RISK ASSESSMENT FOR COMPLEX CASES

Patient___________________________ Dr____________________ Date______________

Risk Factors Low Medium High

ASA TYPE 1 ASA TYPE 3

Medical Status ASA TYPE 2
Non Smoker Smoker

Patient's Esthetic
Low Medium High
Expectations

Smile Line Low Medium High

Periodontal Status Healthy Gingivitis Periodontitis

Slightly Uneven, Uneven Levels (>1.0 mm),

Gingival Levels and Even Levels-Low-
Medium-scalloped, Highly-Scalloped,
Biotype Scallop,Thick Biotype
Medium Biotype Thin Biotype
Endodontic Treatment -
Small and Medium Large Restoration,
Biomechanics Intact Dentition
Sized Restorations Structurally Compromised
Teeth
History of Small Carious
Dental Caries Intact Dentition Active Caries
Lesions

Tooth Alignment Normal Arch Form Minor Crowding Significant Crowding

Normal - Load Test Muscle Pain, Can

TMJ Pain - Load Tests
TMJ/Muscles Negative - Normal Accept Load with
Positive - Abnormal ROM
ROM Tension

Normal Muscle Size Moderate Muscle Size Large Muscle Size and High
Bite Force
and Bite Force and Bite Force Bite Force

Low to No Wear, Moderate Wear, Heavy Wear, Attrition,

Tooth Wear
Attrition, Erosion Attrition, Erosion Erosion

Chewing Pattern Vertical Side to Side Front to Back, All Around

Average Guidance on Flat Guidance, Group

Guidance Pattern Steep Guidance
Cuspids Function

Class II, Deep Overbite,

Occlusal Design Class I Class III, End to End
Large Overjet, Openbite

Canted Facially, Flat

Occlusal Planes Level Uneven, Posterior Step
Sagittally

Restricted Chewing
Occlusal Disease Normal Function Pattern, Parafunction, Bruxism, Bite Changes
Occlusal Dysfunction

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 FORCE MANAGEMENT CHECKLIST

Patient Name__________________________ Doctors Name___________________________

1. What is the chewing and wear pattern?

____________________________________________________________________________
2. What is the condylar position?
____________________________________________________________________________

3. When and where the tooth contacts will occur?

____________________________________________________________________________

4. What is the overbite?

____________________________________________________________________________

5. What is the overjet?

____________________________________________________________________________

6. What is the vertical dimension?

____________________________________________________________________________

7. Which teeth will touch in the guidance?

____________________________________________________________________________

8. What is the angle of guidance?

____________________________________________________________________________

9. What is the envelope of function?

____________________________________________________________________________

10. What is the terminal position of the guidance?

____________________________________________________________________________

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