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Palatinalt retinerade överkäkshörntänder: en prospektiv longitudinell randominiserad studie Kod: Patients Name……………………………………………… Date of birth:…….…-……….. Male …… Female….. Age….....yrs…..…mo Controls Scheduled Examined Fail to come Cancelled /No rebooking Cast models Yes/No Photos Yes/No CB-CT Yes/No OPG Yes/No Comments Base line 6 month 12 month PATIENT HISTORY General diseases: ……………………………………………………………………………….. Medication………………………………………………………………………………………… Allergy: ………………………………………………………………….………………………… Trauma: …………………………………………………………………………………………… Extractions: ……………………………………………………………………..………………… Oral habits: …………………………………………………………………..…………………… Previous orthodontic treatment: ………………………………………………………………… Premature born……………week Heredity: ………………………………………………………………………………...………… Siblings………Name……………………...……………………..….................Age…………… Half siblings…………….Name……………………………………….…………….Age…….... Height: baseline……………..cm, 6-month………………….cm, 12-month………………cm Menarche: …………………..age CLINICAL EVALUATION -midline deviation: maxilla right/left ………....mm, mandible right/left ………..…..mm -midline frenum maxilla: normal/abnormal, mandible: normal/abnormal -deviation in tooth morphology: none/malformed/discoloured/hypoplasia/other……… Palatinalt retinerade överkäkshörntänder: en prospektiv longitudinell randominiserad studie Kod: -palpable upper canines:yes/no/not applicable Baseline……………………………………………..… 6-month …………………………………………..….. 12-month…………………………………….………… - uvula: uni/bifid……………………………………………………………………………… -other findings……………………………………………………………………………….. GENERAL ROENTGEN ANALYSIS Premature Eruption………………………….. Supernumerary tooth……………………… Impacted tooth……………………………….. Root fracture…………………………………. Root remnant………………………………… Deviating root shape………………………… Atypical position……………………………… Caries…………………………………………. Deep fillings…………………………………... Trauma………………………………… Premature loss dec tooth…………………. Persisting dec tooth…………………………. Agenesis……………………………………… Root resorption………………………………. Root filling…………………………………….. Transposition…………………………………. Periodontal conditions………………………. Pulp conditions………………………………. Enlarged dental follicle……………………… Condyle……………………………………… CAST ANALYSIS: Overjet:…………………………………… Overbite:……………………………………………. Molar relation:left…………………………………….right………………….….……………….. Canine relation:left..…………………………………right………………………..…………….. Supraocclusion:……………………………… infraocclusion …………………………………. Curve of Spee: extreme/normal/flat Midline: maxilla correct/towards right/left….mm, mandible correct/towards right/left....mm Transversal deviations: crossbite………………………………………………………………. scissors bite………………………………………………………….. Median diastema:…………………mm Other deviations:………………………………………………………………………………….. Apical base: maxilla: wide/normal/small, mandible: wide/normal/small Arch form: max:elipse/narrow/broad/Ώ-shaped, Mand: parable/narrow/broad/Ώ -shaped Migration of teeth:………………………………Rotations:…………………………………….. Morphologic deviation of teeth:………………………………………………………………….. Abnormal position:………………………………………………………………………………... Palatinalt retinerade överkäkshörntänder: en prospektiv longitudinell randominiserad studie Kod: Space analysis: Maxilla R buffer zone Front Space Need Difference L buffer zone SPECIFIC ROENTGEN ANALYSIS Root apex of the PDC : closed /not closed…………………………………….... Root development of the PDC: 1/3……………2/3……………3/3…………… Root resorption: …………………………………………………………………..... Follicle……………………………………………………………………………….. α- angle: baseline………………………………………………………………….. 6 month ………………………………………………………………….. 12 month…………………………………………………………………... d-distance: baseline………………………………………………………………… 6 month:……………………………………………………………….. 12 month:……………………………………………………………… s1-5: baseline ………………………………………………………………………. 6 month………………………………………………………………………. 12 month …………………………………………………………………….. Unilaterala fall: Xe= flicka ex (10) Xn= flicka nonex (10) Ye= pojke ex (10) Yn= pojke nonex (10) Bilaterala fall: Xev = flicka ex vänster (5) Xeh= flicka ex höger (5) Yev= pojke ex vänster (5) Yeh= pojke ex höger (5) Palatinalt retinerade överkäkshörntänder: en prospektiv longitudinell randominiserad studie Kod:
