LAB 1
DENTAL ASSISTING PROGRAM
STUDENT___________________
DENTAL MATERIALS
DATE ______________
COURSE DENT 1200
INSTRUCTOR___________
_____________________________________________________________
LAB EVALUATION FORM: Demonstrate Zinc Oxide Eugenol Cement Mixing Techniques
Scoring:
3 points
2 points
1 point
0 point
-
Task performed satisfactorily without prompting.
Task performed satisfactorily with self-initiated correction.
Task performed with prompting required.
Unable to perform
Performance Objective: The student will demonstrate the ability to mix zinc oxide eugenol dental cements
For a sedative base or temporary restoration.
Tasks:
Points
1. Select matching powder and liquid, spatula and pad.
_____
2. Fluff powder
_____
3. Dispense powder, cover
_____
4. Dispense liquid , cover
_____
5. Incorporate powder into liquid using flat side of blade. _____
6. Gather entire mass into one unit to check consistency. _____
7. Clean off spatula
Possible 21 pts
_____
Actual score________ % grade_________
LAB 2
DENTAL ASSISTING PROGRAM
STUDENT___________________
DENTAL MATERIALS
DATE ______________
COURSE DENT 1200
INSTRUCTOR___________
_____________________________________________________________
LAB EVALUATION FORM: Demonstrate Zinc Phosphate Cement Mixing Techniques
Scoring:
3 points
2 points
1 point
0 point
-
Task performed satisfactorily without prompting.
Task performed satisfactorily with self-initiated correction.
Task performed with prompting required.
Unable to perform
Performance Objective: The student will demonstrate the ability to mix zinc phosphate cements
for luting.
Tasks:
Points
1. Select matching powder and liquid, spatula and slab.
_____
2. Chill slab then dry
______
3. Fluff powder and dispense
_____
4. Divided powder
_____
5. Dispense liquid
_____
6-10. Incorporate powder into liquid in timed increments.
1st -15-20 sec
2nd 15 sec
3rd – 15 sec
4th – 15 sec
5th- 15-20 sec
11. Gather entire mass check consistency.
_____
______
______
______
______
_____
12. Clean up of spatula and mixing slab.
_____
Possible 36 pts
Actual score________ % grade_________
LAB 3
DENTAL ASSISTING PROGRAM
STUDENT___________________
DENTAL MATERIALS
DATE ______________
COURSE DENT 1200
INSTRUCTOR___________
_____________________________________________________________
LAB EVALUATION FORM: Demonstrate Polycarboxylate Cement Mixing Techniques
Scoring:
3 points
2 points
1 point
0 point
-
Task performed satisfactorily without prompting.
Task performed satisfactorily with self-initiated correction.
Task performed with prompting required.
Unable to perform
Performance Objective: The student will demonstrate the ability to mix polycarboxylate cement
for luting.
Tasks:
Points
1. Select matching powder and liquid, spatula and pad.
_____
2. Fluff powder and swirl liquid.
_____
3. Dispense powder onto mixing pad.
_____
4. Dispense liquid onto mixing pad.
_____
5. Incorporate powder into liquid using flat side of blade.
_____
6. Gather entire mass into one unit to check consistency.
_____
7. Clean up of spatula and mixing pad.
_____
Possible 21 pts
Actual score________ % grade_________
LAB 4
DENTAL ASSISTING PROGRAM
STUDENT___________________
DENTAL MATERIALS
DATE ______________
COURSE DENT 1200
INSTRUCTOR___________
_____________________________________________________________
LAB EVALUATION FORM: Demonstrate Glass Ionomer Cement Mixing Techniques
Performance Objective: The student will demonstrate the ability to mix glass ionomer cement
For luting.
Scoring:
3 points
2 points
1 point
0 point
-
Task performed satisfactorily without prompting.
Task performed satisfactorily with self-initiated correction.
Task performed with prompting required.
Unable to perform
Tasks:
Points
1. Select matching powder and liquid, spatula and pad.
_____
2. Fluff powder and swirl liquid.
_____
3. Dispense powder onto mixing pad.
_____
4. Dispense Liquid onto mixing pad.
_____
5. Incorporate powder into liquid using flat side of blade.
_____
6. Gather entire mass into one unit to check consistency.
_____
7. Clean up of spatula and mixing pad.
_____
Possible 21 pts
Actual score________ % grade_________
LAB 5
DENTAL ASSISTING PROGRAM
STUDENT___________________
DENTAL MATERIALS
DATE ______________
COURSE DENT 1200
INSTRUCTOR___________
_____________________________________________________________
LAB EVALUATION FORM: : Demonstrate Calcium Hydroxide Cement Mixing Techniques
Performance Objective: The student will demonstrate the ability to mix calcium hydroxide cement
for a liner.
Scoring:
3 points
2 points
1 point
0 point
-
Task performed satisfactorily without prompting.
Task performed satisfactorily with self-initiated correction.
Task performed with prompting required.
Unable to perform
Tasks:
Points
1. Select correct cement, spatula and pad.
_____
2. Dispense base and catalyst onto mixing pad.
_____
3. Incorporate pastes together into homogenous mix.
_____
4. Gather entire mass into one unit to check consistency. _____
5. Clean up of spatula and mixing pad.
Possible 15 pts
_____
Actual score________ % grade_________
LAB 6
DENTAL ASSISTING PROGRAM
STUDENT___________________
DENTAL MATERIALS
DATE ______________
COURSE DENT 1200
INSTRUCTOR___________
_____________________________________________________________
LAB EVALUATION FORM: : Demonstrate Using the Dental Amalgamator
Performance Objective: The student will demonstrate the ability to use the dental amalgamator
Scoring:
3 points
2 points
1 point
0 point
-
Task performed satisfactorily without prompting.
