Orthodontics Case Record for english languages

<%@ Language=VBScript %> Orthodontics Case Record for english languages

Orthodontics Case Record

Name & Family:	File No:
Age:	Sex:
Address & Phone Number:
Chief Complaint:
Medical History:
Dental History:

Extraoral Examination

Profile:			Shape of Head:
Convex	Concave	Straight	Mesocephalic	Dolicocephalic	Brachycephalic
Facial Divergence:			Shape of Face:
Anterior	Posterior	Straight	Round	Oval	Square
Facial Symmetry:			Lips:
Symmetrical	Asymmetrical		Competent	Incompetent	Everted
Nasolabial Angle:			Mentolabial Sulcus:
Normal	Acute	Obtuse	Normal	Deep	Shallow
Tongue Size:			Tongue Activity:
Normal	Small	Large	Normal	Tongue thrusting
T.M.J.			Frenum:
Normal	Pain	Clicking	Normal	Abnormal
Path of closure:			Breathing:
Normal	Deviated left	Deviated right	Oral	Nasal	Ora-nasal

Intraoral Examination

Permanent Dentition:

ِDeciduous Dentition:

Overjet.......... Overbite.........

Molar relation......... Canine relation.........

Details of malocclusion present

	Crowding		Open bite		Rotation		Anterior crossbite
	Spacing		Deep bite		Proclination		Posterior crossbite

Diagnostic Aids

	ُStudy models		OPG		Lateral cephalogram		Bitewing radiographs
	Occlusal radiographs		Photographs

Diagnosis.............................................................................................................................

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Treatment Objectives ..........................................................................................................

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Treatment plan....................................................................................................................

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I consent to the treatment plan described above by my Orthodontist and have been notified of the possible side effects and complications of the above treatment.

Patient Signature Doctor's Signature

توجه : تمامی تصاویراین سایت از کارهای لابراتوار تخصصی حبیبی تهیه گردیده است لذا استفاده از تمام یا بخشی از آنها بدون داشتن مجوز کتبی ممنوع است

لابراتوار ارتدنسي حبيبي: تهران_ خيابان مطهري_ خيابان تركمنستان_ كوچه افرا پلاك 2 تلفن: 88427515 , 88427525 , 88408012 (021)

نشاني پستي: تهران_صندوق پستي 459-15655 لابراتوار حبيبي تلفن: 88427525-021 E.mail: ortholab@irantooth.com