Chief Complaint Identifying Data Age Sex Race Occupation

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Chief Complaint

Chief Complaint

Identifying Data • • Age: Sex: Race: Occupation:

Identifying Data • • Age: Sex: Race: Occupation:

Contributory Medical or Dental History (Ignore if normal) • Medical diagnosis and history •

Contributory Medical or Dental History (Ignore if normal) • Medical diagnosis and history • Medications • Previous orthodontics, splints, surgery, etc.

Temporomandibular Disorder (Ignore if normal)

Temporomandibular Disorder (Ignore if normal)

Clinical Diagnostic Exam • Dental: • Periodontal: • Neurologic, Muscular, Orthopedic,   Neurovascular: •

Clinical Diagnostic Exam • Dental: • Periodontal: • Neurologic, Muscular, Orthopedic,   Neurovascular: • Occlusal Analysis:

Pre-treatment Facial slides Frontal      Frontal/Smiling

Pre-treatment Facial slides Frontal      Frontal/Smiling

Pre-treatment Facial slides Right 45゜ Right Profile

Pre-treatment Facial slides Right 45゜ Right Profile

Pre-treatment X-Rays Cephalometric Film Frontal Lateral

Pre-treatment X-Rays Cephalometric Film Frontal Lateral

Pre-treatment X-Rays Panoramic Film or Full Mouth X-Rays

Pre-treatment X-Rays Panoramic Film or Full Mouth X-Rays

Pre-treatment X-Rays Wrist Film (Growing Patients)

Pre-treatment X-Rays Wrist Film (Growing Patients)

Pre-treatment X-Rays SMV

Pre-treatment X-Rays SMV

Pre-treatment TMJ X-Rays Axis Oriented Tomograms or CBCT

Pre-treatment TMJ X-Rays Axis Oriented Tomograms or CBCT

Pre-treatment Intraoral Slides Right Buccal Upper Occlusal Frontal   Overjet Left Buccal    Lower

Pre-treatment Intraoral Slides Right Buccal Upper Occlusal Frontal   Overjet Left Buccal    Lower Occlusal

Pre-treatment Mounted Models Right Buccal Frontal Left Buccal Right Overjet CPI Left Overjet

Pre-treatment Mounted Models Right Buccal Frontal Left Buccal Right Overjet CPI Left Overjet

Pre-treatment CPI or MPI

Pre-treatment CPI or MPI

Pre-treatment Axiograph or Axi-path

Pre-treatment Axiograph or Axi-path

CO-CR Conversion • Tracing CO in Black • Tracing CR in Purple

CO-CR Conversion • Tracing CO in Black • Tracing CR in Purple

Pre-treatment Ricketts CR

Pre-treatment Ricketts CR

Pre-treatment Roth-Jarabak CR

Pre-treatment Roth-Jarabak CR

Reason of splint therapy

Reason of splint therapy

Splint Therapy Progress Slides 00 Weeks Later Right Buccal Frontal   Overjet Left Buccal

Splint Therapy Progress Slides 00 Weeks Later Right Buccal Frontal   Overjet Left Buccal  

Splint Therapy Progress Slides 00 Weeks Later Right Buccal Frontal   Overjet Left Buccal

Splint Therapy Progress Slides 00 Weeks Later Right Buccal Frontal   Overjet Left Buccal  

Splint Therapy Progress Slides 00 Weeks Later Right Buccal Frontal   Overjet Left Buccal

Splint Therapy Progress Slides 00 Weeks Later Right Buccal Frontal   Overjet Left Buccal  

Splint Therapy Progress Slides 00 Weeks Later Right Buccal Frontal   Overjet Left Buccal

Splint Therapy Progress Slides 00 Weeks Later Right Buccal Frontal   Overjet Left Buccal  

CPI Data Sheet Summary

CPI Data Sheet Summary

Changes in CPI data during splint therapy Left Right Initial 00 weeks 00 weeks

Changes in CPI data during splint therapy Left Right Initial 00 weeks 00 weeks L R

Post Splint Facial slides Frontal      Frontal/Smiling

Post Splint Facial slides Frontal      Frontal/Smiling

Post Splint Facial slides Right 45゜ Right Profile

Post Splint Facial slides Right 45゜ Right Profile

Post Splint X-Rays Cephalometric Film Frontal Lateral

Post Splint X-Rays Cephalometric Film Frontal Lateral

Post Splint TMJ X-Rays Axis Oriented Tomograms or CBCT

Post Splint TMJ X-Rays Axis Oriented Tomograms or CBCT

Post Splint Intraoral Slides Right Buccal Upper Occlusal Frontal   Overjet Left Buccal   

Post Splint Intraoral Slides Right Buccal Upper Occlusal Frontal   Overjet Left Buccal    Lower Occlusal

Post Splint Mounted Models Right Buccal Right Overjet Frontal Left Buccal Left Overjet

