CPSP IMM Orthodontics-Template For Treated Cases of Candidates

ORTHODONTIC CASE TEMPLATE
COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN
FULLY DOCUMENTED SHORT CASE HISTORY

IMM ORTHODONTICS
DATE OF EXAMINATION: [ _____________ , ____________ ]
CANDIDATE EXAMINATION ROLL NUMBER: [ ___________ ]
PATIENT’S NAME INITIALS: [ _________ ]
PATIENT’S MR NUMBER: ______________
CASE NUMBER: [ _____ ]

CATEGORY:___________
ABO DISCREPANCY SCORE:___________
(Case number, Category & minimum ABO DI score as mentioned in FCPS-II Orthodontic curriculum)
Assessment of treated cases will only be done if the template is followed in true letter and
spirit, otherwise the cases will not be considered as part of the practical exam.
CASE SUMMARY
(Frontal at smile Pretreatment 4X3”) (Frontal at smile Posttreatment 4X3”)
(A brief description of the case, maximum 150 words, Arial, 12pt, single spacing)
1
SECTION 1. PRE-TREATMENT ASSESSMENT

1.1 PRE-TREATMENT PHOTOGRAPHS: EXTRA-ORAL (Minimum set of clear, non-tempered
photographs with white/light blue background)
(Frontal at rest 4X3”) (Frontal at smile 4X3”)
(Right Profile at Rest 4X3”) (Oblique at Rest 4X3”)
Optional: Any additional Intraoral photographs up to a maximum of one page can be added on the next page
2
1.2 PRE-TREATMENT PHOTOGRAPHS: INTRA-ORAL (Minimum set of clear, non-tempered photographs)
(Anterior 1.5”X3.5”)
(Right buccal 1.5X3”) (Left buccal 1.5X3”)
(Upper occlusal 3X4”) (Lower occlusal, width 3”)
3
1.3 PRE-TREATMENT STUDY MODELS (Minimum set of photographs clear, non-tempered)
(Original dental casts {Non-tempered, showing original impression surface, properly trimmed*} are
mandatory part of records. Additionally, insert 3D Images or photographic views of dental casts [Maroon
background for 2D & white for 3D])
* Mahmood A, Farooq A, Jabbar A. A MODIFIED TECHNIQUE OF ORTHODONTIC MODEL TRIMMING.

Pakistan orthodontic Journal, 1(1), 34-40
4
1.4 PATIENT DETAILS
Initials
Gender
Date of birth
Age at start of treatment
Any relevant medical history
Any relevant dental history
Other relevant information
1.5 CLINICAL EXAMINATION: EXTRA-ORAL FEATURES
Skeletal Anterioposterior:
Skeletal Vertical:
Skeletal Transverse:
Soft tissue Assessment:
Smile Assessment
TMJ Assessment
1.6 CLINICAL EXAMINATION: INTRA-ORAL FEATURES
Soft tissue
Oral hygiene
Erupted teeth present
General dental condition
5
1.7 CROWDING / SPACING
Maxillary arch
Mandibular arch
1.8 OCCLUSAL FEATURES
Incisor relationship
Overjet (mm)
Overbite (mm)
Centerlines
Canine relationship right side
Canine relationship left side
Molar relationship right side
Molar relationship left side
Crossbites
Displacements CO CR
Other occlusal features
Bolton Analysis (3-3)
Bolton Analysis (6-6)
Absent Teeth
Teeth of poor prognosis
6
1.9 PRE-TREATMENT OPG RADIOGRAPHIC FILM

(Original, non-tempered & preferably digital. Please do not insert picture of radiograph)
7
1.10 Optional: Any other relevant radiograph Periapical, Occlusal, CBCT Hand & Wrist etc.
(Any additional Radiographs can be added on the next page)
1.11 Teeth present on OPG / peripical
1.12 Other relevant radiographic findings
8
1.13.1 PRE-TREATMENT LATERAL CEPHALOGRAM AND TRACING

