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DEPARTMENT OF ORTHODONTICS& DENTOFACIAL

ORTHOPAEDICS

PATIENT RECORD

Patient’s name:.......................................................Date of birth:........./........../......................

Age:........................... Sex: male/female OP number:.........................................

Occupation :

Parent’s name: ..................................................................................................................

Occupation : ..................................................................................................................

Annual income : ....................................... Ceph.no :.........................................................

OPG no :........................................................

Permanent addresss: Temporary address:

..................................................................... ........................................................................

..................................................................... .......................................................................

..................................................................... ........................................................................

..................................................................... .......................................................................

Phone no: ...................................................land line............................................................cell

Mother tongue:...........................................Medium of education:.............................................

Diet: veg nonveg mixed School:..................................................................

Ethnic origin:.............................................. Standard:...............................................................

Presenting complaint :

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Motivated by: self others

DIAGNOSTIC AIDS USED

1.Study models 2.Orthopantomograph 3.Lateral cephalogram

4.Intra oral X rays

a.Periapical b.Occlusal c.Shift cone(for impacted canines)

5.Facial photographs 6.Carpal X ray 7.P.A.cephalogram

8.Any other investigation or consultation:-

HISTORY

1 a) Informer: patient Father mother any other

i) Condition of the mother during pregnancy:

Normal Medication Trauma Disease

ii) Delivery : full term Premature
iii) Type of delivery:
Normal Forceps Caesarean

b) Medical history:

i) Major illnessor injuries in the past/surgical operations undergone

ii) Presently under treatment for:

iii)Allergies :

c) Childhood history:

i) Prolonged bottle feeding How long?

ii) Habits: Digital/pacifier sucking, nail biting, cheek sucking, tongue sucking & tongue
thrusting , bruxism/ clenching

iii)Mouth breathing habit: mouth : open/closed

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snoring : yes / no

Respiratory obstruction :

Treatment under gone :

iv) Mental development :

v) Mile stones in development

sitting / crawling/standing /walking /running /speaking

vi) Do any other members of the family have similar dental or facial characters

father mother siblings relatives

vii) Recent increase in height :

viii) Menstruation( in girls) / Change of voice (in boys)

How long back?

d) Dental history:

i) Caries:

ii) Periodontal problems :

iii)Trauma:

iv)Any teeth extracted :

CLINICAL EXAMINATION

GENERAL EXAMINATION:

i) Height : normal advanced retarded

ii)Weight : normal advanced retarded

iii) Gait :

iv) Posture :

v) Body type : Ectomorphic Mesomorphic Endomorphic

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EXTRA ORAL EXAMINATION:

Frontal view

i) Head shape : Mesocephalic Dolicocephalic Branchycephalic

ii) Cephalic index :maximum skull width x 100

maximum skull length

Dolichocephalic x-75.9 , Mesocephalic 76.0 – 80.9 , Branchycephalic (short skull) 81.0 - 85.4 , Hyperbranchycephalic 85.5 - x

iii) Facial index :Morphological facial height x 100

Bizygomatic width

Mesoprosopic Euryprosopic Leptoprosopic

Hypereuryprosopic x – 78.9 , Euryprosopic 79.0 , Mesoprosopic 84.0 – 87.9 , Leptoprosopic 88.0- 92.9 , Hyperleptoprosopic 93.0 - x

iv) Symmetry :

Rule of fifths

v) Vertical proportionality

Upper face :

Middle face :

Lower face: Nose – Stomium :

Stomium – Chin :

vi) Inter labial gap :

vii) Dental midline v/s Jaw midline

Upper :

Lower :

viii) smile arc: Constant Flat Reverse

ix) Incisor exposure on smile :

x) Height of philtrum – Height of commissures:

Profile view

i) Facial outline : Straight Convex Concave

Anterior divergent Posterior divergent

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ii) F M P A : average / high / low

Soft tissues

i) Lips : Competent Incompetent Potentially competent

: Short upper lip Short lower lip

ii) Lip contour : Normal Everted

iii)Exposure of upper incisor below upper lip line:.........................mm

iv) Resting L lip line: Average Low High Lip trap

v) Lip protrusion : Upper Lower Both

vi) Lip step : Slightly negative Markedly negative Positive

vii)Naso labial sulcus : Acute Normal Obtuse

viii)Mento labial sulcus: Normal Shallow Deep

ix) Size of chin : Normal Prominent Receding

x) VTO in patient with receding chin:

FUNCTIONAL ANALYSIS

Functional Occlusion

i)Difference between CR and CO : ............................................................................

ii)Anterior glide : ............................................................................

iii)Lateral glide : .............................................................................

iv) Freeway space :………………………………………………….

TMJ Examination

i) Palpation

Tenderness : yes /no

:Right ....................................................................................
:Left ......................................................................................
ii)Auscultation :
iii) Joint resiliency test :

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Mandibular movements
i) Maximum mouth opening :....................................mm
ii) Right excursion :.....................................mm
iii)Left excursion :.....................................mm
iv)protrusion :.....................................mm
v) path of mandibular closure : normal deviated

Muscle examination
Masseter :..................................................................................................................
Lateral pterygoid :..................................................................................................................
Tongue
Crenation : Present / Absent

Symmetry : Present / Absent

Palpation :..................................................................................................................

Respiration

Oral Nasal Oronasal

Tests carried out :..................................................................................................................

Deglutition

Normal

Abnormal (describe):.......................................................................................................................................................

Speech

Normal

Abnormal (describe):.....................................................................................................................................................

Habits

Duration : ................................................................................................................................

Intensity : ...............................................................................................................................

Frequency :................................................................................................................................

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INTRA-ORAL EXAMINATION

General condition of mouth

i)Oral hygiene :

ii) Dental Caries i.r.t. :

iii) Teeth present :

Abnormalities of teeth

i)Shape :

ii)Size :

iii)Number :

Upper arch

Angulation Rotation Inclination Crowding/spacing

Labial segment

Canines

Buccal segment

Arch form : ‘U’ Shaped / ‘V’ Shaped / Square

Any other abnormality ( Transposition , extra teeth, impacted teeth):

Lower arch

Angulation Rotation Inclination Crowding/spacing

Labial segment

Canines

Buccal segment

Archform : ‘U’ Shaped / ‘V’ Shaped / Square

Any other abnormality ( Transposition , extra teeth, impacted teeth):

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In occlusion:

1. Antero-posterior Relationship:
Molar relation :
Canine relation : cl I / cl II / cl III
Incisor Relation : cl I / cl II / cl III
Overjet :
2. Vertical Relationship:

Overbite :

3. Transverse relationship:

Cross bite / Scissor bite :

4. Midline :

Soft tissue
Frenal attachment :Upper : mucosal / gingival / papillary / papillary penetrating
Lower : mucosal / gingival / papillary / papillary penetrating

Gingival recession :

Visible pathologies (Discoloration of teeth , sinus , abscess etc)

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DIAGNOSTIC AIDS & THEIR ANALYSIS

MODEL ANALYSIS
Space Analysis: Permanent Dentition
Size of the teeth (mesiodistal width)

Upper

6 5 4 3 2 1 1 2 3 4 5 6

Lower

Right Left
Curve of Spee : Lower

PONT’S ANALYSIS:
S.I = M.P.V = M.M.V =
C.P.V = S.I x100 C.M.V = S.I x100
80 64

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CAREY’S ANALYSIS :
UPPER LOWER
Arch perimeter
Space available

Mesiodistal width 54321 12345

54321 12345

Space Required :
Discrepancy b/w arch length & tooth material =
Indicated for

ASHLEY HOWE’S ANALYSIS :

Maxillary acrh
T.T.M = P.M.D = P.M.B.A.W=
≤ 37% = Extraction
≥44% = Non extraction
37-44% = Borderline case

P.MB.A.W % =P.M.B.A.W x100 =

T.T.M

Mandibular arch
T.T.M. = P.M.D = P.M.B.A.W =

P.M.B.A.W % = P.M.B.A.W x100 =

T.T.M

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BOLTON’S ANALYSIS :

BOLTON TOOTH RATIO

ANT.RATIO :Mand6 TM x 100 =77.2 % Max 12 TM=

Max 6 TM Mand 12TM=
Max.6 TM =
OVERALL RATIO :Mand 12 TM x 100 = 91.3% Mand 6 TM =
Max 12 TM

