Name: Case #: Date of Class:

Orthodontic Case Workup Form

Clinical Examinations:

Extraoral Examinations
Frontal:
Facial form: Mesofacial_____ Dolichofacial______ Brachyfacial_______
Facial symmetry: Symmetric_____ Asymmetric_____ (Specify_______________________________)
Lower facial height: Normal_____ Increased______ Decreased______
Facial midline compared with dental midlines:
Maxillary: On _____ or ___mm to R/L
Mandibular: On _____ or ___mm to R/L
Profile:
Facial form: Straight_____ Convex______ Concave______
Lower facial height: Normal_____ Increased______ Decreased______
Nasolabial angle: Average_____ Acute______ Obtuse______
Lip protrusion: Upper: Normal_____ Protrusive______ Retrusive______
Lower: Normal_____ Protrusive______ Retrusive______
Mentolabial fold: Average_____ Shallow______ Deep______
Chin Projection: Normal_____ Increased______ Decreased______
Neck/chin angle: Average_____ Acute______ Obtuse______
Throat length: Average_____ Increased______ Decreased______

Intraoral Examinations
Soft Tissue:
Pathology:
Hygiene:
Pocket depth > 3mm: BOP:
Reduced keratinized gingival tissue:
Abnormal frenum attachment:

Dentition:
Dentition: Primary_____ Early mixed_____ Late mixed_____ Permanent_____
Occlusion: Molar: Class I_____ (R/L) Class II_____ (R/L) Class III_____ (R/L)
Canine: Class I_____ (R/L) Class II_____ (R/L) Class III_____ (R/L)
(Primary molar): Flush terminal plane_____ (R/L) Distal step_____ (R/L) Mesial step_____ (R/L)
Overall: Class I_____
Class II Div 1 _____ (Sub Div R/L) Class II Div 1 _____ (Sub Div R/L)
Class III _____ (Sub Div R/L)
Overjet: _____mm
Overbite: _____%
Crossbite: Anterior_____ Posterior buccal_____ Posterior lingual_____
Name: Case #: Date of Class:

Model Analyses:

Arch form: Maxillary: Ovoid_____ Square_____ Tapered_____ Omega_____

Mandibular: Ovoid_____ Square_____ Tapered_____ Omega_____

Space analysis:
Maxillary: Space available: _____mm Space required: ______mm Spacing/Crowding: _____mm.
Mandibular: Space available: _____mm Space required: ______mm Spacing/Crowding: _____mm.

Bolton analysis: 3-3: _____mm Maxillary/Mandibular Excess/Deficiency

6-6: _____mm Maxillary/Mandibular Excess/Deficiency

Radiographic Analyses:

Panoramic:
Pathology:
Maxillary sinus:
Root morphology: Dilaceration #___________ Shortened #_____________ Other _________________
Medial condylar morphology: Normal _____ Abnormal _____ (Specify___________________________)

Cephalometric Analysis:
Skeletal A-P: SNA= , SNB= , ANB= . Class I _____ Class II _____ Class III _____
Mandibular plane angle: SN-GoGn= , Normal _____ Hyperdivergent ______ Hypodivergent ______
Dental: Maxillary incisors: U1-SN= , Normal angulation _____ Proclined_____ Retroclined _____
Mandibular incisors: L1-GoGn= __, Normal angulation ____ Proclined____ Retroclined _____
Name: Case #: Date of Class:

Prioritized Problem List:

Pathology:

Please summarize problems into the following five categories and put them in order (1 through 5) based
on treatment needs (1 being most prominent):

_____ Anterior-Posterior (A-P):

_____Vertical:

_____ Transverse:

_____ Dental alignment:

_____ Facial Proportions and Esthetics: