WORLD BOARD
OF LINGUAL
ORTHODONTISTSGUIDELINES FOR CASE PRESENTATION
TO THE EXAMINATION
OF THEWORLD BOARD OF LINGUAL ORTHODONTISTS

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WORLD BOARD OF LINGUAL ORTHODONTISTS (WBLO)
0. INTRODUCTION
Since WSLO was founded in 2004 we had had in mind, and discussed, the creation of a way to certify
and control a high standard of lingual treatment throughout the world. Now the time has come tofound WBLO (World Board of Lingual Orthodontists). Respecting the initial aim of the WSLO
which means in agreement and involving all lingual orthodontic societies, the WSLO promotes thefounding of the World Board of Lingual Orthodontists (WBLO), in order to recognize the efforts
made by all lingual orthodontists in realizing the highest standards of treatment quality.
The WBLO will certify lingual orthodontists with a worldwide standard of clinical excellence.

WBLO presentation and organization
WBLO is an independent organization that has their own trademark and an independent website(www.wblo.net).
WBLO website is linked with WSLO , ESLO and could also be linked to all the lingual orthodontic
societies website.
The purpose of the Board is to enhance the standards of lingual orthodontic treatment throughout theworld by providing a unified standard against which Orthodontists who desire can be judged,
independently of national examinations.
All the national lingual orthodontic societies could apply WBLO case presentation requirements totheir national Model Display Active Membership. This will help their affiliates to enhance their casepresentations, when they apply to join their own national lingual orthodontic societies. These
presentations could also be used at a later time in their application to the WBLO.
WBLO membership is only an honorific title, and would indicate that the orthodontist has
demonstrated clinical excellence in lingual orthodontic treatment. WBLO does not have any legal
value.
All WBLO members will have the right to use on cards, letterheads, directories and announcements
the designation "Member of the World Board of Lingual Orthodontists".
WBLO examination sessions will be held at all WSLO meetings.
Examination sessions can also be held during ESLO meetings and any International Lingual
Orthodontic Meeting.
In this case, the WBLO Examination Committee should be invited to attend the meeting andorganize the examination session.
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Each organizing group will be responsible for covering expenses of the WBLO examining members
invited to take part.
The Board Examination Committee will be composed of the President and at least 3 examiners . The
examination committee will be in charge for 4 (four) years from the date of election. If necessary,
additional examiners will be named, in relation to the number of participants for any specific session.
The Board Examination Committee will be named collegially by the WBLO assembly, that will beheld during the WSLO meeting. All the examiners must have already submitted their cases to the
WBLO and passed the examination (certified).
At the 3rd WSLO Congress held in Buenos Aires (2009) the founding of the WBLO was discussed. 9
Candidates to be the founding members of the WBLO were chosen. They will present the 8 cases
required by the WBLO bylaws before next year’s ESLO Congress in London. The WBLO will befounded after the ESLO Congress by all candidates whose case studies have been found to be of a
sufficiently high standard. This initial evaluation will be carried out by Dr. Lorenzo Moser, former
president of the EBO.
The first regular examination for WBLO membership will be held at the fourth WSLO Congress
which will be held in Osaka in April 2010.
All orthodontist who become WBLO certified members are eligible to become part of the board
examination committee.
The case presentation standard requested by WBLO is the same as any international orthodontic
board (European Board and / or American Board ) in order to keep a high standard and to berecognized internationally by WFO ( Word Federation of Orthodontics).
The guide to prepare for the examination of the WBLO was inspired from the: “European Board Of
Orthodontists. An illustrated guide to prepare for the examination of the European Board of
Orthodontists” by H.S. Duterloo, P. Palanché.
1. OBJECTIVES
1 .l To enhance the standards of lingual orthodontic treatment throughout the world by providing astandard against which the orthodontists who so desire can be judged independently of national
examinations.
1.2 The WBLO will encourage the spirit of self-improvement among colleagues who are specialists
in lingual orthodontics in the world.
1.3 The standards of orthodontic treatment will be judged by the Board Examination Committeenamed collegially by WBLO assembly. All the examiners must have already submitted their cases to
WBLO and passed the examination (certified).
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1.4 WBLO membership is only an honorific title, and would indicate that the orthodontist has
demonstrate clinical excellence in lingual orthodontic treatment. Membership of the WBLO does
not have any legal value.
2. ELIGIBILITY
The candidate presenting for WBLO must fulfill the following educational and professional
requirements:2.1 The candidate must have undertaken a period of full-time training in orthodontics of at least three
years duration or its equivalent, approved by the National Specialist Committee in Orthodontics orthe appropriate body in the country in which the orthodontist resides. The candidate shall submit to
WBLO a full curriculum vitae since of his/her orthodontic training, the acceptability of which will beconsidered by the Board.
2.2 The candidate shall confirm that the cases presented pursuant to these regulations have been
diagnosed and treated under the sole responsibility of the candidate and that all such cases werediagnosed and treated after he/she had satisfied the training period required by regulation 2.1.
2.3 The examination fee as applicable must be paid before the date of the examination. If a candidate
withdraws from the examination less than 3 months before the date of the examination a portion of
the fee paid will be forfeited. All such withdrawals must be in writing.
2.4 The candidate must sign an agreement which declares that decisions of the Board will be accepted
as final.
3. THE EXAMINATION
3.1 The examination shall consist of:
3.1.1 the presentation of the number of cases required covering a spectrum of malocclusions
as specified. Marks will be allocated for the complexity of the cases, the excellence of thetreatment results and the presentation.
3.1.2 the oral examination will focus on the candidate's knowledge, understanding and ability
to carry out orthodontic treatment to a high standard and to understand the theoreticalprinciples underlying the treatment. The language used shall be English.
3.2 The result of the examination could be "accepted” or "deferred". When a candidate is deferred, theBoard will advise the candidate on re-examination. The candidate can only re-sit the examination
twice and the time interval between such re-examinations shall be advised by the Examination Board.
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3.3 Anonymity
A candidate number will be given to each candidate in order to keep secret his/her identity secret fromthe examiners.
All case presentations have to be made fully anonymously.
The identity of candidates is only revealed at the end when the decision who is accepted or deferred
has been taken.
TYPE OF CASES
The cases presented shall cover the following malocclusions:1. ADULT MALOCCLUSION
An adult not requiring orthognathic surgery but requiring comprehensive therapy and significant
diagnostic and biomechanical skills, which also may include interdisciplinary co-operation.
2. CLASS I MALOCCLUSION
A malocclusion with either a dentoalveolar protrusion, open bite, deep overbite or a significant archlength deficiency, or eruption problems requiring orthodontic treatment.
3. CLASS II DIVISION 2 MALOCCLUSION
Exhibiting an anterior deep overbite with at least two retroclined incisors and a Class II canine
relationship.
4. CLASS II DIVISION 1 MALOCCLUSION
A malocclusion with a high Frankfort mandibular plants angle. Minimum FM angle of 30 degrees
and/or SN to Go-Gn angle of 37 degrees
5. CLASS II DIVISION 1 MALOCCLUSION
A malocclusion with a significant mandibular arch length deficiency. In at least one of the two Class
II:1 cases the treatment must involve extractions in both dental arches (excluding extraction of third
molars).
6. CLASS III MALOCCLUSION
A class III malocclusion requiring orthodontic treatment but not requiring orthognatic surgery
therapy.
7. A SEVERE SKELETAL DISCREPANCY
A malocclusion with a severe anteroposterior and/or vertical discrepancy including comprehensive
surgical-orthodontic therapy.
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8. A SIGNIFICANT TRANSVERSE DISCREPANCY
A posterior crossbite that requires full appliance treatment.
9. REPLACEMENT CASE
If a candidate is unable to produce a case for categories 1, 2, 4, 6 or 8 they may substitute with anothercase from another category but must give an explanation why it has been substituted and may only dothis for one case.
ADDITIONAL INFORMATION TO THE LIST OF TYPES OF CASES
In only one case should orthognathic surgery. If a candidate is unable to produce a case for categories
1, 2, 4, 6 or 8 they may substitute with another case from another category but must give an
explanation why it has been substituted and may only do this for one case. Categories 3, 5 and 7 aremandatory.
Also note the requirement in case 5 where it is stated that at least either in case 4 or case
5 treatment must involve extractions in both arches (excluding extraction of third molar).
Note the description of case 3. The requirements state that an anterior deep overbite, at least
two retroclined incisors and a Class II canine relationship is required, but not a Class II molar
relationship! So a suitable case may have either a Class I or a Class II molar relationship.
Both are acceptable.