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MIXED DENTITION ANALYSIS :

INFERENCE FROM MODEL ANALYSIS :

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RADIOGRAPHIC AND CEPHALOMETRIC RECORD :

OPG (ORTHOPANTAMOGRAPH)
Teeth present:
Teeth absent:

IOPA radiographs :

Any other radiograph:

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HAND WRIST RADIOGRAPHS

STAGE

1.PP2 2.MP3 3.PiSi 4.S 5.MP3 cap 6.DP3u 7. 8.MP3u 9.Ru

H1 H2 Rcap PP3u
R= PP1 cap

10.6 12.0 12.6 13.0 14.0 15.0 15.9 15.9 18.5

8.1 8.1 9.6 10.6 11.0 13.0 13.3 13.9 16.0

ANY OTHER INVESTIGATION:

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CEPHALOMETRIC ANALYSIS

STEINER’S ANALYSIS

Measurements Mean Actual Inference

S
SN-FH 6-80
K

E SNA 820

L
SNB 800
E
ANB 20
T

A Go-Gn to SN 320

L
Occ to SN 140

D UI to NA 4mm

E UI to NA(angle) 220
N
LI to NB 4mm
T
LI to NB (angle) 250
A
I to T (angle) 1310
L

SN to UI 1020

DOWN’S ANALYSIS

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Angles Norms Range Pre-RX Inference Post

RX
S
Facial angle
K (N pog-FH) 87.80 820 to 950

E Angle of 00
convexity
L (N-A-Pog at A)
AB to N Pog -4.80 00 to -90
E (at point A)

T Mandibular 21.90 17 0to 280

Plane angle
A
Y Axis 59.40 530 to 660
L (S Gn at FH )

Cant of occlusal +9.30 +1.50 to 140

plane

I to T angle 135.40 1300-1500

D
E
N LI to mand.plane 1.40 -8.50 to +70
T
A LI to occ.plane 14.50 +3.50 to
L +200

UI to A Pog line +2.7mm -1mm to

+5mm

INFERENCE:-

WITS APPRAISAL

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AB Difference

Ideal

Male : AO is 1mm behind BO

Female : AO is coincident with BO

TWEED’S ANALYSIS

Angles Norms Pre-RX Inference Post RX

1. FMA 250 (220-280)

2. FMIA 650 (600-750)

3. IMPA 900 (850-950)

INFERENCE :-

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McNAMARA’S ANALYSIS

Measurement Means Pre RX Inference Post RX

Point A to N-perp 0 to 1 mm

Pogto N-perp -4 to 0 mm

Facial axis angle (Ba-N to Ptm-Gn) 00

Mandibular plane angle 220 ± 40

(Me-Go to FH plane)

Effective maxi. Length(Co - A)

Effective mand. Length(Co- Gn)

Maxillary-mandibular diff.

Lower ant. facial height(ANS-Me)

U1 to point A 4-6 mm

L1 to A-Pog distance 1-3mm

Naso-labial angle 1020±80

INFERENCE:-

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RICKETT’S ANALYSIS

Measurement Mean at Age Pre-RX Inference Post-

age 9 changes RX

Facial axis
S (Ba-N to Pt-Gn) 900+30 None
K Facial angle
E
L (FH-NPog) 870+30 +1/3 yrs
E Mandibular plane
T angle 260+40 -1/3 yrs
A Lower facial height
L
(ANS Xi-Xi PM) 470+40 None
Mandibular arc
(DC Xi-Xi PM) 260+40 -1mm/2 yrs
Convexity at point A
(NPog to A in mm) 2+2mm -1mm/5yrs
D
E
L1 to A Pog 1+2mm -1mm/3yrs
N
T L1 inclination
A (APog to incisor axis) 220+40 None
L U6 to pterygoid
vertical 21 mm +1mm/yrs

INFERENCE :-

SOFT TISSUE ANALYSIS

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STEINER’S LIP ANALYSIS

Position of lips to Pre-RX Inference Post RX

reference plane

Upper lip

Lower lip

INFERENCE :-

RICKETT’S LIP ANALYSIS

Position of lips to Pre-RX Inference Post RX

reference plane

Upper lip
(2-3mm behind)

