VI. Case presentation template

1.0 Case presentation requirements:

Each Affiliate Member shall be required to present the following records for each case presented:

I. Case Presentation Form

Use the enclosed outline as a form for submitting each case. The space between each heading can be varied according to your needs.
II. Complete Orthodontic Records
Complete records must be taken and presented annually representing the initial, progress, and completion (immediate post-treatment) stages.

A. Dental Casts

Initial, progress, and completion casts of each case are required. All casts are to be made from excellent impressions.
Impressions should extend far enough to allow accurate reproduction of all soft and hard tissue anatomy in the dental casts.
Trimming or carving on the anatomical portion of the dental casts should be limited to the removal of bubbles and defects. After the casts are prepared, they should be smoothed and polished in such a manner that tooth and soft tissue detail are not destroyed.
The casts should be presented in an unmounted, dental articulated reference position. The backs must be trimmed flat with the teeth in maximum intercuspation.
If the casts are to be presented in a joint dictated position (Centric Relation) a semi-adjustable articulator should be used. The casts should be mounted on the articulator using either an estimated or true hinge axis recording. Representative diagrams are shown.
Documentation of a significant difference between the maximum intercuspation and centric relation positions should be noted and explained.
This documentation may be demonstrated as simply as an inter-occlusal registration bite for unmounted models or by the more complex use of an instrument that records a change in condylar axis of rotation such as a Condylar Axis Indicator (CPI), a Mandibular Position Indicator (MPI) or a Veri-Check instrument.

B. Cephalometric Records

1. Initial, progress, and completion lateral head radiographs are required with the nose facing to the right of the viewer. Printed digital photographs on high quality photographic paper are accepted.
2. The head should be oriented in natural head position with the lips in repose.
3. Radiographs should be of good diagnostic quality with both hard and soft tissues visible.
4. Other radiographs, such as Posterior-Anterior head films and TMJ imaging, should be included as you feel appropriate to completely diagnose the case and assist in treatment planning.
5. If possible, all head radiographs should be taken with the same cephalostat so that magnification is consistent and superimposition can be performed. Ideally, a calibration scale attached to the mid-sagittal plane (nasion rest) should be visible.
6. Right and left ear rod concentricity should be tested in order to calibrate the cephalostat and minimize errors in head positioning.
7. All radiographs are to be dated and identified with the patient’s initials or number.
8. Identification labels should include a minimum of patient initials, Angle Society case number and date of film.
9. Radiographs should be labeled to distinguish right and left where appropriate.
Each radiograph should be placed in a separate transparent sheet.

C. Tracings

1. All tracings must be oriented with the nose facing to the right of the viewer.
2. Initial tracings should be drawn in black; first progress in blue; second progress in green; and completion in red using a 0.5 mm lead or ink. Computer tracings and superimpositions are permitted (Quickceph, Dolphin, Vistadent), as long as a consistent scale is used.
3. Identification labels should include a minimum of patient initials, Angle Society case number and date of film.
4. Each tracing should be in a separate transparent sleeve, not attached to the radiograph. Digital tracings should be printed onto the radiographs.
5. The tracings should record one of Margolis, Tweed, Steiner, Ricketts, or McNamara analyses. A sample cephalometric analysis form is included in the following pages. You are encouraged to use this form.
6. Any analysis used must include at least the following:
a. ANB difference
b. Mandibular plane.
c. Molar relationship.
d. Incisor angulations.
e. Soft tissue contour.
7. A Visualized Treatment Objective (VTO) is recommended. This may be computer generated.
8. Three composite tracings are required (digital or manual).
a. Craniofacial Composite: Register on Sella with the best fit on the anterior cranial base bony structures (Planum Sphenoidum, Cribriform Plate, Greater Wing of the Sphenoid) to assess overall growth, soft tissue, and treatment changes.
b. Maxillary Composite: Register on the lingual curvature of the palate and the best fit on the maxillary bony structures to assess maxillary tooth movement.
c. Mandibular Composite: Register on the internal cortical outline of the symphysis with the best fit on the mandibular canals to assess mandibular tooth movement and incremental growth of the mandible.
Note: If Frankfort Horizontal is drawn on the original tracing, it should be transferred to subsequent tracings. By not drawing Porion and Orbitale on the subsequent tracings, one will be reminded to superimpose on the cranial base and transfer the original Frankfort Horizontal. This will help reduce tracing and measurement error.