PRESENTATION OF CASES
Each case to be presented shall have the following records in English.
1. (a) A diagnostic description of the malocclusion and the Functional status.
(b) Treatment plan including the reasons for it.
(c) A resume of the actual treatment carried out including any difficulties encountered.
2. Dental casts taken immediately before the treatment, at the end of the treatment and at least one
year after the end of the treatment.
3. An initial and final lateral skull radiograph with the teeth in habitual occlusion is mandatory(original film, not printed).
4. Such other skull radiographs as may be necessary for subsequent monitoring.
5. Tracings of the lateral skull radiograph(s), initial and final are mandatory. Tracing
superimpositions are not mandatory. See tracing requirements.
6. Periapical or panoramic radiographs of adequate diagnostic quality before and at the end oftreatment (original film, not printed).
7. Frontal full face (smiling and not smiling), profile full face, and intra-oral color photographs (5 X
8cms) of the occlusion from frontal, right, and left side taken at the beginning, end and at least one
year after the treatment. In addition intraoral color photograph with occlusal view (upper andlower) with lingual appliance are mandatory at the beginning, during and at the end of thetreatment. See photograph requirements.
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IDENTIFICATION OF RECORDS
Each item in the case presentation, including each upper and each lower cast, cephalometric film,
tracing, radiograph and color photographs, must be clearly marked with the following information:- Candidate's number.
- Case number or patient's name.
- Date on which the record was made.
- Patient's age to the nearest month, e.g. "1 1-8"
- Stage of treatment:o Beginning of the treatment. (Black color label)o End of the treatment. (Red colored label)o Follow up records at least one year after the treatment. (Green colored label)
Adhesive labels should be used to identify study cast models; adhesive colored labels should be used
to identify stage of treatment of cast models.
EXAMINATION PROCEDURE
The Candidate would lay out the models a required time before the examination. The Examiners
would then examine the cases and the oral examination of the Candidate would take place later.
The Board of Examiners will decide which Candidates have satisfied the Examiners. The Candidates
shall be informed by letter of the results of the examination. The names of the successful Candidates
would be presented to the Council and then the Business Meeting of the Society.
MEMBERSHIP
Membership of the WBLO shall be granted to the candidates who have demonstrated a theoreticalstandard which is in accordance with the requirements of the Board, but this would not grant the rightof practice in any country.
All WBLO certified members will be listed on WBLO website.
The use of the designation "Member of the World Board of Lingual Orthodontists" (in English or in
the national language) on cards, letterheads, directories and announcements can only be used if so
permitted by national laws and regulations. In case of ethical misconduct or a Member acting
unprofessionally, membership may be revoked by and at the absolute discretion of the Council of the
WBLO.

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THE CASE PRESENTATION
4.1 GENERAL SET-UP OF CASE PRESENTATIONSIn order to examine a large number of cases fairly and accurately, it is important that casepresentations are standardized as this helps the work of the Examination Committee andprovides an objective means to compare with the set standards.
In this Chapter detailed instructions and recommendations are given on how to produce thecase presentations. The time needed to produce the case presentation binders and the dental
casts is estimated at 12-15 hours per case. The use of computer for Board case presentation is not
accepted.
Paper size is A-4. Each page should be placed in a transparent protective cover and the pages
placed in a suitable binder or file. Be sure that material can not fall out of the folder as it may get lost.
Candidates must write all texts in English (pages in the Index of Pages marked by *)Candidates must limit texts, to the text boxes provided.
The size of the type can be changed, but the spacing should remain constant.
Tracings should be made in the prescribed colors - black, red and green, on transparent
material and placed inside the protective covers. White background paper should not be
included, as the tracings will be removed for checking and comparison. Each of the cases
presented must follow the index of pages. Each page is, unless otherwise stated, mandatory.
It is in the spirit of the WBLO that records are as close to the real anatomy, morphology andpathology as possible. Reasonable digital cropping, resizing or rotation is permissible.

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4.2 CASE PRESENTATION INDEX OF PAGES
Index of pages
Number Title of page
WBLO - 01 COVER
WBLO - 02.1* RÉSUMÉ OF CASE 1
WBLO - 02.2* RÉSUMÉ OF CASE 2
WBLO - 02.3* RÉSUMÉ OF CASE 3
WBLO - 02.4* RÉSUMÉ OF CASE 4
WBLO - 02.5* RÉSUMÉ OF CASE 5
WBLO - 02.6* RÉSUMÉ OF CASE 6
WBLO - 02.7* RÉSUMÉ OF CASE 7
WBLO - 02.8* RÉSUMÉ OF CASE 8
WBLO - 02.9* RÉSUMÉ OF CASE 9
WBLO - 03* DIAGNOSTIC DESCRIPTION OF THE MALOCCLUSIONWBLO - 04 FACIAL PHOTOGRAPHS BEFORE TREATMENTWBLO - 05 INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION INCLUDING INTRA-ORAL OCCLUSAL
VIEW BEFORE TREATMENTWBLO - 06 LATERAL SKULL RADIOGRAPH BEFORE TREATMENTWBLO - 07 TRACING OF LATERAL SKULL RADIOGRAPH BEFORE TREATMENTWBLO - 08 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT I
WBLO - 09 PERIAPICAL OR PANORAMIC RADIOGRAPHS BEFORE TREATMENTWBLO - 10 ANY OTHER RADIOGRAPHS BEFORE TREATMENTWBLO - 11* RADIOGRAPHIC ANALYSIS BEFORE TREATMENTWBLO - 12* TREATMENT PLAN AND THE REASON FOR IT
WBLO - 12(1)* INTRA-ORAL OCCLUSAL COLOUR PHOTOGRAPHS OF THE TREATMENT STEPS (UPPER ARCH)
WBLO - 12(2)* INTRA-ORAL OCCLUSAL COLOUR PHOTOGRAPHS OF THE TREATMENT STEPS (LOWER ARCH)
WBLO - 13* RÉSUMÉ OF THE TREATMENT CARRIED OUT INCLUDING ANY DIFFICULTIES ENCOUNTEREDWBLO - 14 FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENTWBLO - 15 INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION INCLUDING INTRA-ORAL OCCLUSAL
VIEW BEFORE TREATMENT AT COMPLETION OF TREATMENTWBLO - 16 LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENTWBLO - 17 TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENTWBLO - 18 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT IIWBLO - 19 PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENTWBLO - 20* RADIOGRAPHIC ANALYSIS AT COMPLETION OF TREATMENTWBLO - 21* DESCRIPTION OF THE TREATMENT RESULTWBLO - 22 FACIAL PHOTOGRAPHS AT RETENTION/ POST-RETENTIONWBLO - 23 INTRA-ORAL COLOUR PHOTOGRAPHS INCLUDING INTRA-ORAL OCCLUSAL VIEW BEFORE
TREATMENT AT RETENTION / POST-RETENTIONWBLO - 24 LATERAL SKULL RADIOGRAPH AT RETENTION/ POST-RETENTIONWBLO - 25 TRACING OF LATERAL SKULL RADIOGRAPH AT RETENTION/ POST-RETENTIONWBLO - 26 CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT III
WBLO - 27* DESCRIPTION OF RETENTION/ POST-RETENTION FINDINGS

red: mandatory pages
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If available, superimpositions may be placed in the back of the folder.
Any other records in the case presentation may be presented to illustrate the case and theseshould be included on subsequent pages. Analyses and methods of superposition should beclearly defined in writing in English. Pages marked with an asterisk (*) contain text boxes fortext written in English. See also 44 and 45 (paragraphs 4.16, 4.17) for additional information.

4.3 IDENTIFICATION AND LABELLING MARKS
Each item in the case presentation, including each upper and lower cast, cephalometric
tracings, radiographs and photographs must be clearly marked with the following information:
Candidate’s number
Case number
The date on which the record was madeThe patient’s age
Stage of treatment
I. Start of treatment (BLACK)II. Completion of treatment (RED)III. Follow up records at least one year after completion of treatment (GREEN)
If you present intermediate records, such as in the early treatment case or a surgical case thecolour code is BLUE
All case presentations have to be made fully anonymously, which means that the name
and/or address, university or office of the candidate has to be removed or masked fromeach item and/or page of all case presentation books.
All cases should give clear evidence of the ability of the candidate to:
1. Formulate an exact and complete orthodontic diagnosis and treatment plan, including thereasons for it;
2. Make correct, weighted clinical judgment in difficult orthodontic situations;
3. Handle the biomechanics of complicated orthodontic conditions;
4. Write a fair and correct evaluation of the treatment provided and its prospects.
The candidate will be asked to put out the models and records required before the examinationand the records will be examined in order to ascertain that all mandatory records arepresented. A photographic record of each of the cases will be taken and preserved by the
Board.

4.4 INCOMPLETE RECORDS
If any case presented has inadequate records the candidate will not be accepted for theexamination. In such circumstances if the candidate wishes to re-apply to be examined at the next
WBLO session he/she will be obliged to pay fees again.

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4.5 THE SYNOPSIS
What is the synopsis? What to fill in? What is its purpose?
The synopsis is a form to be filled by the candidate summarizing the essential data of each categoryof the eight cases. It gives an easy overview for the examiners to check if allnecessary cases are present. The synopsis is saved as a record of the examination. Twocompleted copies of the synopsis need to be present. An example of the synopsis is seen on the next
page. Appendix 1 contains synopsis forms

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SYNOPSIS OF CASE REPORTS
CANDIDATE NUMBER:
CATEGORY
AND NAME

TREATMENT
SUMMARY

AGE & DATE
A-RECORDS

AGE & DATE
B-RECORDS

AGE & DATE
C-RECORDS

1.Adult
malocclusion
Name:
2.Class 1
malocclusion
Name:
3.Class II Div. 2
malocclusion*
Name:
4.Class II Div. 1
malocclusion**
Name:
5.Class II Div. 1
malocclusion***Name:
6.Class III
malocclusion
Name:
7.Severe Skeletal
Discr. SurgicalName:
8.Transversal
discrepancy
Name:
9. Replacement
Case
Name:
*The Class II division 2 case should exhibit an anterior deep bite with at least two retroclined
incisors and a Class II canine and molar relationship.
** A malocclusion with a high Frankfort mandibular plane angle, minimum FM angle of 30°
and/or S-N to Go-Gn angle of 37°.
*** A malocclusion with a significant mandibular arch length deficiency.
Either in case 2 or 5 the treatment must involve extractions in both dental arches.

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4.6 THE “CASE RÉSUMÉ” PAGE
The case résumé page is (after the cover-page) page 2 in the case presentation book.
It contains a summary of all pertinent data of the case. This makes it easy for the examiners to checkif all requirements regarding timing, extractions etc., are available. It is a quick way to make one
familiar with the case, before going into detailed evaluation.
Fill in these forms completely and check carefully if they are compatible with the rest of theinformation in the case presentation book. Do not leave information incomplete as this leaves
questions and is not to your advantage.
The next page shows an example of the résumé page.
Appendix 1 contains one résumé page for each of the 8 types of cases, also for the“replacement case” in case you need to present one.
WHAT SHOULD I FILL IN ON THE CASE RÉSUMÉ PAGE?
Where “DATE” is asked fill in the actual date (dd/mm/yyyy) at which the event occurred.
“AGE” age is filled as number of years and months. Thus: if the patient is 20 years and 5
months: 20.5 years.
“TEETH MISSING BEFORE TREATMENT”: These are teeth not present in the jaws (on intra-oral
examination, casts and radiographs) before treatment. For instance: agenesis 35, 45.
Teeth you have extracted in relation to the orthodontic treatment are mentioned under
treatment plan.
If retention has not ended, write: continued.
To indicate the type of tooth the FDI Two Digit System is used. For instance: 23 is the upper leftcanine.