Lower lip
(1-2mm behind)

INFERENCE :-

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HOLDAWAY’S ANALYSIS

Measurement Mean Pre RX Inference Post-RX

Facial angle 900
Upper lip curvature 2mm-5mm
Skeletal convexity at pt. A -2 to +2
H-angle 70 to150
Nose tip to H line 12 mm
Upper sulcus depth 5 mm
Upper lip thickness 15 mm
Upper lip strain 14 -16 mm
Lower lip to H line -1 to 2mm
Lower sulcus depth 5mm
Soft tissue chin thickness 10mm-12mm

INFERENCE:-

CEPHALOMETRIC ANALYSIS FOR ORTHOGNATHIC SURGERY

Measurements Mean Actual Inference

CRANIAL BASE female Male

Ar – Ptm (II HP) 32.1± 1.9mm 37.1 ± 2.8mm

Ar – N (II HP) 50.9 ±3mm 52.8 ±4.1mm

HORIZONTAL (SKELETAL)
N-A-Pog angle 2.60+5.10 3.9±6.4

N-A (II HP) -2±3.7mm 0.0±3.7mm

N-B (II HP) -6.9±4.3mm -5.3±6.7mm

N-Pog (II HP) -6.5±5.1mm 14.3±8.5mm

VERTCAL (SKELETAL AND DENTAL)

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N-ANS (Per HP ) 50 ±2.4mm 54 ±3.2mm

ANS –Gn(Per HP) 61.3 ±3.3mm 68.6 ±3.8mm

PNS-N(perHP) 50.6 ±2.2mm 53.9 ±1.7mm

MP-HP angle 24.20 ± 50 230 ± 5.90

U1-NF 27.5 ±1.7mm 30.5 ±2.1mm

L1-MP 40.8 ±1.8mm 45 ±2.1mm

U6-NF 23 ±1.3mm 26 ±2.2mm

L6-MP 32 ±1.9mm 35.8± 2.6mm

MAXILLA AND MANDIBLE

PNS-ANS (II HP) 52.5± 3.5mm 57.5± 2.5mm

Ar-Go(linear) 46.8 ±2.5mm 52 ±4.2mm

Go-Pog(linear) 74.3 ±5.8mm 83.7 ±4.6mm

B-Pog(II MP) 7.2 ±1.9mm 8.9 ±1.7mm

Ar-Go-Gn (angle) 1220 ±6.90 1190 ±6.50

DENTAL
OP upper–HP(angle) 7.10 ±2.50 6.10 ±5.10

A-B (II OP) 0.4 ±2.5 mm -1.1 ± 2mm

Upper 1-NF (angle) 1120 ±5.30 1110 ±4.70

Lower1 -MP(angle) 95.90 ±5.70 95.90 ±5.70

COMPOSITE ANALYSIS

Parameter Mean Pre RX Inference Post-

RX
SKELETAL
SNA 820
SNB 800
ANB 20
N per to A 0-1mm
N per to Pog -4 to 0mm
Go-Gn –SN 320
Angle of inclination 850
LAFH …

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Eff. Maxillary length …

Eff. Mandibular.length …
Y axis 530 – 660
Facial axis 900+30
Saddle angle 1230 ± 50
Articular angle 1430 ± 60
Gonial angle 1280 ± 70
Sum of posterior angles 3960 ± 60
DENTAL
UI to NA (angle) 220
UI to NA (mm) 4mm
SN to U1(angle) 1020
LI to NB( angle) 250
LI to NB (mm) 4mm
LI to A Pog (mm) -1 to 5mm
LI to Mand.(angle) 850 -950
Inter-incisal angle 1310
SOFT TISSUE
S line to upper lip 0
S line to lower lip 0
Nasolabial angle 1020 ± 80

SAGITTAL RELATION

HARD TISSUE Pre -treatment post-growth End of Rx Retention Change

modulation/surgery
Normal Measure- Measure- Measure- Measure- Measure-
ment class ment class ment class ment class ment class
ANB 2°

