Course #DMD6300 Clinical Foundations

Project: Alginate Impressions on Live Patients; Fabricate Maxillary and Mandibular Study Casts
Student Name:
Date:
Criteria Clinically Acceptable Student Self-Evaluation: Faculty
(As determined by Requires Written Statement Evaluation
course and project)
Operatory Operatory properly set up for Critical error: infection control incomplete
Set UP infection control
PPE Proper PPE for working on live Critical error: PPE incomplete
patients
Instrument Only necessary instruments and Critical error: missing instruments and messy setup
Set-Up materials on counter and
organized
Instruments Clean spatulas Critical error: dirty spatulas and bowl
Clean mixing bowls
Preparation Alginate packets Critical error: wrong tray selection
Water Vial
Max impression tray
Mand impression tray
Tray adhesive
Border (rope) wax
Darice Heat Tool
Maxillary Vestibular areas clearly captured Critical error: Impression lacks details
Impression No punch through
No alginate in throat
Mandibular Vestibular areas clearly captured Critical error: Impression lacks details; tongue placement
Impression No punch through wrong
Tongue placed forward and
rested on tray
No alginate in throat.
Final Disinfected Critical error: No disinfection, wrap distorts impression
Impressions Properly wrapped
Max Cast Base parallel to occlusal plane Critical error: Base not parallel to occlusal plane, incomplete
Land area approx. 2 to 3 mm land area, blebs or holes, base not smooth and not flat planes
wide
No blebs or holes on or in cast
All base surfaces flat and smooth
Mand Cast Base parallel to base of max cast Critical error: Base not parallel to base of Max cast, no land
Land area approx. 2 to 3 mm area, blebs or holes, base not smooth and not flat planes
wide
No blebs or holes on or in cast
All base surfaces flat and smooth
Outcomes: Student is to determine clinical outcomes of this project prior to final faculty assessment -

Requires Faculty Student accurately self-assess this Student has Student fails in being able to self-assess. Faculty
Initial project difficulty in self- More effort is required. Assessment:
assessing work.
Needs to work
on details Pass No Pass