Cdamp (Complete a minimum of 2 preformed crowns, one of each if possible.)

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CDAMP (Complete a minimum of 2 preformed crowns, one of each if possible.)

EVALUATION: Fabricate Preformed Polycarbonate/Aluminum

Provisional Coverage

STUDENT NAME ___________________________ ID # _____________________

DATE ____________________ PATIENT’S INITIALS ______ or MODEL _____

Materials: 0 – 10 points

The following armamentarium is present:

___ Appropriate personal protective equipment (PPE), basic set up,

articulating paper, floss, various sizes of preformed provisional acrylic or aluminum

crowns, resin/acrylic provisional material and related supplies, scissors,

handpiece or dental lathe with acrylic bur/stone, rag wheel, and pumice

Steps: 0 – 10 points each (N/A if not applicable)
___ 1. Using appropriate PPE and aseptic technique, finds suitable preformed

crown with correct mesial and distal width

___ 2. Determines the desired height of the crown

___ 3. Makes necessary preliminary margin adjustments

___ 4. Dispenses correct amount of provisional material to adequately line preformed


___ 5. Prepares provisional material/s and fills crown within working time

___ 6. Seats loaded crown over preparation

___ 7. Monitors curing process

___ 8. Removes excess material at correct stage of curing process

___ 9. Makes final margin adjustments

___10. Checks occlusion with articulating paper and makes necessary


___11. If needed, polishes adjusted areas for a smooth surface

___12. Provisional coverage meets established criteria

  1. Esthetically pleasing and comfortable to patient

  2. Proper mesial and distal contact to adjacent teeth

  3. Acceptable incisal/occlusal alignment

  4. Fits snugly and accurately along the prepared margin of the tooth

  5. Shows less than ½ mm of space between the restoration and finish line of the prep’s margin

Preceptor declares skill was successfully completed. (75% of total possible points)

PRECEPTOR’S SIGNATURE _________________________________________

STUDENT’S SIGNATURE____________________________________________


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