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Orthodontic Assessment
Date
Clinician
Patient Name
Reason for attendance
Extra Oral Examination
Skeletal
Class I
Class II
Class III
Mild
Moderate
Severe
FMPA
High
Average
Low
Lower Face Height
High
Average
Low
Facial Asymmetry
Yes
No
Details
Soft Tissue
Details
Teeth Missing
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
Intra Oral Examination
Incisor Relationship
Class I
Class II
div I
div II
Class III
Overjet
mm
Overbite
% overlap of incisors
Centerlines
Coincident
Deviated
Upper
Lower
Left
Right
by
mm
Displacement on closure
Yes
No
Details
Molar Relationship
Right
Class I
Class II
1/4
1/2
3/4
Full
Class III
Left
Class I
Class II
1/4
1/2
3/4
Full
Class III
Canine Relationship
Right
Class I
Class II
1/4
1/2
3/4
Full
Class III
Left
Class I
Class II
1/4
1/2
3/4
Full
Class III
Crossbite
Yes
No
Details
Spacing / Crowding
Upper Arch
Lower Arch
Biotype
Thin
Normal
Thick
Tooth Height / Width
Details
Radiographs taken
OPG
Ceph
PA (number)
BW
Details
Case Summary
Problem List
Treatment Aims (Ideal)
Treatment Aims (Compromise)
Treatment Plan
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