Protocol of practical training

Simulating part

Name and surname:

ID:

Week from
to

                                              Cavity

                                             Rubberdam

                                              Matrix

                                               Base

                                              Filling

                                               Total

Class I cavity in the first maxillary molar (16 or 26), composite filling with rubberdam







Class II cavity MO preparation for composite in the first maxillary premolar (14 or 24), composite
filling with rubberdam







Class II cavity in the first mandibulary molar (46 or 36) for amalgam OD, base, filling







Class V cavity in the first maxillary molar (16 or 26) for amalgam, base, filling







Class III cavity in the central maxillary incisor (21 or 11) mesially, composite fillings with
rubberdam







Class III cavity in the central maxillary incisor (21 or 11) distally, composite fillings with
rubberdam







Class IV cavity in the second maxillary incisor (12 or 22) messially, composite filling







Class V cavity preparation for glassionomer (14 or 24), filling







Class V cavity preparation for composite (21 or 11), filling







                                               TOTAL







Clinical part

 Name and surname:

ID:


                                               Date


                                              Patient


                                             Diagnosis


                                            Performance


                                               Code

                                 Name and signature of the teacher


















































































Assistance- write A to the performance