Laporan Status Ortho elektif

7/25/2019 Laporan Status Ortho elektif

1/19

PEMERIKSAAN

DAN PERAWATAN ORTHODONTI

NOMOR MODEL:

NAMA PASIEN :

OPERATOR :

NO.MHS :

PEMBIMBING :

PROGRAM STUDI KEDOKTERAN GIGI

FAKULTAS KEDOKTERAN

UNIVERSITAS SRIWIJAYA

2015

Status Pemeriksaan dan Perawatan Orthodon ti


2/19

STATUS PEMERIKSAAN

DAN PERAWATAN ORTHODONTI

Operator :

No.Mhs :

Pembimbing :

No. Kartu :

No. Model :

I. IDENTITAS

Nama pasien :

Umur :

Suku :

Jenis kelamin :

Status Kawin :

Alamat :

Telepon :

Pekeraan :

!uukan dari :

Nama A"ah :

Suku :

Umur :

Pekeraan orang tua :

Nama #bu :

Suku :

Umur :

Pekeraan :

Alamat orang tua :



3/19

II. WAKTU PERAWATAN

Penda$taran : Tgl.

Pen%etakan : Tgl.

Pemasangan alat : Tgl.

!etainer : Tgl.

III. PEMERIKSAAN KLINIS

A. Peme!"#$$% S&'(e")!* + A%$m%e#!# ,

Ke-&$% U)$m$ :

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R!/$$) Ke#e$)$% :

Kelahiran : Normal & Komplikasi

Urutan kelahiran : Anak Ke....dari.....anak

Nutrisi : AS#......................... bulan

Pen"akit berat "ang pernah diderita :

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Kelainan Kongenital :

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4/19

'ain(lain :

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Keterangan :

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R!/$$) G!! :

)igi *e%idui :

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)igi +er%ampur :

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)igi Permanen :

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5/19

Ke'!$#$$% B&&" : A$ 3 T!$" A$

Jenis

Kebiasaan

*urasi ,rekuensi #ntensitas Keterangan

R!/$$) Ke-&$$ +'e"$!)$% e%$% "e-&$% 4$#!e%,: A$3T!$"

$$

A$ I'& S$&$$ L$"!-$"! S$&$$ Peem4&$%

Keterangan :

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IV. PEMERIKSAAN OBJEKTIF

Um&m :

Jasmani : +aik Sedang Jelek

Ket : --------......

Mental : +aik Sedang Jelek

Ket : --------...... Status gii :

Tinggi badan /T+0 : m

+erat badan /++0 : kg

#ndeks masa tubuh /#MT0 1 ++/ kg 0 1 1

T+2 / m 0

Kategori status gii : Kurang Normal 'ebih



6/19

L6"$- :

$. E"#)$ O$- :

W$($ De4$%

+entuk kepala : +rakise$ali Mesose$ali *olikose$ali

#ndeks kepala : 'ebar kepala 333 4 566 1 4 566

Panang kepala

1

+entuk muka : 7ipereuriprosop 8uriprosop

Mesoprosop 'eptoprosop

7iperleptoprosop

#ndeks muka : Jarak N 9 )N 33 4 566 1 4 566

'br +iigomati%

1

Simetri : Simetris & Tidak simetris

Proporsi : Normal & Tidak normal

Tonus otot mastikasi : Normal & Tidak normal

Tonus otot bibir : Normal & Tidak normal Posisi bibir waktu istirahat : Tertutup & Terbuka

W$($ S$m4!%

Pro$il muka : 'urus ekung embung

'. I%)$ O$-

J$!%$% L&%$"

)ingi;a : Normal & Tidak normal & 7"perplasia & 7ipertropi& Mudah berdarah

Mukosa : Normal & Tidak normal

'idah : Normal & +esar & Ke%il

Tonsil : Normal & Tidak normal

Palatum : Tinggi & Normal & !endah

,renulum : ,ren. 'abii Superior : Tinggi & Normal & !endah

,ren. 'abii #n$erior : Tinggi & Normal & !endah



7/19

,ren. 'abii 'ingualis : Tinggi & Normal & !endah

7"giene mulut : O7#(S ......... +aik Sedang Jelek

Peme!"#$$% G!! :

V VI III II I I II III IV V

7 8 9 5 ; 2 1 1 2 ; 5 9 8 7

7 8 9 5 ; 2 1 1 2 ; 5 9 8 7

V VI III II I I II III IV V

Ke)e$%$% :

K : Karies ! : !adiks T : Tambalan

# : #nla" 4 : Telah di%abut P : Persistensi

#m : #mpaksi J : Jaket O : +elum 8rupsi

Ag : Agenesis + : +ridge 8n : Prwtn endodontik

A%$-!#$ F&%#!

Penelanan : Normal & Tidak normal

+i%ara : 'idah normal & 'idah terletak di antara

gigi

Penutupan mulut : Normal & +ibir mengenai bagian palatinal

gigi atas

Pernapasan : Mulut tertutup & Mulut terbuka

Sen"um : )usi terlihat & Normal

Kelainan TMJ : Ada & Tidak ada



8/19

V. ANALISA

A. A%$-!#$ F6)6 W$($

Tampak *epan Tampak samping

+entuk waah : O;al & +ulat & Persegi

Pro$il muka : embung & 'urus & ekung

Simetri : Simetris & Tidak simetris

Proporsi : Normal & Tidak normal

)aris Orbita : Seaar & Tidak seaar

B. A%$-!#$ M6e- S)&!

1. R$$% A)$#

A$ S$!)$-

#nklinasi gigi insisi;us : Normal & Tidak Normal

Pergeseran gigi posterior : ......................................................