(Original, non-tempered & preferably digital. Please do not insert picture of radiograph,
insert analysis drawing preferably digital)
9
1.13.2 PRE-TREATMENT CEPHALOMETRIC ANALYSIS
Variables Normal Pre-Treatment

T0
SNA 82° ± 2
SNB 80° ± 2
ANB 0° ± 4
Wits appraisal ♂1, ♀0 mm
SN to maxillary plane 6° ± 4
SN Mandibular Plane 32° ± 4
Maxillary mandibular planes angle 25° ± 4
FH Mandibular Plane 26° ± 4
Face height ratio (Lower to total face height) 54% ± 4
Jaraback Ratio 65% ± 4
Upper incisor to SN plane angle 102° ± 5
Upper incisor to maxillary plane angle 108° ± 5
Lower incisor to mandibular plane angle 90° ± 5
Interincisal angle 135° ± 5
Lower incisor to APog line 0mm
Upper lip to Ricketts E Plane -3 ± 2mm
Lower lip to Ricketts E Plane -2 ± 2 mm
Nasiolabial angle* 102° ± 8
Sources of normal values: Jacobson (1975) Am J Orthod. 67:125-133.

Houston WJB, Stephens CD & Tulley WJ (1992) A textbook of
orthodontics. Wright, Oxford.
overbite depth. Eur J Orthod. 11:139-143.

*Legan HL & Burstone CJ (1980). Soft tissue cephalometric
analysis for orthognathic surgery. J Oral Surg. 38:744-51.
10
1.13.3 INTERPRETATION AND JUSTIFICATION
Sagittal
Vertical
Dental
Soft tissues
11
1.14 Optional: Additional cephalometric View/Analysis e.g., Grummons, McNamara, COGS

etc. with its interpretation and justification (Can use additional pages)
12
1.15 ABO Discrepancy Index (ABO DI)
Total Score ____________________
Cangialosi TJ, Riolo ML, Owens Jr SE, Dykhouse VJ, Moffitt AH, Grubb JE, Greco PM, English
JD, James RD. The ABO discrepancy index: a measure of case complexity. Am J Orthod
Dentofacial Orthop. 2004 Mar 1;125(3):270-8.
13
1.16 DIAGNOSTIC SUMMARY

(Maximum 100 words font Arial 12pt)
1.17 PROBLEM LIST
Pathological Problem
Skeletal
Dental
Soft Tissues
Prioritized problem list
Treatment objectives
14
1.17 TREATMENT PLAN: (Category 1,2,3,4 as per FCPS-II Orthodontic curriculum)
(Mention here Extraction/Non-surgical, Extraction/ Surgical, Non-Extraction etc.)
___________________________________________________________________________________
Extractions:
Appliance prescription:
Any other Appliance:
Anchorage:
Additional dental treatment:
Proposed retention strategy:
Age at start of active treatment:
Total active treatment Duration:
15
1.18 Prediction tracing if required
16
SECTION 2. MID TREATMENT / TREATMENT PROGRESS /

POST FUNCTIONAL / PRESURGICAL
(Mandatory for those who started training from Jan 2021, Mid treatment stage: complete canine
distalization in extraction cases, phase I stage in functional cases, pre surgical in orthognathic
cases, molar distalization before space closure in anterior area, expansion, CLP cases etc.)
2.1 MID-TREATMENT PHOTOGRAPHS: EXTRA-ORAL
(Minimum set of photographs clear, non-tempered with white/light blue background)
Optional: Any additional extratraoral photographs up to a maximum of one page can be added on next page
17
2.2 MID-TREATMENT PHOTOGRAPHS: INTRA-ORAL (Minimum set of photographs clear, non-

tempered)
18
2.3 MID-TREATMENT OPG RADIOGRAPHIC FILM

Original, non-tempered & preferably digital. Please DO NOT insert picture of radiograph)
19
2.4.1 MID-TREATMENT LATERAL CEPHALOGRAM AND TRACING