Post Splint Mounted Models Right Buccal Right Overjet Frontal Left Buccal Left Overjet

Post Splint Split Cast Check 

Post Splint Split Cast Check 

Post Splint Ricketts CR

Post Splint Ricketts CR

Post Splint Roth-Jarabak CR

Post Splint Roth-Jarabak CR

Pre Splint VS Post Splint Full Superimposition • Tracing Pre Splint in Black •

Pre Splint VS Post Splint Full Superimposition • Tracing Pre Splint in Black • Tracing Post Splint in Green

Pre Splint VS Post Splint 5 Point Superimposition • Tracing Pre Splint in Black

Pre Splint VS Post Splint 5 Point Superimposition • Tracing Pre Splint in Black • Tracing Post Splint in Green

Post Splint Axiograph or Axi-path

Post Splint Axiograph or Axi-path

Post Splint Mounted Models 3 -D Check Right Buccal Right Overjet Frontal Left Buccal

Post Splint Mounted Models 3 -D Check Right Buccal Right Overjet Frontal Left Buccal Left Overjet

Problem List After Splint Therapy

Problem List After Splint Therapy

Treatment Plan

Treatment Plan

Mechanics

Mechanics

Post Splint VS VTO Full Superimposition • Tracing Post Splint in Green • Tracing

Post Splint VS VTO Full Superimposition • Tracing Post Splint in Green • Tracing VTO in Red

Post Splint VS VTO 5 Point Superimposition • Tracing Post Splint in Green •

Post Splint VS VTO 5 Point Superimposition • Tracing Post Splint in Green • Tracing VTO in Red

Post Splint VS VTO Image

Post Splint VS VTO Image

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left Buccal    Lower Occlusal 00 months Later

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left Buccal    Lower Occlusal 00 months Later

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left Buccal    Lower Occlusal 00 months Later

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left Buccal    Lower Occlusal 00 months Later

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left Buccal    Lower Occlusal 00 months Later

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left

Treatment Progress Intraoral Slides Wire sequence Right Buccal Upper Occlusal Frontal   Overjet Left Buccal    Lower Occlusal 00 months Later

End of fixed type appliance therapy Mounted Models Right Buccal Frontal Left Buccal Right

End of fixed type appliance therapy Mounted Models Right Buccal Frontal Left Buccal Right Overjet CPI Left Overjet

End of fixed type appliance therapy Axi-path or Axiograph

End of fixed type appliance therapy Axi-path or Axiograph

Gnathological Positioner Set-up Right Buccal Right Overjet Frontal Left Buccal Left Overjet

Gnathological Positioner Set-up Right Buccal Right Overjet Frontal Left Buccal Left Overjet

Post-treatment Intraoral Slides Right Buccal Upper Occlusal Frontal   Overjet Left Buccal    Lower

Post-treatment Intraoral Slides Right Buccal Upper Occlusal Frontal   Overjet Left Buccal    Lower Occlusal

Post-treatment Mounted Models Right Buccal Frontal Left Buccal Right Overjet CPI Left Overjet

Post-treatment Mounted Models Right Buccal Frontal Left Buccal Right Overjet CPI Left Overjet

Post-treatment CPI or MPI

Post-treatment CPI or MPI

Post-treatment Facial slides Frontal      Frontal/Smiling

Post-treatment Facial slides Frontal      Frontal/Smiling

Post-treatment Facial slides Right 45゜ Right Profile

Post-treatment Facial slides Right 45゜ Right Profile

Post-treatment X-Rays Cephalometric Film Frontal Lateral

Post-treatment X-Rays Cephalometric Film Frontal Lateral

Post-treatment X-Rays Panoramic Film or Full Mouth X-Rays

Post-treatment X-Rays Panoramic Film or Full Mouth X-Rays

Post-treatment TMJ X-Rays Axis Oriented Tomograms or CBCT

Post-treatment TMJ X-Rays Axis Oriented Tomograms or CBCT

Post-treatment Ricketts

Post-treatment Ricketts

Post-treatment Roth-Jarabak

Post-treatment Roth-Jarabak

Post Splint VS Post Tx Full Superimposition • Tracing Post Splint in Green •

Post Splint VS Post Tx Full Superimposition • Tracing Post Splint in Green • Tracing Post Ontho. in Blue

Post Splint VS Post Tx 5 Point Superimposition • Tracing Post Splint in Green

Post Splint VS Post Tx 5 Point Superimposition • Tracing Post Splint in Green • Tracing Post Ontho. in Blue

VTO VS Post Tx Full Superimposition • Tracing VTO in Red • Tracing Post

VTO VS Post Tx Full Superimposition • Tracing VTO in Red • Tracing Post Ortho. in Blue

VTO VS Post Tx 5 Point Superimposition • Tracing VTO in Red • Tracing

VTO VS Post Tx 5 Point Superimposition • Tracing VTO in Red • Tracing Post Ortho. in Blue