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RÉSUMÉ OF CASE N° …
CASE CATEGORY:…………………………………
NAME :BORN :SEX :PRETREATMENT RECORDS :

AGE:

DATE:

TREATMENT STARTED :

AGE:

DATE:

TREATMENT ENDED :

AGE:

DATE:

POSTTREATMENT RECORDS :

AGE:

DATE:

RETAINERS :a) upper:

CLASSIFICATION :TEETH MISSING BEFORE TREATMENT :TREATMENT PLAN :APPLIANCE :ACTIVE TREATMENT TIME :b) lower:
RETENTION ENDED :a) upper:DATE:b) lower:

DATE:

AGE:

DATE:

RETENTION TIME :(POST-)RETENTION RECORDS :TIME OUT OF RETENTION :CANDIDATE NUMBER:

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4.7 ABOUT THE TEXT BOXES
The text must be in English in the text boxes.
{See pages marked with asterisk (*) in the Case Presentation Index of Pages; pages 26/27].
The text boxes provide limited space for you to fill in with text. The purpose of using text
boxes is to encourage the candidate to be short, clear and precise in their statements. It is
recommended to carefully check the texts and have them read and edited by someone who isfamiliar with producing condensed texts in English, as in abstracts or summaries.
Base your description of the malocclusion as much as possible on findings from the records
and the examination of the patient. Your treatment plan should be logically based upon thesefindings.
When describing treatment plans make a distinction between “strategic” and “tactical“
aspects. Strategic aspects are, for instance, if you extract permanent teeth and why. Tacticalaspects are planning the types of mechanics. There is an advantage in describing evidence based
clinical decisions. Be critical and avoid illogical reasoning such as: “four premolars
were extracted, because this is an extraction case”, “clinical judgment of the existing
crowding led to the decision to treat non-extraction”, or questionable statements such as ”thepatient was given 3 treatment options… to choose from”; the patient selected option…”
Be realistic about the description of the treatment result. If there are details where one could
have improved if circumstances where better or where there is need for future surveillance forother reasons, be open. Do not let the examiners guess if you have noticed such details or not.
On page WBLO-13 (A Résumé of the actual treatment carried out, including any difficulties
encountered) list the treatment sessions with the actual dates and brief indication what wasundertaken, the progress, etc. Describe specific events and findings, etc.
NOMENCLATURE: It is to your advantage use correct nomenclature in the descriptions.
The use of an orthodontic dictionary is recommended. To name teeth use the FDI Two Digit
System.
Reference: Daskalogiannakis J. Glossary of Orthodontic Terms
Quintessence Publishing Co Ltd, New Malden Surrey
UK Price £65; ISBN: 3-87652-760-0

4.8 DENTAL TOMOGRAM/PANORAMIC RADIOGRAPH
The panoramic radiograph (dental tomogram) is the universally used radiograph fororthodontic patients. However, in many patients with complex dental developmental
disturbances and those with skeletal or functional abnormalities, additional radiographs may
be necessary, apart from the initial cephalograms. Such radiographs might be essential for acomplete understanding the clinical problem at hand and thus need to be included.

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Panoramic radiographs should be of sufficient quality to permit interpretation for diagnosis; original
film radiographs are preferable but printed radiographs are acceptable on condition that highquality paper for photo printing is used.
The literature is replete with articles emphasizing the advantages and disadvantages ofpanoramic radiographs. In addition to this, different types of machines produce different
images each with specific characteristics.
Panoramic radiographs are also used for evaluation of possible root position and mesiodistal
tooth angulations, third molar position and other conditions towards the end or after treatment.
Recent studies indicate that interpretations of mesiodistal root angulations should be
performed very carefully and cautiously (Mckee et al., 2001).

4.8.1 GENERAL RECOMMENDATIONS FOR PANORAMIC
RADIOGRAPHS
Patient position is extremely important to obtain a useful panoramic radiograph. When theocclusal plane is approximately 7 degrees anterior downwards to the horizontal a slightly
curved image results. In this way the double images of the palatal vault and the nasal floor areusually above the apices of maxillary teeth.

Thus in extreme cases, where the occlusal plane makes a larger than normal angle to the nasal
floor, the head of the patient is positioned upward so that the angle of the occlusal plane
approaches 7 degrees. However, in subjects with a severe mandibular backward position, evenwhen the patient is asked to move the mandible forward it may not be possible to obtain animage of the lower jaw and teeth without considerable distortion. This is due to the position of
the image layer of the machine and the oblique position of the (lower) anterior teeth.
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The teeth appear twisted with blunted apices. The coronal part is within the range of theimage layer with relatively little enlargement. The apical parts of the roots, however, arepositioned backward and more or less outside the range of the image layer so that this part ofthe image is transversally enlarged. Similarly, the coronal part of a palatally impacted
maxillary canine is imaged larger, because of its backward position relative to the image
layer. In deep bite cases, have the patient bite either on a bitefork provided with the machineor a cotton role, so that the anterior teeth are not imaged in overlap.
The patient’s head should also be placed as precisely as possible with the midsagittal plane in
the same position as the midline of the machine. Some machines have light indicators to findthe correct position. Incorrect placement may lead to unacceptable distortions and blurring.
The asymmetrical patient obviously creates a problem; the position of the eyes and/or the
bipupillar line might be of help, but distortion and blurring might be unavoidable.
Measurements on panoramic radiographs are not so reliable to detect small asymmetries(Türp et al , 1995). However, when a group of morphological indications of (mandibular)
asymmetry can be observed it is possible to make correct diagnostic conclusions.

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Under the conditions mentioned above it might not always be necessary to take additional
radiographs. It is recommended that the panoramic and cephalogram are first analysed
together and then decide if additional radiographs are essential. Usually, conditions in theupper anterior region are reasons for extra radiographs.
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Do not crop the radiograph to just the teeth; important or additional information might be lost.
For instance: images of the mandibular condyles might indicate a need for additional records.
Panoramic radiographs from the same patient (e.g. before and after treatment) produced withdifferent machines can only be compared with extreme caution. The reason is that the shapeof the image layer is usually different in various types of machines. Measurements are very
unreliable in such situations.
References:
Türp J C, W Vach, JR Strub, K Harbich, KW Alt 1995 Erkennung von mandibulären
asymmetrien auf der Panoramaschichtaufnahme Schweiz MZ 105:755-759
McKee I W, Glover K E, Williamson P C, Lam E W, Heo G, Major P W 2001 The effect ofvertical and horizontal positioning in panoramic radiography on mesiodistal tooth angulations.
The Angle Orthodontist 71: 442-451.

4.9 CEPHALOMETRIC RADIOGRAPH

Quality cephalograms are usually produced if one follows the prescriptions provided by the
manufacturer of the cephalometer and when the film is developed in a well-maintained
development machine or digitally processed. Regularly check the earplugs of the machine toensure that the patient is correctly positioned. Identical conditions for each cephalogram are afundamental requirement for diagnosis and evaluation of growth/treatment changes.
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Special software programs may include advanced image enhancement toolsthat can significantly improve the clarity of the radiograph.
Original film radiographs are preferable but printed radiographs are acceptable on condition
that reproduction ratio 1:1 is respected and high quality paper for photo printing is used.