(Original, non-tempered & preferably digital. Please do not insert picture of radiograph, insert
analysis drawing preferably digital)
20
2.4.2 CEPHALOMETRIC ANALYSIS PRETREATMENT AND MID-TREATMENT COMPARISON
Pre- Mid- Change

Variables Normal Treatment Treatment B/W
T0 T1 T0 & T1
SNA 82° ± 2
SNB 80° ± 2
ANB 0° ± 4

Maxillary mandibular planes
25° ± 4
angle
Face height ratio (Lower to
54% ± 4
total face height)
Upper incisor to SN plane
102° ± 5
angle
Upper incisor to maxillary
108° ± 5
plane angle
Lower incisor to mandibular
90° ± 5
plane angle
Upper lip to Ricketts E Plane -3 ± 2mm
Lower lip to Ricketts E Plane -2 ± 2 mm
21
2.5 MID-TREATMENT Additional Radiographs

(CLAP, Post expansion etc. if required (Original, non-tempered & preferably digital)
22
2.6 KEY STAGES IN TREATMENT PROGRESS
DATE STAGE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
23
SECTION 3. POST-TREATMENT ASSESSMENT
3.1 POST-TREATMENT PHOTOGRAPHS: EXTRA-ORAL

(Minimum set of photographs clear, non-tempered with white/light blue background)
(Optional: Any additional extraoral photographs up to a maximum of one page can be added on the next page)
24
3.2 POST-TREATMENT PHOTOGRAPHS: INTRA-ORAL (Minimum set of photographs clear, non-tempered)
(Optional: Any additional Intraoral photographs up to a maximum of one page can be added on the next page)
25
3.3 POST-TREATMENT STUDY MODELS (Minimum set of photographs, clear & non-tempered)
(Insert 3D Images or photographic views of dental casts [Maroon background for 2D & white for 3D)
26
3.4 POST - TREATMENT PHOTOGRAPHS: (With Retainers Min 3 images clear & non-tempered)
27
3.5 END OF TREATMENT OPG RADIOGRAPHIC FILM

Original, non-tempered & preferably digital. Please do not insert picture of radiograph)
28
3.6.1 END OF TREATMENT LATERAL CEPHALOGRAM AND TRACING

(Original, non-tempered & preferably digital. Please do not insert picture of radiograph, insert
analysis drawing preferably digital)
29
3.6.2 END OF TREATMENT CEPHALOMETRIC ASSESSMENT
Pre- Mid- End of Change

Variables Normal Treatment Treatment Treatment B/W
T0 T1 T2 T0 & T2
SNA 82° ± 2
SNB 80° ± 2
ANB 0° ± 4

Maxillary mandibular
25° ± 4
planes angle
Face height ratio (Lower to
54% ± 4
total face height)
Upper incisor to SN plane
102° ± 5
angle
Upper incisor to maxillary
108° ± 5
plane angle
Lower incisor to
90° ± 5
mandibular plane angle

Upper lip to Ricketts E
-3 ± 2mm
Plane
Lower lip to Ricketts E
-2 ± 2 mm
Plane
Additional Radiographs If required insert on next page (CLAP, Surgical etc.)
30
ORTHODONTIC CASE TEMPLAT
3.6.3 INTERPRETATION AND JUSTIFICATION OF CEPHALOMETRIC CHANGES
Sagittal
Vertical
Dental
Soft tissues
31
3.7 CEPHALOMETRIC SUPERIMPOSITION OVERALL
Overall superimposition, registered on Sella-Nasion line at Sella
T0 Pre-treatment: Black
T1 Mid-treatment: Blue
T2 Near End/End of Treatment: Red
(Use pointer size 0.2/0.3mm)
32
3.8 CEPHALOMETRIC SUPERIMPOSITION INDIVIDUAL
T0 Pre-treatment: Black
T1 Mid -treatment: Blue
T2 Near End/End of Treatment: Red
(Use pointer size 0.2/0.3mm)
3.8.1 Maxillary superimposition, registered on the anterior surface of the palatal vault
3.8.2 Mandibular superimposition, registered on Bjork’s stable mandibular structures
33
3.9 American Board of Orthodontics Grading System for Dental Casts and panoramic
Radiographs (ABO GS)
Total Score ____________________
The American Board of Orthodontics Grading System for Dental Casts and Panoramic
Radiographs [Internet] [Revised June 2012] Available from:
https://www.americanboardortho.com/media/1191/grading-system-casts-radiographs.pdf
34
SECTION 4. CRITICAL APPRAISAL