Task performed satisfactorily with self-initiated correction.
Task performed with prompting required.
Unable to perform
Tasks:
Points
1. Assemble materials: amalgamator, premeasured capsules,
amalgam well, amalgam carrier, amalgam condensor. Cotton
pliers
2. Prepare capsule by twisting the cap, squeezing the capsule,
or using an activator.
3. Insert the capsule into the amalgamator and close the cover.
4. Activate the amalgamator for prescribed time and speed.
5. Remove capsule, open capsule, and empty amalgam into well.
6. Use CP to replace pestle and close capsule
7. Hold the carrier and load the amalgam.
8. Pack the carrier tightly, wiping away excess on side of well.
9. Transfer carrier to operator.
10. Prepare to exchange the condensor for a carrier.
(practice loading and dispensing)
11. clean up carrier and condenser, expel any excess amalgam into
the appropriate container.
12. Place scrap in container
13. Dispose of capsule
Possible 39 pts
_____
_____
_____
_____
_____
______
_____
_____
_____
_____
_____
______
________
Actual score________ % grade_________
LAB 8
DENTAL ASSISTING PROGRAM
STUDENT___________________
DENTAL MATERIALS
DATE ______________
COURSE DENT 1200
INSTRUCTOR___________
_____________________________________________________________
LAB EVALUATION FORM: : Taking Alginate Impressions
Performance Objective: The student will demonstrate the ability to mix alginate material and take
maxillary and mandibular alginate impressions of a manikin.
Scoring:
3 points
2 points
1 point
0 point
-
Task performed satisfactorily without prompting.
Task performed satisfactorily with self-initiated correction.
Task performed with prompting required.
Unable to perform
Tasks:
Points
1. Assemble materials: flexible bowls, spatulas, alginate material,
with water and powder measuring devices, water, impression trays
2. Try impression trays in the oral cavity to determine correct size.
3. Measure impression water and place in bowl for mandibular impression
4. Fluff can of alginate and measure powder into bowl
5. Mix the alginate with a stirring motion until homogenous
6. Load the material into the mandibular impression tray
7. smooth with wet finger
8. Place excess alginate on occlusals
9. Seat impression tray into oral cavity and hold until set
10. Remove impression and check for details
11. Wrap impression in wet paper towel and set aside.
12. Measure impression water and place in bowl for maxillary impression
13. Fluff can of alginate and measure powder into bowl
14. Mix the alginate with a stirring motion until homogenous
15. Load the material correctly into the maxillary impression tray
16. Smooth with wet finger
17.Place alginate on occlusals
18. Seat impression tray into oral cavity and hold until set
19. Remove impression and check for details
20. Wrap impression in wet paper towel and set aside
Possible 60 pts
Actual score________ % grade_________
_____
_____
_____
_____
_____
_____
_____
______
_____
_____
_____
_____
_____
____
_____
______
______
_____
_____
_____
LAB 9
DENTAL ASSISTING PROGRAM
STUDENT___________________
DENTAL MATERIALS
DATE ______________
COURSE DENT 1200
INSTRUCTOR___________
_____________________________________________________________
LAB EVALUATION FORM: Pouring Alginate Impressions of typodont with Plaster
Inverted technique
Performance Objective: The student will demonstrate the ability to pour maxillary and mandibular
alginate impression with laboratory plaster.(75/150) Assemble materials: flexible lab bowls, spatulas, scale,
plaster, powder and water measuring devices, vibrator with paper cover on platform, room temperature water and
impressions, glass slabs
Scoring:
2 point - Task performed
0 point - Unable to perform
Tasks:
No Voids on teeth
31
30
29
28
27
26
25
24
23
22
21
20
19
18
15
14
13
12
11
10
9
8
7
6
5
4
3
2
Level base ½-3/4 inch thick,
Impression was not “buried”
Level base ½-3/4 inch thick,
Impression was not “buried”
Models labeled
Possible 66 pts
MAx
Max
Mand
Mand
_________
_________
__________
__________
__________
_________
_______
________
_________
_________
_________
_________
_________
__________
_________
__________
_________
___________
____________
___________
_________
___________
___________
__________
_________
__________
___________
___________
__________
___________
__________
___________
___________
Actual score________ % grade_________
LAB 14
DENTAL ASSISTING PROGRAM
STUDENT___________________
DENTAL MATERIALS
DATE ______________
COURSE DENT 1200
INSTRUCTOR___________
_____________________________________________________________
LAB EVALUATION FORM: Preparing Acrylic custom Temporary (Provisional) Restoration
Performance Objective: The student will demonstrate the ability to prepare a custom acrylic temporary
(provisional) restoration.
Scoring:
Tasks:
2 points - Task performed
0 point - Unable to perform
1. Fabricated matrix
Points
_______
2. Temporary is esthetic
_______
3. Occlusion correct
_______
4. Covers CEJ
_______
5. Has Mesial Contact
_______
6. Has Distal Contact
________
7. Anatomic anatomy correct
_______
8. No rough edges
________
Possible 16 pts
Actual score________ % grade_________