4.10 WHAT SHOULD I EXPLAIN ABOUT RADIOGRAPHS?
Radiographs, such as panoramic or dental tomograms, periapicals and cephalograms, are notself-explanatory. This means that relevant findings from these radiographs must be mentioned
in the texts on the pages in the case presentation book provided for that purpose (pages 11 and20). The reason for this is that examiners should have no doubts that you have observed therelevant findings and from where you obtained the items mentioned in the text of yourdiagnosis, treatment plan or in the description of the treatment result. This makes theevaluation of the cases clear and logical to the examiners and is thus to your advantage. For
example, when you mention items seen on the panoramic radiograph do not limit yourself toonly the teeth and their immediate structures. There are may be other items visible that are ofclinical significance: e.g. is there a difference in the images of the condyles or in themandibular contours? In the end-of-treatment panoramic radiograph: what about position,
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developmental stage and prospects of third molars? What was your advice to the patient on
the basis of that radiograph?

4.11 CAN I USE MY OWN CEPHALOMETRIC ANALYSIS?
Yes you can! However measurement of cephalograms according to the WBLO Morphological
Assessment Form is mandatory. Other cephalometric procedures are acceptable, if they areclearly explained. Be aware that examiners might be unfamiliar with the analysis you use.
Place that information in the back of the folder in the section “Additional records”.
If you want to use your own cephalometric analysis, indicate the additional landmarks as wellon the tracing, or include an extra copy of the tracing with the data of your analysis.

4.12 WHAT DO I HAVE TO DO WITH MY MEASUREMENTS?
As is the case with radiographs, the measurements of a cephalometric assessment or analysis
are not self-explanatory. It is insufficient to only present the numbers and leave theinterpretation to the examiners. The conclusion of your observations and measurements aredescribed in words on the pages provided for that purpose (pages 11 and 20). For example:“on the basis of the cephalometrics it is concluded that the face is retrognathic, but the sagittal
jaw relationship is normal”. Or: “the cephalometric data reveal that growth and treatmentchanges have normalised the sagittal jaw relationship”.
All the above advice is aimed at making the presentation of your diagnosis andtreatment plan as clear and logical as possible, based on the described observations andanalysis.

Page 21 of 46

4.13 CEPHALOMETRICS: TRACINGS, LANDMARKS, LINES

Example tracing of the before treatment cephalogram (colour: black)
Hand tracings are mandatory and must be produced using a 0.5 mm lead pencil on thintransparent acetate tracing paper so that the accuracy of the tracing can be checked. Do not use a felt
pen: it is usually much too thick. The landmarks used for the WBLO Morphological Assessment
should be indicated on the tracing. If you also want to use your own cephalometric analysis thenindicate the necessary landmarks as well on the tracing. Computerized production of tracings
is not acceptable, however computerized preparation and printing of tracings (andsuperimpositions) is acceptable to enhance presentation. The original must be available forchecking the accuracy of the tracing. Place them with the additional material in the back of
the folder. Pre-treatment tracing in black (mandatory), post-treatment tracing in red(mandatory), follow-up record tracings in green are not mandatory, but
desirable, if available.

Page 22 of 46

Example of the end of active treatment tracing in red
Place the tracings in the cover sheets and remove the indicated part of the page, so that it iseasy for the examiners to check the tracing and compare with the cephalogram.
When interpreting and describing changes in the measurements you observe be aware of theerror of the method, before you make definite statements about changes due togrowth/treatment when evaluating your case.
Reference:
Kamoen A, Dermaut L, Verbeeck R 2001 The clinical significance of measurement error in
the interpretation of treatment results. European Journal of Orthodontics 23: 569-578

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4.14 CEPHALOMETRIC MORPHOLOGICALASSESSMENT I
Pre-treatment

Mean SD

Sagittal Skeletal
Relations
Maxillary Position
S-N-A

82º ± 3.5º

Mandibular Position
S-N-Pg80º ± 3.5º

Sagittal Jaw Relation
A-N-Pg2º ± 2.5º

Vertical Skeletal
Relations
Maxillary Inclination
S-N/ANS-PNS

8º ± 3.0º

Mandibular
Inclination
S-N/Go-Gn
Vertical Jaw Relation
ANS-PNS/Go-Gn

33º ± 2.5º

25º ± 6.0º

Dento-Basal
Relations
Maxillary Incisor
Inclination
1-ANS-PNS
Mandibular Incisor
Inclination
1 -Go-Gn
Mandibular Incisor
Compensation
1 -A-Pg (mm)Dental Relations

110º ± 6.0º

94º ± 7.0º

2 ± 2.0

Overjet (mm)3.5 ± 2.5

Overbite (mm)2 ± 2.5

Interincisal Angle
1/1

132º ± 6.0º

CANDIDATE NUMBER:
CASE NUMBER:

DATE:
Page 24 of 46

AGE

4.15 WBLO CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT
It is mandatory to fill in the forms for the WBLO Cephalometric Morphological Assessment(example on page 42). The morphological assessment is not a cephalometric analysis. The
reason for including this mandatory form is to make it possible for the examiners tofamiliarize themselves more easily with the main characteristics of the case and to comparewith other cases.
It is perfectly alright if you use your (own) usual cephalometric analysis and you may include
that in the additional records, provided that you explain it properly so that it is understandable
for anyone who is not familiar with that analysis. Do not forget to indicate landmarks on yourtracing.

For the WBLO Cephalometric Morphological Assessment, overbite and overjet
are measured as indicated.

Page 25 of 46

4.15 CEPHALOMETRIC SUPERIMPOSITION
Superimposition of tracings is not mandatory. However if post-treatment radiographs areauthorized in your country superimposition may greatly enhance the evaluation of the case.
Björk’s method (Björk and Skieller, 1983) of superimposition on natural reference structures in the
cranial base, the mandible and maxilla is recommended. The illustrations in 4.15.1, 4.15.2 and
4.15.3 are printed here as examples to demonstrate how these superimpositions look.
If you use superimpositions describe also your interpretations and findings.

