 5 Point Superimposition
- Tracing Post Splint in Green
- Tracing VTO in Red
45Post Splint VS VTO Image
46Treatment Progress Intraoral SlidesWire sequence
Right Buccal Frontal
Left Buccal
Upper Occlusal Overjet Lower
Occlusal
00 months Later
47Treatment Progress Intraoral SlidesWire sequence
Right Buccal Frontal
Left Buccal
Upper Occlusal Overjet Lower
Occlusal
00 months Later
48Treatment Progress Intraoral SlidesWire sequence
Right Buccal Frontal
Left Buccal
Upper Occlusal Overjet Lower
Occlusal
00 months Later
49Treatment Progress Intraoral SlidesWire sequence
Right Buccal Frontal
Left Buccal
Upper Occlusal Overjet Lower
Occlusal
00 months Later
50Treatment Progress Intraoral SlidesWire sequence
Right Buccal Frontal
Left Buccal
Upper Occlusal Overjet Lower
Occlusal
00 months Later
51Treatment Progress Intraoral SlidesWire sequence
Right Buccal Frontal
Left Buccal
Upper Occlusal Overjet Lower
Occlusal
00 months Later
52End of fixed type appliance therapy Mounted
Models
Right Buccal Frontal
Left Buccal
Right Overjet CPI
Left Overjet
53End of fixed type appliance therapy Axi-path or
Axiograph
54Gnathological Positioner Set-up
Right Buccal Frontal
Left Buccal
Right Overjet
Left Overjet
55 Post-treatment Intraoral Slides
Right Buccal Frontal
Left Buccal
Upper Occlusal Overjet Lower
Occlusal
56Post-treatment Mounted Models
Right Buccal Frontal
Left Buccal
Right Overjet CPI
Left Overjet
57 Post-treatment CPI or MPI
58 Post-treatment Facial slides
Frontal Frontal/Smiling
59 Post-treatment Facial slides
Right 45? Right Profile
60 Post-treatment X-RaysCephalometric Film
Frontal Lateral
61 Post-treatment X-RaysPanoramic Film or Full
Mouth X-Rays
62 Post-treatment TMJ X-Rays Axis Oriented
Tomograms or CBCT
63Post-treatment Ricketts
64Post-treatment Roth-Jarabak
65Post Splint VS Post Tx Full Superimposition
- Tracing Post Splint in Green
- Tracing Post Ontho. in Blue
66Post Splint VS Post Tx 5 Point Superimposition
- Tracing Post Splint in Green
- Tracing Post Ontho. in Blue
67VTO VS Post Tx Full Superimposition
- Tracing VTO in Red
- Tracing Post Ortho. in Blue
68VTO VS Post Tx 5 Point Superimposition
- Tracing VTO in Red
- Tracing Post Ortho. in Blue