Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Alumno: _______________________________________
Fecha:_________________
Docente: ______________________________________
Edad:_________________
Comuna:_______________
MOTIVO DE CONSULTA:
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ANAMNESIS PRXIMA
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Clasificacin ASA:_________________________________________________________________
Nombre y telfono medico tratante:_________________________________________________
ANAMNESIS REMOTA
Antecedentes mrbidos:
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Antecedentes quirrgicos:
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Frmacos:
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Alergias: ATB:____
analgsicos:____
anestsicos:____
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1.8
1.7
1.6
1.5
1.4
1.3
1.2
1.1
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
3.8
3.7
3.6
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EXAMEN ENDODONTICO
EXAMEN CLINICO EXTRAORAL:
Cambios de color:_______
EXAMEN RADIOGRAFICO
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TEST ENDODONTICOS
Frio____________________________________________________________________________
Calor____________________________________________________________________________
Vitalometro______________________________________________________________________
Percusion________________________________________________________________________
Otros____________________________________________________________________________
DIAGNOSTICO:
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TRATAMIENTO:
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EXAMEN PERIODONTAL
ANTECEDENTES DE ENFERMEDAD PERIODONTAL
Dolor: __________________________________________________________________________
Hemorragia: _____________________________________________________________________
Movilidad dentaria: _______________________________________________________________
Antecedentes familiares: ___________________________________________________________
HBITOS
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EXAMEN RADIOGRAFICO
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CARACTERISTICAS DE LA ENCA:
Color:___________________________________________________________________________
Forma: __________________________________________________________________________
Posicion: ________________________________________________________________________
Tamao: ________________________________________________________________________
Consistencia y Superficie: __________________________________________________________
INTERCONSULTAS:
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DIAGNSTICO:
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Lateral: __________________
Relacin intermaxilar:
Horizontal: Overjet (mm) ___________
vis a vis______
cruzada_____
Vertical: Overbite (mm) ___________ vis a vis_____ Abierta_____ Invertida_____
Relacin dentaria posterior:
Derecha: 1:1_____________________________________________________________
2:1_____________________________________________________________
Izquierda: 1.1_____________________________________________________________
2.1_____________________________________________________________
3. ANLISIS DINAMICO DE MODELOS ARTICULADOS
Protrusin: (piezas que contactan y piezas que interfieran en la desoclusin)
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Lateralidad: (piezas que contactan y piezas que interfieran en la desoclusin)
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Gua de desoclusion:_______________________________________________________________
Escuela: _________________________________________________________________________
DIAGNSTICO OCLUSAL:
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