4.15.1 GENERAL SUPERIMPOSITION
Superimposition on stable structures in the anterior cranial base

Page 26 of 46

4.15.2 SUPERIMPOSITION OF THE MANDIBLE

Local superimposition on natural reference structuresin the mandible

Page 27 of 46

4.15.3 SUPERIMPOSITION OF THE MAXILLA

Local superimposition on natural reference structures in the maxilla
References
Björk A, V Skieller 1972 Facial development and tooth eruption. An implant study at the age ofpuberty. American Journal of Orthodontics 62: 339-383
Björk A, V Skieller 1976 Postnatal growth and development of the maxillary complex. In:
McNamara Jr. J A (ed.) Factors affecting the growth of the midface. Monograph No. 6,
Craniofacial Growth Series, Center for Human Growth and Development, University of Michigan,
Ann Arbor, pp 61-69
Björk A, V Skieller 1983 Normal and abnormal growth of the mandible. A synthesis of longitudinal
cephalometric implant studies over a period of 25 years. European Journal of Orthodontics 5: 1-46

Page 28 of 46

4.16 OTHER ADDITIONAL RADIOGRAPHS
In more complicated cases additional radiographs might be necessary for complete diagnosis andtreatment planning. Such radiographs should be placed with (A) The records before treatment on
page WBLO-10 of the Case Presentation Book of that case. Explain on page WBLO-11, the need forthese records and your interpretation and conclusions.
The routine standard use of posteroanterior or anteroposterior cephalograms and/or hand/wrist
radiographs is not recommended. In cases of dental trauma or impacted unerupted teeth peri-apicals
and/or other radiographs may be necessary for correct diagnosis and to demonstrate theappropriateness of your treatment decisions. In cases of severe developmental craniofacial
deformities other three-dimensional imaging techniques may be needed.
Failure to include such records may impair judgment for the examiners.

4.17 LIMITATIONS IN PATIENT RECORDS
The Board promotes and recommends strict radiation dosage control.
In some countries limitations exist in taking radiographs.
They create no particular problem with regard to the requirements for the WBLO case presentations.
Regarding post-treatment records, the guidelines of the BSO* are used as an example. These create
no problem provided that proper evaluation of the treatment that was proposed is possible. The
treatment of complicated and difficult cases often needs records during, towards the end, or evenafter orthodontics. They are needed to evaluate the treatment effects or as a starting point for othertreatments such as prosthetics and/or periodontics or surgery.
* Reference
Isaacson K G, Thom A R (2nd edition 2001) Orthodontic radiographs: guidelines. British
Orthodontic Society ISBN 1 899297 05
The WBLO distinguishes between mandatory records and additional other records.
The WBLO has therefore in the form “instructions to candidates” the following statements:
B records (Completion of Treatment),
Page WBLO-16: “lateral skull radiograph at the completion of treatment is not mandatory but usefulifavailable”
It is obvious in such condition that WBLO-17 (tracing in red) and WBLO-18 (CephalometricMorphological Assessment II) are not mandatory, but useful if available.
Page WBLO-19 (Peri-apical or panoramic radiograph at completion of treatment) and page WBLO20(Radiographic analysis at completion of treatment) are mandatory.
C records: similar rules.
In addition to the above, examiners always take a close look at “additional records” for better
evaluation of the case. For instance, a careful cephalometric evaluation of the growth/treatment
effects with additional cephalograms, tracings and superimpositions may greatly enhance thePage 29 of 46

evaluation. The examiners also look to the justification for records, in particular radiographs; forinstance the demonstration of a large number of TMJ radiographs when from the described
diagnostics nothing indicated that there was a problem to be diagnosed in that way. This, of course,
may obviously negatively influence the marks. Though only 10% of the marks are given for record
quality, excellent records can considerably improve proper judgment. In short: the candidate hasquite some freedom in what to present, but there is a minimum of mandatory records and of course
the presentation of the case must be such that it can be properly evaluated. Additional records may
be useful for the evaluation of the case. For instance the use of intra-oral photographs taken during
treatment to explain and/or demonstrate specific treatment mechanics.

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4.18 THE DENTAL CASTS
Three sets of dental casts are mandatory. Only dental casts images are not acceptable.
They should show correct anatomical detail of all the teeth and the surrounding tissues.
They should be made of white orthodontic plaster, soaped and lightly polished.
The dimensions of the base of the casts are shown in the figures.
Wax or silicone bites may be useful for protection.
The occlusion will be judged by placing the upper and lower cast together with the backside of thebase on the table.
The use of articulators and mounted models is acceptable.
All dental casts (upper and lower) should be identified as shown in the figures.
Identification:
A circular identification mark (for instance a coloured sticker) is placed on the front of the lower
cast and on the left side of both casts.
This colour of the mark is different at the three stages of the presentation:
At the before treatment records: black
At the completion of treatment records: red
At the (post) retention records: green
The casts are further identified by placing a label on the back of the upper and lower casts with:
1. The candidate’s number on the left side of the upper cast
2. The case number on the right side of the upper cast
3. The date the impression was made on the left side of the lower
4. The patient’s age on the right side of the lower.
REMEMBER THAT ALL THE REQUIREMENTS FOR THE CASE PRESENTATIONS ARE
MADE TO FACILITATE THE EVALUATION BY THE EXAMINERS WITHIN A LIMITEDTIME FRAMEWORK AND TO AVOID OMISSIONS, MISTAKES OR CONFUSION.
FOLLOWING THE REQUIREMENTS EXACTLY IS TO YOUR ADVANTAGE.

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Page 32 of 46

4.19 THE EVALUATION OF OCCLUSION ON DENTAL CASTS
With the immediate after treatment (red) cast the candidate has the opportunity to demonstrate how
well he/she is able to handle the biomechanics of the orthodontic appliance used and how the
occlusion changed.
The “at least” one year after treatment cast (green) shows the final occlusion as it has settled. This is
the cast to evaluate finishing details and minor changes that occurred during settling and- possibly further growth. It may also provide estimation on the prospects of stability.
Studies on adult dental occlusion have a long history dating back to the beginning of the lastcentury when Angle (1899) for the first time presented a systematic description, and, in more recent
years, the evaluation by Andrews (1972).
Page 33 of 46

