McGill University Health Clinic – montreal general hospital



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FACULTY OF DENTISTRY - mCGILL UNIVERSITY

DIVISION OF ORTHODONTICS

McCALL Dental Clinic

McGill University Health Clinic – MONTREAL GENERAL HOSPITAL

ORTHODONTIC EXAMINATION



Patient’s Name: __________________________________________________________________ Chart No.: ___________________
Date of Birth: _________________________ Sex:  M  F
Patient Motivation: ____________________________________________________________________________________________



  1. History




Chief Complaint




Medical History
















Dental History
















Referring Dentist






  1. Extra Oral Examination




    1. Facial Type:  normocephalic  brachycephalic  dolychocephalic




    1. Facial Symmetry:

symmetrical face

asymmetrical face

upper dental midline

upper midline: deviated ______ mm to the ______________________________

lower mandibular midline: deviated ______ mm to the ______________________________

lower dental midline: deviated ______ mm to the ______________________________




    1. Facial Proportions:  normal facial proportions  increased lower face height  decreased lower face height


Comments_________________________________________________________________________________

__________________________________________________________________________________________


    1. Facial Profile:

normal

convex:  slight  moderate  severe

concave:  slight  moderate  severe
Etiology _________________________________________________________________________________________________


    1. Lips

upper lip length:  normal  short

at rest:  normal  strained  deficient lip seal

upper incisor showing (at rest):  0mm  2mm  4mm  6mm


  1. Neuromuscular Examination




    1. Tongue at rest:  normal  anterior tongue posture

b. Swallowing pattern:  normal  infantile (tongue thrust)



  1. Temporomandibular Examination




    1. Muscles of Mastication

masseter ____________________________________________________________________

temporalis____________________________________________________________________

pterygoid_____________________________________________________________________

insertion of posterior neck muscles _____________________________________________




    1. Articular Capsule

palpation_______________________________________________________________________



________________________________________________________________________________



    1. Mandibular Range of Motion



5. Intra-Oral Examination


  1. Teeth Present: ( see Diagram )

  2. Missing Teeth _ _ _ _ _ _ _ _ _ _ _ _ _ _

  3. Molar Classification. Right side 4. Molar Classification. Left side

      • Cl I Cl I

      • Cl II Cl II

      • Cl III Cl III



  1. Canine Class. Right side 6. Canine class. Left side

      • Cl Cl I

      • Cl II Cl II

      • Cl III Cl III

7. Overbite  negative  0%  10%  25%  50%  75%  100%

8. Overjet  negative (in centric relation)  end-to-end 2mm 4mm 6mm 8mm 10mm

9. Dental Midline (refer to Facial Examination)

10. Soft Tissue Assessment
Oral Hygiene  Good  Fair  Poor
Periodontal Assessment

          1. Normal

          2. Gingivitis Moderate – Severe

          3. Attached gingival: Adequate – Inadequate Teeth involved: _____________________

          4. Probing: 16 ---- 26 ------ 36 ----- 46 -----

Lower incisors -------------------

Upper incisors -------------------


          1. Crossbite

            1. Teeth involved ___________________________

            2. Functional  yes  no



          1. Arch Shape

Shape

UPPER

LOWER

normal





tapered





square








            1. Normal Upper Lower

            2. Tapered Upper Lower

            3. Square Upper Lower



Quadrant

normal

mild

moderate

severe

UR









UL









LR









LL











6. Panoramic Radiograph Analysis

Number of Teeth




Upper Canine Angulation




Upper Molar Angulation




Suspected Dental Decay




Abnormal Sequence of Eruption




Bone Pathology




Condyles





7. Dental Casts Analysis (validation of the clinical findings)


1. Molar Rotation

normal  Mesially rotated ( moderately, severely )

2. Angle Classification

Cl I  Cl II  Cl III ____________________________________________________________

3. Overbite




4. Overjet




5. Midlines




6. Tooth Positioning

abnormal tip _______________________

abnormal torque ______________________

rotation

7. Arch Length Analysis

Insert Page 3 front of old design retyped.


Bolton Analysis

    1. 43, 42, 41, 31, 32, 33 = =  LA

    2. 13, 12, 11, 21, 22, 23 = =  UA

    3. LA/ UA = (norm = 77%)

Interpretation __________________________________________________________________________________________
8. Cephalometric Analysis

CEPHALOMETRIC ANALYSIS


Measurement

Value

Normal

Standard Deviation

Skeletal

SNA




81

3

SNB




78

3

ANB




3

2

Facial Angle




88

4

Witts




2

2

Mand. Plane Angle




33

3

Y axis




60

4

Dento-Alveolar

Upper inc. to NA




23

6

Lower inc. to NB




27.5

5

Upper inc./ Lower inc




130

7

Lower Inc. to Mand. Plane




91.4

4


Interpretation of Results





Position of the maxilla in relation to the cranial base:










Position of the mandible in relation to cranial base:










Position of the upper incisor in relation to the maxilla










Position of the mandible in relation to the mandible










Growth direction predictions










Vertical component (facial proportions)











Diagnosis


































































Treatment Plan

1. Objectives of Treatment




























2. Sequence of Treatment




























3. Mechanotherapy

























4. Summary





























Date: ___________________200___ Student’s Name (please PRINT): ____________________________________

Instructor’s Name (please PRINT): ____________________________________

Instructor’s Signature (mandatory): __________________



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