D. Panoramic and Intra-Oral Radiographs

1. Initial, progress, and completion panoramic or full mouth intra-oral radiographs shall be required, particularly in multidisciplinary cases.
2. All radiographs must be of good diagnostic quality
3. Identification labels should include a minimum of patient initials, Angle Society case number and date of film.
4. Radiographs should be labeled to distinguish right and left where appropriate.
5. Dental, periodontal and skeletal anatomy, including mandibular condyles, should be identifiable on panoramic films.
E. Photographs (prints)
1. Initial, progress, and completion photographs are required.
2. Facial photographs should be taken in natural head position with the lips in repose and smiling. (In addition, other views may be presented depending upon diagnostic value)
3. Frontal and profile views should be taken with lips in repose and smiling; the profile views should be oriented with the nose to the right.
4. Facial images should be one quarter (1/4) life size.
5. Intra-oral photographs shall include frontal, right and left lateral, and maxillary and mandibular occlusal views. (Intra-oral color slides are optional and do not replace the need for prints.)
6. Intra-oral photographs should be approximately at 1:1 magnification.
Records and Case Presentation Form shall be organized in the official binder of Angle East.

2.0 General presentation instructions

Your written presentation should include a discussion of the patient’s diagnosis, a detailed problem list (including the patient’s and/or parents’ chief concern), your goals and objectives of treatment as well as the benefits and limitations of the treatment plan(s) proposed and finally selected. Your presentation should be supported with the documentation of your clinical examination and the patient’s diagnostic records. Angle’s Classification of the molar relationship should be used to select cases in the following categories. Cases are to be numbered according to the following guidelines:
Case I. Class II, division 1 with 6 mm or more of overjet, at least a side with 5 mm class II molar
Case II. Class II, division 1 with 6 mm or more of overjet, at least a side with 5 mm class II molar
Case III. Class II, division 1 with 6 mm or more overjet or class II division 2 or class II div 2, at least a side with 5 mm class II molar
Case IV. Four unit extraction
Case V. Adult treatment
Case VI. Class III or adult treatment
Two [2] additional cases have to be brought from one of the above categories, totaling eight [8], from which the Examining Committee and Affiliate will select six [6] cases to be completed. At least three (3) of the six (6) selected cases must be completed to the standards of excellence acceptable to the Examining Committee as partial fulfillment of the requirements for membership in Angle East. Treatment can not be initiated more than 90 days prior to the annual meeting.
It is critical to carefully and properly select the necessary cases per the assigned category. Cases that do not fit the assigned category will not be accepted and the Affiliate will be required to present replacement cases at the next annual meeting.
Evaluation of the treatment results will be based on the attainment of the treatment goals and objectives that you have forecasted as well as consideration of the following orthodontic treatment objectives:
1. Balance and harmony of facial features with proper proportions and symmetry, including the smile.
2. Maximum esthetics of the teeth and supporting soft tissues.
3. Treatment complementing facial growth, specifically demonstrating control of vertical skeletal and dental relationships.
4. Health of the teeth and the supporting tissues.
5. Coordinated arch form with all the teeth aligned within their supporting structures, including permanent second molars
6. Intercuspation of teeth supporting dental stability, free of interference and trauma.
7. Functional overjet and overbite relationships.
8. Proper axial inclinations and torque of all teeth, including 2nd molars.
9. Correction of all rotations
Complete space closure where appropriate

