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1.
2.
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4.
Classification of Malocclusion:
Overjet:
mm
Overbite:
mm
Teeth Clinically Present:
___ ___ ___ ___ ___ ___ I ___ ___ ___ ___ ___ ___
..
___ ___ ___ ___ ___ ___ I ___
___ ___ ___ ___ ___
..
___ ___ ___ ___ ___ ___ I ___
___ ___ ___ ___ ___
6. Dental Midline:
7. Dental Midline to Midsagittal Plane
Upper:
Lower:
8. Palatal Depth:
9. Arch Form
Upper:
Lower:
10.
normal
normal
broad
broad
Arch Width
Upper:
Lower:
11.
tappered
tappered
narrow
narrow
normal
normal
wide
wide
Arch Dimensions
1. Intercanine Perimeter
Upper:
2. Intercanine Width
Upper:
3. Arch Length
Lower:
Lower:
Upper:
4. Arch Prmeter:
Upper:
5. Arch Width:
Upper:
12.
Lower:
Lower:
Lower:
Upper Left:
Lower Left:
Upper Right:
Lower Right:
13.
Upper:
Lower:
14.
Right
15.
Lower
Left
Right
Upper:
Lower:
16.
Diastema
no
yes
mm
Left