(Max 250 words – Arial font, 12pt)
4.1 Facial Aesthetics
4.2 Smile Aesthetics
4.3 Skeletal
4.4 Dental
Maxillary
Mandibular
4.5 Retention
35

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ORTHODONTIC CASE TEMPLATE

COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN

FULLY DOCUMENTED SHORT CASE HISTORY

DATE OF EXAMINATION: [ _____________ , ____________ ]

CANDIDATE EXAMINATION ROLL NUMBER: [ ___________ ]

PATIENT’S NAME INITIALS: [ _________ ]

PATIENT’S MR NUMBER: ______________

CASE NUMBER: [ _____ ]

(Frontal at smile Pretreatment 4X3”) (Frontal at smile Posttreatment 4X3”)

SECTION 1. PRE-TREATMENT ASSESSMENT

(Frontal at rest 4X3”) (Frontal at smile 4X3”)

(Right Profile at Rest 4X3”) (Oblique at Rest 4X3”)

1.2 PRE-TREATMENT PHOTOGRAPHS: INTRA-ORAL (Minimum set of clear, non-tempered photographs)

(Right buccal 1.5X3”) (Left buccal 1.5X3”)

(Upper occlusal 3X4”) (Lower occlusal, width 3”)

1.3 PRE-TREATMENT STUDY MODELS (Minimum set of photographs clear, non-tempered)

(Right buccal 1.5X3”) (Left buccal 1.5X3”)

(Upper occlusal 3X4”) (Lower occlusal, width 3”)

* Mahmood A, Farooq A, Jabbar A. A MODIFIED TECHNIQUE OF ORTHODONTIC MODEL TRIMMING.

1.4 PATIENT DETAILS

Age at start of treatment

Any relevant medical history

Any relevant dental history

Other relevant information

1.5 CLINICAL EXAMINATION: EXTRA-ORAL FEATURES

Soft tissue Assessment:

1.6 CLINICAL EXAMINATION: INTRA-ORAL FEATURES

Erupted teeth present

General dental condition

1.7 CROWDING / SPACING

1.8 OCCLUSAL FEATURES

Canine relationship right side

Canine relationship left side

Molar relationship right side

Molar relationship left side

Other occlusal features

Bolton Analysis (3-3)

Bolton Analysis (6-6)

Teeth of poor prognosis

1.9 PRE-TREATMENT OPG RADIOGRAPHIC FILM

1.11 Teeth present on OPG / peripical

1.12 Other relevant radiographic findings

1.13.1 PRE-TREATMENT LATERAL CEPHALOGRAM AND TRACING

1.13.2 PRE-TREATMENT CEPHALOMETRIC ANALYSIS

Variables Normal Pre-Treatment

Wits appraisal ♂1, ♀0 mm

SN Mandibular Plane 32° ± 4

Maxillary mandibular planes angle 25° ± 4

FH Mandibular Plane 26° ± 4

Face height ratio (Lower to total face height) 54% ± 4

Jaraback Ratio 65% ± 4

Upper incisor to SN plane angle 102° ± 5

Upper incisor to maxillary plane angle 108° ± 5

Lower incisor to mandibular plane angle 90° ± 5

Interincisal angle 135° ± 5

Lower incisor to APog line 0mm

Upper lip to Ricketts E Plane -3 ± 2mm

Lower lip to Ricketts E Plane -2 ± 2 mm

Nasiolabial angle* 102° ± 8

DATE OF EXAMINATION: [ _ , ]