3.0 Specific areas to be evaluated by examining committee

Written Presentation
1. Diagnosis and Problem List (including the patient’s chief concern and contributory medical and dental histories)
2. Treatment Plan(s) indicating detailed goals and limitations of proposed treatment plan(s). Specific treatment goals or objectives should be established and assessment of tooth movement (incisors, molars and canines) and surgical movement when surgery is planned. Include a discussion of the biomechanics that will be needed to achieve the goals proposed in the selected treatment plan.
3. Documentation and analysis of the progress and final results will be compared to the original treatment goals that you forecasted at the start of treatment. Discuss any limitations of treatment and/or unanticipated results.
Diagnostic Records
1. Photographs
a. Diagnostic quality of images
b. Assessment of facial soft tissue balance and harmony
c. Changes forecast with treatment and/or growth
2. Panoramic Radiographs
a. Diagnostic quality of image
b. Visualization of hard tissue anatomy including mandibular rami and condyles
c. Integrity of dentition, periodontium and condyles
d. Alignment of dental units
e. Absence of root resorption
3. Cephalometric Radiographs & Tracings (Lateral and Posterior-Anterior views)
a. Diagnostic quality of images
b. Presence of initial, progress and completed radiographs, tracings and composite superimpositions
c. Discussion of cephalometric data that should support diagnosis, problem summary, the establishment of treatment goals and objectives and the proposed effects of treatment mechanics on treatment outcome
d. Attainment of “forecast” treatment goals and objectives
i. Influence of growth on maxillo-mandibular relationship
ii. Influence of treatment on maxillo-mandibular relationship
iii. Changes in soft tissue of face
iv. Changes in the occlusal plane
v. Changes in overjet and overbite
vi. Torque and A-P position of anterior teeth

4. Dental Casts
a. Accurate replication of anatomical structures
b. Documentation of maxillo-mandibular relationship using upper and lower dental casts (models related in maximum intercuspation) or models related using a condylar reference position (CRP / CR)
c. If dental casts are related via a CRP / CR, please provide documentation of discrepancy between CRP / CR and MIC / CO and discuss significance of discrepancy
d. Occlusal plane changes
e. Overjet and overbite changes
f. Relationship of dental and skeletal midlines
g. Changes in dental arch symmetry
h. Changes of dental arch width at the canine and molar areas
i. General alignment
j. Correction of dental rotations
k. Angulation and torque of anterior and posterior teeth (including 2nd
molars)
l. Marginal ridge relationships
m. Occlusal contacts of anterior and posterior teeth
Documentation of tooth size discrepancies and their management
Periodontal soft tissue changes

4.0 A synopsis of case report is mandatory and must be provided.

A copy of the synopsis must be submitted to the Chair of the Examining Committee and one copy must lie on the table for case display. We recommend using the table below in one page set up in landscape view.

Edward H.Angle Society Eastern Component
Synopsis of Case Reports
Candidate: Dr John Do

#	Name	Treatment category & summary	Age & date of record
			A	A’	B	Tx time
1	Joan Smith	Class II, division 1 with 6 mm or more of overjet, at least a side with 5 mm class II molar	__Y __M MM/DD/YY	__Y __M MM/DD/YY	__Y __M MM/DD/YY	XX months
2		Class II, division 1 with 6 mm or more of overjet, at least a side with 5 mm class II molar				XX months
3		Class II, division 1 with 6 mm or more of overjet, at least a side with 5 mm class II molar				XX months
4		Four unit extraction				XX months
5		Adult treatment				XX months
6		Adult treatment or class III				XX months
7		Any of the above category
8		Any of the above category

5.0 We recommend the following template for case resume.

Suggested template for resume:

Title page
First page: Resume
Second page: Cephalometric summary
Third page: Case history and diagnosis
Fourth page: Treatment plan. Prognosis. Specific treatment objective.
Fifth page: Graphic representation of the VTO
Sixth page: Treatment progress at 1 year. Result achieved at 1 year.
Seventh page: Treatment progress at 2 year. Result achieved at 2 year.
Eighth page: Final results achieved. Retention. Final evaluation.

Clinical exam committee will evaluate your resume following these evaluation forms:

Case presentation initial
Case presentation progress
Case presentation final