Sie sind auf Seite 1von 1

STUDENT EVALUATION SHEET

PRIMARY MOLAR SSC PROFICIENCY - ORTHODONTICS/PAEDIATRIC CLINIC ATTEMPT#


____________

STUDENT: _________________________________________ INSTRUCTOR: ______________________________________


PATIENT NAME: ____________________________________ FILE NO: __________________________________________
CLASS OF 20_____DATE: ____________________________ INSTRUCTOR INITIAL: _______________________________

Circle Appropriate Grade

TOOTH NUMBER GRADE COMMENTS


EVALUATE PRE-OP OCCLUSION U S ______________________________________________________________
CROWN PREPARATION:

(a) Occlusal reduction U S ______________________________________________________________


(b) Interproximal reduction U S ______________________________________________________________
(c) Assess need for buccal lingual U S ______________________________________________________________
reduction

(d) Functional cusp bevel and U S ______________________________________________________________


rounding of line angles

ACCESS & REMOVAL OF CARIES U S ______________________________________________________________

BASE APPLICATION (if required) U S ______________________________________________________________


SSC SELECTION & ADAPTATION U S ______________________________________________________________
SSC CEMENTATION, FINISH,
POLISH & OCCLUSION CHECK U S ______________________________________________________________
FINAL EVALUATION U S ______________________________________________________________
________________________________________________________________________________________________________
_
NOTE:
1. Students must perform independently. FOR INSTRUCTOR USE ONLY:
2. If any procedure is unsatisfactory, the final evaluation is unsatisfactory.
3. Unsatisfactory refers to a critical error that can lead to failure such as:
Next RECALL DUE:______________________
(i) poor/inadequate preparation OR overpreparation
(ii) caries remaining or failure to recognize that pulpotomy is required (mmm/yy)
(iii) unnecessary damage to surrounding and/or adjacent tissues
(iv) poor/incorrect SSC selection/fit/occlusion or cementation

Das könnte Ihnen auch gefallen