Kur;a spee : Normal & Tidak normal

A$ T$%#


9/19

Supra ;ersi : Ada & Tidak ada

2. R$$% B$/$

A$ S$!)$-

#nklinasi gigi insisi;us : ...........................................................

Pergeseran gigi posterior : ...........................................................

Kur;a spee : *alam & Normal

A$ T$%#


10/19

O;eret : 55 :........ mm 5

!elasi Kanisus : Kanan............ Kiri .............

!elasi M5 permanen : Kanan............. Kiri .............

ross bite anterior : ........................................................

A$ T$%#


11/19

5. S"em$ G!!G!! D$-$m Ke$$$% O"-!

A$ A%)e!6

A$ K$%$%

A$ K!!


Midline :

!elasi Kaninus:

!elasi Molar :

O;er et : < 5 1 .....mm

>5

O;er bite : 5

!elasi Molar Kanan /?

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!elasi Kaninus:

!elasi Molar :

O;er et : 55 1 .....mm

=5

O;er bite : 55 1 .....mm

=5

!elasi Molar Kanan /550

=?

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12/19

VI. PERHITUNGAN

A%$-!#$ R&$% R$$% A)$#

Ukuran mesiodistal gigi : 5 s&d 5 1 mm

Selisih /@&(0 1 mm

Ukuran mesiodistal gigi : @< 1 mm

Selisih /@&(0 1 mm

Ukuran mesiodistal gigi : =>@==@= 1 mm

'engkung gigi => s&d = 1 mm

Selisih /@&(0 1 mm



13/19

Ukuran mesiodistal gigi : >>@>=@> 1 mm

'engkung gigi >> s&d > 1 mm

Selisih /@&(0 1 mm

Me)6e P6%)

Metode Pont digunakan untuk mengetahui pertumbuhan dan

perkembangan ke arah lateral pada periode gigi permanen.

aran"a adalah :

*engan umlah lebar mesiodistal gigi 5


14/19

Metode Korkhaus digunakan untuk mengetahui pertumbuhan dan

perkembangan ke arah anteroposterior&mengukur tinggi lengkung

rahang.

aran"a adalah:

Ukur arak dari inter P5 ke tengah insisi;us sentral kanan kiri.

Korkhaus men"atakan arak insisi;us permanen !A dan P5 !A

adalah:

Jarak pada garis sagital antara titik pertemuan insisi;us

permanen sentral dan titik dimana garis sagital tersebut

memotong garis trans;ersal "ang menghubungkan P5 !A pada

palatum.

+andingkan hasil pengukuran dengan umlah lebar insisi;us

atas sebagaipredictor dengan indeks "ang ada di tabel.



15/19

+ila kurang maka mengalami retraksiB bila berlebih maka

mengalami protaksi.7asil Pengukuran

Me)6e H6/e#

Metode 7owes digunakan untuk mengetahui keseimbangan gigi(

gigi atas dengan lengkung gigi dan lengkung basaln"a.

aran"a adalah:

Ukur lebar lengkung gigiB "aitu arak trans;ersal inter P5

!AB diukur pada pun%ak tonol bukal P5 atas kanan dan kiri.

Ukur lebar lengkung basalB "aitu arak trans;ersal inter

$ossa %aninaB diukur pada pun%ak apeks P5 atas kanan dan

kiri.

Ukur panang perimeter lengkung gigiB "aitu umlah mesio(

distal gigi M5 !A kanan dan kiri.

'ebar inter P5 !A sekurang(kurangn"a =>F dari ukuran

mesio(distal M5 kanan dan kiri !A.

'ebar inter $ossa %anina sekurang(kurangn"a ==F dari

ukuran mesio(distal M5 kanan dan kiri !A.

7asil Pengukuran

Jarak inter tonol P5(P5 1

Jumlah mesio distal M5(M5 1

#nter P5 1 arak inter tonol P5(P5 4 566 F

> Md M5(M5

?

1



16/19

Keterangan :

Jarak inter $ossa %anina 1 mm

#nter $ossa %anina 1 arak inter $ossa %aninus 4

566 F

> Md M5(M5

?

Keterangan :

VII. ANALISA FOTO RONTGEN

Je%!# F6)6 : Panoramik & Periapikal & +ite Ging


7asil $oto ronsen ditempel &dilampirkan disini :

(((


17/19

Ke)e$%$% :

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VIII. DIAGNOSA ORTHODONTI

M$-6"-! K-$# ...................!

)!4e............e%$% :

M$-46#!#! !! !%!

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I@. ETIOLOGI :

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@. RENANA PERAWATAN

A. Me%&%$"$% $-$) 6)66%)! -e4$#$% +em6


18/19

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R$$% B$/$

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@I. SKETSA PESAWAT ORTHODONTI

A. R$$% A)$# Ke)e$%$%

B. R$$% B$/$ Ke)e$%$%


Alat(alat "ang digunakan :

Alat(alat "ang digunakan :


19/19

@II. PROGNOSIS

A. +aik & +uruk & Meragukan

B. Keterangan :

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PalembangB

Men"etuuiB

Pembimbing Operator


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Laporan Status Ortho elektif