FMR Data Collection

NAME AND SURNAME :

AGE:

Facial analysis (for Smile design) Esthetics

Horizontal reference
Vertical reference
Pupils Lips
Face central line
Others
Others
TMJ Mobility* TMJ Pain*
Right Vertical Left
Dentolabial analysis
________ _______ _______
Lip length Short Long Average
1 2 3
pain / no pain pain / no pain pain / no pain
Lip shape Thin Full
Smile exposure Low Average High Gummy Smile
Buccal corridor space Present Not Present Right: 1 2 3
Right joint Left joint
Anterior occlusal plane orientation Straight Inclined Clicking Clicking
Left: 1 2 3
Dental analysis Early / Late Early / Late
*mark only if severe / familiar

Maxillary incisal edge visibility at rest _ _ _ _ _ _ _ _ mm Crepitus Crepitus

Muscle Pain
Posterior occlusal plane orientation Acceptable Modify Supraeruption Subluxation Subluxation
Maxillary central incisor width _ _ _ _ _ mm length _ _ _ _ _ mm
Protrusion
Teeth colour Acceptable Modify Developmental causes Masseter
_______
lntra-arch analysis - select if needs modifying Temporalis:
pain / no pain
• Right
Midline Crowding Diastema Rotations Crossbite
*draw deflection / deviation Anterior Middle Posterior
Gingiva analysis
• Left
Gingival zenith symmetry Acceptable Modify
Obstructive Sleep Apnea
Anterior Middle Posterior
Gingival scallop form Flat Normal High
Suboccipital
MALLAMPATI CLASSIFICATION
Trapezius
Sternocleidomastoid
2D/3D RADIOLOGY Imaging Suprahyoid
Caries _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Tendon of temporalis [intraoral]
Periapical lesions _ _ _ _ _ _ _ _ _ Clenching test
Resistance test
Periodontal bone loss class 1 class 2 class 3 class 4
Circle muscle causing referred pain
Localized _ _ _ _ _ _ _ _ _ _ _ _ _ Narrow arches
Is this pain familiar? _ _ _ _ _ _ _ _ _ _ _ _ _ _
Generalized High palatal vault
Peri - implant bone loss _ _ _ _ _ _ _ _ _ _ _ _ _ Tongue scalloping

Bone dimension for prosthetically guided implants

Enlarged tonsils
Forward head posture
Incisal relationship Occlusion
Class 1 Class 2 Class 3
R L Maxillary sinusitis Increased neck circumference
*PG/DISE indicated Overbite 2-4mm >4mm <2mm
Other bone pathologies _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Overjet 0-3mm >3mm <0mm
Airway restriction _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Periodontium Positive CCP test Fremitus present
TMJ ANALYSIS CPITN 0-4 / *
CBCT Is the bite repeatable Yes No
R L Erosion of cortical bone
Narrowing of the joint space
Dental Condition
R L
R L Significant deviation from central position Periodontal phenotype ( THICK / THIN )
R L Abnormal size of the condyle Gingival recession _ _ _ _ _ _ _ _ _ _ _ _ _ _ Defective restorations
MRI Violation of the supracrestal tissues Remaining tooth structure without ferrule
Disc displacement Tooth hypermobility _ _ _ _ _ _ _ _ _ Erosion Attrition Abrasion
R L With reduction Carious Lesions
Oral hygiene
R L Without reduction, with limitation Periapical disease _ _ _ _ _ _ _ _
R L Without reduction, without limitation Attached Keratinized Mucosa (AKM) around teeth
Missing teeth
R L Effusion Attached Keratinized Mucosa (AKM) for
implant placement Hypodontia

DIAGNOSIS / BASED ON 1. INTERVIEW 2. EXAMINATION [Link]

TMD PERIODONTAL DENTAL Other common orofacial pains:
Sinusitis
Healthy tooth structure
Pulpal pain
Healthy Periodontium Caries Periapical lesion
Functional Disorders Gingivitis Erosion Active Stagnant
Tension type headache
Neuropathic pain
Acceptable function Periodontitis / Periimplantitis Attrition Active Stagnant Migraine
R L Hypermobility of the condyles Recession Abrasion Active Stagnant Psychogenic pain
Restriction due to: Implant requires soft&hard Compromised with enamel or ferrule Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
tissue management
Muscle / TMJ Compromised without ferrule
Disc displacement: RISK FACTORS
With reduction
ESTHETICS Ongoing eating disorder
R L
R
R
L
L
With catching
Without reduction with limitation
OCCLUSION Acceptable
History of TMD problems
Bruxism Muscle hypertrophy
Easy to improve with prosthodontics
R L Without reduction without limitation Stable repeatable bite Occupational hazard
Primary occlusal trauma Unacceptable Autoimmune diseases
Degenerative TMJ disease: Necessary interdisciplinary treatment
Otolaryngologic disorders
Constricted chewing pattern Internal discoloration
R L Active Lip incompetence
Unrepeatable bite Lip hypermobility
R L Stable Tongue thrust
Occlusal dysesthesia Altered passive eruption Obstructive sleep apnea
Orthodontic disorder Too short / Long lip History of unsuccessful procedures
Pain Disorders Maxillary excess Chronic stress / PTSD / Depression
No pain Neurologic disorders / Migraines
Local myalgia (acute) Other systemic conditions
Myofascial pain with referral
Muscle spasm
TREATMENT PATHWAY
Centrally mediated myalgia (chronic) Esthetics TMD Occlusion Dental Condition Perio/Implant
Arthralgia SIMPLE SIMPLE SIMPLE SIMPLE SIMPLE
COMPLEX COMPLEX COMPLEX COMPLEX COMPLEX
SPECIALIST SPECIALIST SPECIALIST SPECIALIST SPECIALIST

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