A┴toB┴on FH 4mm
AO to BO 0-1mm

Beta Angle 27° to 35°

NA – Pog 0-5°

AB – NPog - 4°

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Skeletal 1750
profile angle

Soft tissue 161°

profile angle

Total tissue 137° male

profile angle 133°female

Soft tissue 970+ 100

facial angle

Sub nasale ┴ 4-6 mm

to chin

SN Orientation angle

EFFECTS OF SOFT TISSUES IF ANY : Basic upper lip Normal [ ] Thick [ ] Thin [ ] (14+1)

Soft tissue chin Normal [ ] Thick [ ] Thin [ ] (10-12)

INFERENCE : Skeletal – Class I [ ] Severity - Mild [ ] Soft tissues - Matching [ ]

Class II [ ] - Moderate [ ] Compensating [ ]
Class III [ ] - Severe [ ] Aggravating [ ]

DISCREPANCY ANALYSIS : (SAGITTAL)

MAXILLA
Max apical base Norms Pre - Rx Post growth Post Rx Retention Change
modulation
SNA 82

┴A - N┴ 2mm

CAUSE
Max size ANS-PNS

Max effective
length Co-ANS
Max placement 18mm
S┴NF -ptm┴NF

MANDIBULAR APICAL BASE

SNB 80

B┴ - N┴ -2mm

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CHIN
N-Pog-FH 87°
(Facial angle)

CAUSE

SIZE
Mand. corpus size 1.05*S
N
Mand. ramus Ht Corpus*
5/7
Mand. eff length

MANDIBULAR PLACEMENT
Saddle angle 123±5°

Post cranial base 32-35m

Effect of gonial 128±7°

angle
Effect of ramus 143±6°
orientation(S-Ar-Go)

INFERENCE:
Fault with - Maxilla Size Placement

Mandible Size Placement

Both

VERTICAL RELATION
A) SKELETAL
Pre - Rx Post Post Rx Retention Change
growth
modulation
Normal Norm High low
al
Mid/lower face ht 45:55

Soft tissue vertical

proportion

SN-Go-Gn 32°

F-M-A 25°

Jarabak Ratio 62-65%

BJORK sum 396±6°

Saddle angle 123±5°

Articular angle 143±6°

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U-Gonial angle 52-55°

L-Gonial angle 70-75°

Y-axis N-S-Gn 66°

Yaxis FH-S-Gn 59°

Facial axis 0°

Compensated by
Ramus Ht?

Basal plane angle 25°

Occlusal 11°
NF
to
MP 140

Vert max
placement
Nasion-ANS 60±4
55±2
Maxillary rotation 85°

DIVERGENCE OF JAW BASES

Pre - Rx Post growth Post - Rx Retention Changes
modulation
a)Anterior Divergent

b)Anterior
Convergent

c)Upward anterior
rotation of both
max - mand
d)Downward anterior
rotation of both max
and mand

INTERACTION BETWEEN SAGITTAL AND VERTICAL READINGS

Pre-Rx P.Gr.mo Pre III Post Rx Retention Change

d
a)Sagittal unaffected by vertical

b)sagittal caused by

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c)Sagittal worsened by

d) Sagittal compensated

UPPER INCISOR EXPOSURE

a)UI exposure at rest

b)UI exposure in smile

c)ANS to Incisor (33±3/30±3)

d)U lip length(22-24/20)

INFERENCE: Vertical skeletal excess

Excess exposure due to Vertical dental excess
Short upper lip

Alveolar support to incisors a) Palatal cortex b)Symphyseal cortex

Skeletal alteration needed Sagittal /Vertical Mand / Max / Both

[ ] [ ] [ ] [ ] [ ]

If needed Not needed

Growth modification Surgery Normal relation Camouflage

[ ] [ ] [ ] [ ]
JUSTIFICATION:

SUMMARY:Sagittal :-

Vertical :-

DENTO ALVEOLAR ANALYSIS CORRELATED WITH SOFT TISSUES

UPPER
Normal Pre-Rx P.Gr.Mod Pre III Post Rx Retention Change
UI-SN 102°

UI-NA 22°, 4mm

UI-N┴ 2-4mm

UI-A Pog 25°,4mm

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UI-N Pog 2mm

Normal Pre-Rx P.Gr.Mod PreIII Post Rx Retention Change

Nasolabial 102+80
angle
Nasal angle

Labial angle
U lip 13-14mm
thickness
Basic U lip 14+1mm
thickness
Lip strain

INFERENCE in relation to cranium & maxilla

Incisor retraction needed

For camouflage treatment .………mm

Supported by a) Nasolabial angle [ ] yes / no [ ]

b)Lip strain [ ] yes / no [ ]
c)Lip thickness [ ] yes / no [ ]
d)lips in relation to esthetic lines [ ] yes / no [ ]