His concept of “six keys to normal occlusion” have been widely used as a standard and led to thedevelopment of pre-adjusted multi-bracketed appliances.
Longitudinal studies of development of the occlusion in orthodontically untreated individuals showthat changes occur also after the permanent teeth have emerged and come into occlusion. This has
been found not only in adolescents but also in adults (Moyers et al., 1976; Schols and van der
Linden, 1988; Duterloo, 1991). These changes include reduction in arch length and increase incrowding, particularly in the anterior areas. In addition, long-term studies of occlusal changes after
orthodontic treatment (Riedel, 1977) show similar tendencies. Minor, individually patterned,changes in occlusion are common. Particularly, changes in the lower anterior area are notorious, butother treatment effects such as changes in the curve of Spee appear more stable (De Praeter et al.,2002). Continued facial growth after the active treatment period is seen as the major cause for thedescribed changes. This makes “green records” of particular interest. Longitudinal, long-term
studies show that the stability of a treatment result has no direct relationship to the excellence of thetreatment performed and is in fact unpredictable. After treatment changes have lead to the universal
application of semi–permanent fixed retention and other devices and procedures to reduce thetendencies of undesirable occlusal changes (Zachrisson, 1997).
Occlusion on dental casts (“red” and/or “green”) can be evaluated and appreciated in several
different ways. It should be remembered that ideal “textbook” occlusion is not always a viable
treatment objective in complex and difficult cases. Extreme variations in morphology of the jaw
bases, crowns and/or the roots of the teeth may lead to occlusal variations that are acceptable. On
the other hand changing tooth morphology is a common orthodontic procedure to improvefunctional occlusal fit and stability.
The Board promotes, as a general rule, that the final occlusion should be as precise as is appropriate
for the case in question. However, undue lengthening of treatment and/or extended procedures toreach for an “ideal” may not be in the interest of the patient. Convincing scientific evidence islacking that in all cases an “ideal” occlusion is essential for total treatment effectiveness. Balanced
weighting of all clinical aspects of treatment characterises the mature and excellent clinician. In
WBLO case presentations this can be demonstrated in the descriptive texts reporting the actual
treatment procedures, progress and result as well as in the dental casts and the photographs.
The literature offers a number of methods to assess “quality” of after-treatment-occlusion as ameasure for quality of treatment. The Peer Assessment Rating (PAR) Index was developed in 1987
by examining over 200 dental casts (Richmond et al., 1992, 1994). This index has recently beenused to develop a treatment outcome standard for fixed appliance treatment in the UK (McMullan etal., 2003). According to the ABO, the PAR index “has good reliability and validity, however thismeasuring system is not precise enough to discriminate between the minor inadequacies of tooth
position that are found in ABO case reports” (Casko et al., 1998). The ABO developed an“objective grading system” after field-testing on 832 casts and panoramic radiographs. Most
common inadequacies in the occlusion are an overjet of mandibular/maxillary second molars andoverjet in the incisor areas; inadequate root angulation was seen most in lateral maxillary incisors,canines, second premolars and mandibular first premolars. The Board introduced the ABO
Page 34 of 46

measuring gauge and developed a grading system to obtain a numerical standard (Casko et al.,1998). With the ABO system seven different criteria are used on dental casts: alignment, marginal
ridges, buccolingual inclination, occlusal relationship, occlusal contacts, overjet and root
angulations. Root angulation is evaluated on panoramic radiographs.
To help candidates evaluate their after treatment casts, the “six keys to normal occlusion”(Andrews, 1972) are presented below.

Page 35 of 46

4.20 IMPLEMENTING THE SIX KEYS
Candidates are encouraged to implement Andrew’s “six keys to normal occlusion” when they selectand evaluate their cases for presentation.

Key I pertains to the occlusion and the interarch relationships of the teeth...
This key consists of seven parts:
1. The mesiobuccal cusp of the permanent maxillary first molar occludes in the groove between themesial and middle buccal cusps of the permanent mandibular first molar, as explained by Angle.
2. The distal marginal ridge of the maxillary first molar occludes with the mesial marginal ridge ofthe mandibular second molar
3. The mesiolingual cusp of the maxillary first molar occludes in the central fossa of the mandibular
first molar
4. The buccal cusps of the maxillary premolars have a cusp-embrasure relationship with themandibular premolars
5. The lingual cusps of the maxillary premolars have a cusp-fossa relationship with the mandibular
premolars
6. The maxillary canine has a cusp-embrasure relationship with the mandibular canine and firstpremolar. The tip of its cusp is slightly mesial to the embrasure
7. The maxillary incisors overlap the mandibular incisors, and the midlines of the arches match.
The cusp-groove and the marginal-ridge conditions of the molars, the cusp-embrasure relationshipof the premolars and canines, and incisor overjet can be observed directly from the buccal
perspective.
The assessment of the lingual-cusp occlusion of the molars and premolars is possible when theseteeth are viewed from their mesiobuccal aspect, as explained below.
Interarch relationship of the posterior teeth of two dentitions can be the same, but the interfacing of
the occlusal surfaces of the two dentitions may differ because of differing crown inclinations.
Judging crown inclination (and therefore occlusal interfacing) is ineffective from the buccal
perspective.
It can be compared to attempting to learn whether the flanges of a hinge are together or apartby looking only at its joint.
Page 36 of 46

Correct occlusal interfacing depends on correct interarch relationship, angulation, and crowninclination. Interarch relationship and angulation are best judged from the buccal perspective;
crown inclination for posterior teeth is best judged from the dentition's mesiobuccal perspective.
Judging posterior occlusion first from the buccal (for angulation and interarch relationship) thenfrom the mesiobuccal aspect (for inclination) provides a perspective that can be systematicallydescribed and quantified.
Such information, along with other occlusal guidelines, provides a set of standards against which
occlusal deviations can be identified.

Key II: Crown Angulation
Essentially all crowns have a positive angulation.
All crowns of each tooth type are similar in the amount of angulation.
Maxillary second molars are positive in angulation only if they have completed their eruption. Third
molars are not present often enough to be evaluated.

Page 37 of 46

Key III: Crown Inclination
As they do in angulation, consistent patterns also prevail in crown inclination, with the following
characteristics for individual teeth.
1. Most maxillary incisors have a positive inclination; mandibular incisors have a slightly negative
inclination. The crowns of the maxillary incisors are more positively inclined, relative to a line 90°
to the occlusal plane. The mandibular incisors are negatively inclined to the same line.
2. The inclinations of the maxillary incisor crowns are generally positive, the centrals more positive
than the laterals.
3. The inclinations of canines and premolars are negative and quite similar.
The inclinations of the maxillary first and second molars are also similar and negative, but slightly
more negative than those of the canines and premolars. The molars are more negative because they
are measured from the groove instead of from the prominent facial ridge, from which the caninesand premolars are measured.
4. The inclinations of the mandibular crowns are progressively more negative from the incisors to
the second molars.

Key IV: Rotations
The fourth key to optimal occlusion is absence of tooth rotations
Page 38 of 46

Key V: Tight Contacts
Contact points should abut unless a discrepancy exists in mesiodistal crown diameter.

Key VI: Curve of Spee
The depth of the curve of Spee ranges from a flat plane to a slightly concave surface.

