Recon - Direct Competency

1144721 (Recon - Direct Competency)

Tran, Pauline
4/26/2020
Last approved by: Castagna, Daniel on 11/26/2019

Summative/Portfolio
Direct Preparation and Restoration Competency -
SUMMATIVE
Summative Exam Number #1 11/26/2019
Is this a Portfolio-style exam? No 11/26/2019
Patient chart number (see bottom of screen) 1168390 11/26/2019
Evaluator 1 - enter Faculty ID# 260 11/26/2019
Evaluator 2 - enter Faculty ID# 612 11/26/2019
Tie-breaking Evaluator ID# (only if required)

Tooth number
12 Yes 11/26/2019

Surfaces
Occlusal Yes 11/26/2019
Distal Yes 11/26/2019
Material Composite 11/26/2019
Preparation Details (Describe)

Section 1: Case Management

Cubicle Set-up/Management Meets All Accepted Criteria 11/26/2019
Patient Management Meets All Accepted Criteria 11/26/2019
Anesthesia Meets All Accepted Criteria 11/26/2019
Independence Slight Deviations from Optimal - Minimal Impact 11/26/2019
** Isolation Slight Deviations from Optimal - Minimal Impact 11/26/2019
** Time Management Yes 11/26/2019

Section 2: Preparation
** Caries Removal Moderate, Clinically Acceptable Deviations 11/26/2019
** Outline Form/Bevel Meets All Accepted Criteria 11/26/2019
** Depth/Internal Form Slight Deviations from Optimal - Minimal Impact 11/26/2019
** Refinement Slight Deviations from Optimal - Minimal Impact 11/26/2019
** Extension/Pulpal Protection Meets All Accepted Criteria 11/26/2019

Section 3: Restoration
** Proximal Contacts(s) Meets All Accepted Criteria 11/26/2019
** Marginal Integrity Meets All Accepted Criteria 11/26/2019
** Contour/Anatomy Meets All Accepted Criteria 11/26/2019
** Occlusion Meets All Accepted Criteria 11/26/2019
** Finish/Polish/Surface Quality Meets All Accepted Criteria 11/26/2019
** Tissue Preservation Meets All Accepted Criteria 11/26/2019

Comments

** These items can constitute critical criteria and result in a

non-passing score.

Printed: 4/26/2020 at 9:37:37PM Page 1 of 2

 Recon - Direct Competency
1144721 (Recon - Direct Competency)
Tran, Pauline
4/26/2020
Last approved by: Castagna, Daniel on 11/26/2019

Printed: 4/26/2020 at 9:37:39PM Page 2 of 2