Corrected figure for upper incisor retraction……………………….mm

LOWER

Normal Pre-Rx P.Gr.Mod Pre III Post Rx Retention Change

LI-FH 65°

LI-MP 950

LI-NB 250,4mm

LI-A Pog 22°,4mm

LI-N Pog 4 mm

LI-NB-NB- 1:1
Pog
Mentolabial 122+10.70
angle M/F 127+12mm

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L-lip thickness 12+5 mm

L-lip length 46+5 mm

INFERENCE

In relation to cranium.………mm

Incisor retraction needed

For camouflage treatment .………mm

Supported by a) mentolabial sulcus [ ] yes / no [ ]

b)Lower Lip thickness [ ] yes / no [ ]
c) Holdaway ratio [ ] yes / no [ ]
d)lips in relation to esthetic lines [ ] yes / no [ ]

Corrected figure for lower incisor retraction……………………….mm

INFERENCE FROM CEPHALOMETRIC ANALYSIS

SPACE ANALYSIS

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DIAGNOSIS AND TREATMENT PLAN

1. Diagnosis and probable etiology

2. Problem List

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3. Treatment objectives

4. Treatment plan

5. Prognosis

6. Type of appliance

7. Anchorage

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8. Retention

CONSENT OF THE PARENT / GUARDIAN

I agree with the above treatment plan and give my full consent for the
treatment procedure for my son /daughter as deemed necessary. I have been
explained about the duration, cost of treatment maintenance of appliance, keeping of
appointments & Co-operation pertaining to the treatment.

Signature of patient/ parent

TREATMENT PROGRESS

DATE WORK DONE SIGNATURE

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TREATMENT PROGRESS

DATE WORK DONE SIGNATURE

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PAYMENT RECORD

Initial payment Rs . Receipt No. ……………….

Date: ……………….

TREATMENT CHARGES

DURATION CHARGES
PT. SIGNATURE
From To Rs.

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PATIENT TRANSFER FORM

From : To :
Dr. …………………………………….. Dr. ………………………………………….
Pin …………phone ……………………… Pin …………phone ………………………..

PATIENT
Name : ………………………………….. Name : …………………………………..
D.O.B.: ………………………………….. …………………………………………….

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ORTHODONTIC TREATMENT
Treatment plan: Required continuation:
1. ………………………………………….. 1…………………………………………..
2. ………………………………………….. 2. …………………………………………
3. ………………………………………….. 3. …………………………………………
4. ………………………………………….. 4. …………………………………………
5. ………………………………………….. 5. …………………………………………
Estimated remaining time: …….months

APPLIANCE
Fixed on : Current mechanics :
Date : Removable/fixed/functional/combination
Type : fixed / upper : …………………………...
Slot : lower : ………………………………….
H.G. : ………. EL ………………………..Elastics : ………………………………...
Removable appl. : ………………………….. H.G. …………………………………….
TPA / Lingual arch : ………………………..

CO-OPERATION (RELEVANT TO FINAL RESULT)

INDICE GOOD FAIR POOR

Brushing …………………… …………………… ……………………

Elastics …………………… …………………… ……………………
Breakages…………………… …………………… ……………………
H.G. …………………… …………………… ……………………
Removable appl. …………………… …………………… ……………………
Appt. schedule …………………… …………………… ……………………

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FINANCIAL AGREEMENT
Total cost : …………………………………. Recommended
Initial payment : ……..................................... Normal schedule
Monthly / quarterly : ………………………... Continue my arrangement
Stagewise (paid) Rs. ………………………… Retention : included / extra
Total before transfer : ………………………..

FINAL CONSENT
The treatment has been rendered to my satisfaction. I have been explained about
the retention phase and I agree to follow all the instructions regarding the same.

Patient / Parent

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