Page 39 of 46

References
Andrews L F 1972 The six keys to normal occlusion. American Journal of Orthodontics 62: 296309
Angle E H 1899 Classification of malocclusion. Dental Cosmos 41: 248-264, 350-357
Casko J S et al. 1998 Objective grading system for dental casts and panoramic radiographs.
American Board of Orthodontics. American Journal of Orthodontics and Dentofacial Orthopedics
114: 589-599
De Praeter J, Dermaut L, Martens G, Kuijpers-Jagtman A M 2002 Long-term stability of theleveling of the curve of Spee. American Journal of Orthodontics and Dentofacial Orthopedics 121:266-272
Duterloo H S 1991 Development of the dentition under the influence of functional In: Hunter W S,
Carlson D S (eds.) Essays in honor of Robert E Moyers. Monograph No. 24 Craniofacial Growth
Series, Center for Human Growth and Development University of Michigan, Ann Arbor, pp 103121
McMullan R E, Doubleday B, Muir J D, Harradine N W, Williams J K 2003 Development of atreatment outcome standard as a result of a clinical audit of the outcome of fixed appliance therapy
undertaken by hospital-based consultant orthodontists in the UK. British Dental Journal 194:81-84
Moyers R E, Van der Linden F P G M, Riolo M, McNamara Jr. J A 1976 Standards of occlusal
development. Monograph No. 5, Craniofacial Growth Series, Center for Human Growth andDevelopment, University of Michigan, Ann Arbor
Richmond S et al. 1992 The development of the PAR Index (Peer Assessment Rating): reliability
and validity. European Journal of Orthodontics 14:125-139
Richmond S et al. 1994 An introduction to occlusal indices. 2nd Edition, Mandent Press.
Riedel R A 1977 Post-pubertal occlusal changes In: McNamara Jr. J A (ed.) The biology of occlusal
development. Monograph No. 7, Craniofacial Growth Series, Center for Human Growth andDevelopment, University of Michigan, Ann Arbor, pp. 113-141
Schols J G J H, van der Linden F P G M1988 Gebiszentwicklung und Gesichtswachstum in derAdoleszenz. Informationen Aus Orthodontie und Kieferorthopädie 20:21-109
Zachrisson B U 1997 Important aspects of long-term stability. Journal of Clinical Orthodontics 31:
562-568

Page 40 of 46

4.21 FACIAL COLOUR PHOTOGRAPHS
Frontal, lateral, and oblique facial color photographs should be presented as prints withdimensions of 5 by 8 cms. with the head positioned in FH and so that the eyes are on one line. Avoid
shadows.

Try to avoid shadows; use preferably white background.
Try to position patient’s head parallel to Frankfurt Horizontal (FH).
(However, an imprint of FH in the photograph in your case is not mandatory)

Page 41 of 46

4.22 INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION
Intra-oral color photographs of the occlusion from frontal, right, and left side and occlusal viewshould be printed in dimensions of 5 by 8 cms. The occlusal line should be horizontal. Prints of theocclusal views of the arches are mandatory.

The horizontal and vertical lines in these pictures indicate the position of the dentition within theframe; there is no need to show them in your case. Occlusal view images should be include at least
first molars in A-P direction.
At least three treatment steps intra-oral occlusal view images (beginning, middle and end oftreatment) showing lingual appliance must be presented for upper and lower arch todemonstrate lingual treatment progress.

Page 42 of 46

EVALUATION BY EXAMINERS
5.1 WHO ARE THE EXAMINERS?
The Council of the WBLO nominates examiners for a four-year period on the basis of membership ofthe Board and their expertise, and the number of examiner will be in relation to the numberof candidates. The language used will be English.

5.2 HOW DO THE EXAMINERS WORK?
For all parts of the examination a score of at least 65% is required for a pass. A case evaluation
form is used with a sequence of marks for each case. No more than 10% of the marks can be gained
from the quality of the records. The difficulty of a case is given due consideration whenassessing the marks. The use of the case evaluation form helps the examiners to calibrate, to besystematic and objective. It also allows the possibility to give balanced weighting to all aspects ofthe case and not just single out, for instance, purely the post-treatment occlusion. The texts therefore
play a major role in the evaluation, as this is where the candidate can explain the rationale forclinical decisions and actions, describe difficulties encountered during treatment, or express doubts
or self-criticism on particularly controversial aspects of the treatment provided.
Two examiners, working independently, see each case. After evaluation of all cases they compare
their results and make a weighted judgment. If this is not possible the complete committee judges
the case(s) or discusses the oral examination to arrive at a decision. Different examiners act for theoral examination independently and they are unaware of the judgment of the cases. The final
judgment on the cases and the oral examination takes place at the adjudication meeting. All final
decisions of the Examination Committee are corporate decisions. The Chairman of the Committee
functions as “Primus inter pares”.

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5.3 THE WBLO CASE EVALUATION FORMSCORE

MINIMUM

MAXIMUM

Photographs

2.5

Dental casts

2.5

Radiographs

2.5

Ceph. tracing

2.5
6.5

Total records

10

Observations

5

Diagnosis

5

Treatment plan

10

Explanation of plan

10
19.5

Total clinics

30

Improvement ofdentofacial aesthetics
Efficiency
therapy/difficulty ofcase
Finishing of occlusion

10

Stability of treatment
resultTotal therapeutics

10
39

60

TOTAL of CASE

65

100

30

10

The examiners, to systematically evaluate each of the cases individually use the form printed above.
The evaluation contains three parts: records, clinics, and therapeutics. The content of each part isindicated in the diagram above. The total number of marks to be gained on a case is 100. The
minimum number of marks to be successful = 65 (65%). This holds for each of the three parts of theevaluation. As one can see 30 marks (30%) can be gained by efficient treatment in a difficult case.
The Board promotes the presentation of difficult cases.

Page 44 of 46

5.4 THE FORM TO PRESENT THE EXAMINATION RESULTThe form below is used by the Examination Committee to evaluate the examination. All the totals
for records, clinic and therapeutics will be filled in. This form and all other individual data remain
confidential and will not be given to anybody else. The Examination Committee, for its confidential
reports to the WBLO Council, may use data (anonymous) for statistics and policy development.

CANDIDATE

Case
1

Case
2

Case
3

Case
4

Case
5

Case
6

Case
7

Case
8

MINIMUM

MAXIMUM

Photographs

2.5

Dental casts

2.5

Radiographs

2.5

Ceph. tracing

2.5

Total records

6.5

10

Observations

5

Diagnosis

5

Treatment plan

10

Explanation of plan10

Total clinics

19.5

Improvement ofdentofacial aesthetics
Efficiency
therapy/difficulty of case

30
10
30

Finishing of occlusion

10

Stability of treatment
result10

Total therapeutics

39

60

TOTAL of CASE

65

100

WBLO …….. (year)

CANDIDATE ..…. RESULT CASES

Total score cases =….…/8 =……………. Minimum score = 520 / 8 = 65

Page 45 of 46

5.5 POSTSCRIPT
Though the WBLO examiners regularly calibrate their judgment to be as objective as possible, somesubjectivity is unavoidable. On the other hand clinical procedures, perfectly applied and accurately
described, together with intelligent, elegant solutions to complex orthodontic problems effectively
show ability and treatment results that can be reliably identified as excellent. It is obvious thatcandidates select the very best available material, but it is unlikely that the presented cases would beunrepresentative of the professional standard of that clinician. It is therefore our opinion that thesuccessful candidate is most likely an excellent clinician.
Candidates usually find the examination a tremendous professional challenge and for most of them,after many months of painstaking preparation, it is an enormously rewarding, if a somewhat
stressful day. The successful candidates are quite rightly proud of their achievement and we have
yet to meet a successful candidate who did not think the WBLO was a very worthwhile pursuit ofclinical excellence.

Page 46 of 46