CENTRO ESCOLAR UNIVERSITY

Patient’s School of Dentistry Clinician’s

Picture Manila-Malolos-Makati Picture
1X1 Prosthodontics Section
1X1
Evaluation Sheet for Complete Denture
Clinician’s Name ____________________________________________ Clinic Level ______________
Patient’s Name _____________________________________________ Age _________ Gender ___________
Learning Tasks Exceptional Highly Acceptable Moderately Major Corrections Clinically CI’s Signature & Score
Acceptable Required Unacceptable Date
(5) (4) (3) (2) (1)
I. Oral Diagnosis Independently Performs dental Performs dental Performs majority of Performs few of
performs charting with charting with close dental charting with dental charting
dental charting minimal supervision close supervision with close
without supervision supervision
supervision
II. Preliminary Impression Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1. Proper mouth conditioning & tray performs all tasks with minimal with close the tasks with close the tasks with
positioning without supervision supervision supervision close supervision
2. Impression details and extent supervision
3. Absence of voids and pressure spots

Remarks:
III. Study cast Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Detailed capture of anatomical performs all tasks with minimal with close the tasks with close the tasks with
landmarks /porous free cast without supervision supervision supervision close supervision
2. Tray and denture base outlines supervision
3. Thickness of base and trimming of cast
Remarks:
IV. Individual Tray Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Design/extent according to material to performs all tasks with minimal with close the tasks with close the tasks with
be utilized without supervision supervision supervision close supervision
2.Proper blocking out (if necessary) supervision
3.Angulation, contour, smoothness &
finishing of handle
4. Presence of tissue stop
Remarks:
V. Border Molding Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Captures the vestibules & peripheral performs all tasks with minimal with close the tasks with close the tasks with
borders without supervision supervision supervision close supervision
2. Amount of material supervision

Remarks:
VI. Final Impression Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Choice and consistency of impression performs all tasks with minimal with close the tasks with close the tasks with
material without supervision supervision supervision close supervision
2.Impression details and extent supervision
3. Absence of voids and pressure spots
Remarks:
VII. Boxing Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Position and tilt of impression tray performs all tasks with minimal with close the tasks with close the tasks with
2.Position and seal of sticky wax without supervision supervision supervision close supervision
3.Height of boxing wax supervision
Remarks:
VIII. Fabrication of Master Cast Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Accurate duplication of the anatomical performs all tasks with minimal with close the tasks with close the tasks with
structures without supervision supervision supervision close supervision
2.Proper denture base outline and extent supervision
3.Absence of voids, defects and nodules
4.Thickness of base and trimming of cast
5. Markings on important landmarks
Remarks:
IX . Trial Record Base Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Extent of borders with provision of performs all tasks with minimal with close the tasks with close the tasks with
peripheral seal without supervision supervision supervision close supervision
2.Rigidity, stability and retention supervision
3.Thickness of material utilized
X. Fabricate Occlusion Rims
1.Proper length, height and width
2.Proper contour, inclination and
termination
3. Proper position and orientation
Remarks:
X. Vertical Registration Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1. Lip and cheek support performs all tasks with minimal with close the tasks with close the tasks with
2. Level of plane of occlusion without supervision supervision supervision close supervision
3. Parallelism of plane of occlusion with supervision
reference lines
4. Establishment of vertical dimension
VDR: _________
VDO: _________
Freeway Space: _________
Remarks:
XI. Centric Registration Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Position of reference lines performs all tasks with minimal with close the tasks with close the tasks with
2.Centric registration and recording without supervision supervision supervision close supervision
3.Recording medium supervision
Remarks:
XII. Pontic and Shade Selection Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Pontic size in relation to classified shape performs all tasks with minimal with close the tasks with close the tasks with
and arch form without supervision supervision supervision close supervision
2.Appropriate Shade supervision
3.Correct bizygomatic distance
measurement
Bizygomatic distance: ________
Anterior Mould: __________
Posterior Mould: __________
Brand: ____________________
Shade: _________

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 Evaluation Sheet for Complete Denture
Clinician’s Name ____________________________________________ Clinic Level ______________
Patient’s Name _____________________________________________ Age _________ Gender ___________

Xlll. Facebow Transfer Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1. Proper positioning of the condylar rods performs all tasks with minimal with close the tasks with close the tasks with
on the articulator without supervision supervision supervision close supervision
2. Correct adjustment of the facebow supervision
based on the horizontal plane.
3.Accuracy of mounting of Upper cast
4. Accuracy of mounting of Lower cast
Remark:

XlV. Mounting of Upper and Lower cast Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1. Presence of cast base notches performs all tasks with minimal with close the tasks with close the tasks with
2. Neatness and adequacy of without supervision supervision supervision close supervision
dental plaster supervision
3. Parallelism and midline orientation
4. Stabilization of screws and pins of
mounting device
Remarks:
XV. Anterior Setting Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Teeth position, inclinations, tilts, slopes performs all tasks with minimal with close the tasks with close the tasks with
and overlap without supervision supervision supervision close supervision
2.Wax contour for esthetic and functional supervision
consideration
3. Correct incisal level
Remarks:
XVI . Anterior Try-in Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1. Adaptation, stability and retention of performs all tasks with minimal with close the tasks with close the tasks with
record base in the patient’s mouth without supervision supervision supervision close supervision
2.Verification of size, form and shade of supervision
anterior denture teeth for esthetics and
phonetics
3. Verification of vertical and horizontal
relationships
Protrusive Registration:

CI’s Signature: _____________________

Remarks:
XVll. Posterior Setting Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Teeth position, inclinations, tilts, slopes performs all tasks with minimal with close the tasks with close the tasks with
and overlap without supervision supervision supervision close supervision
2.Wax contour for esthetic and functional supervision
consideration
3. Maximum intercuspation
4. Protrusive Movement
Remarks:
XVlll. Trial fitting of Wax Denture Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1. Re-checking of adaptation, stability and performs all tasks with minimal with close the tasks with close the tasks with
retention of record base in the patient’s without supervision supervision supervision close supervision
mouth supervision
2. Re-verification of vertical and horizontal
relationships
3. Considerations on esthetics, phonetics
and function
4. Movements at centric, lateral excursion
and protrusion
Remarks:
XlX. Wax up & Festooning Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Wax contour according to desired form performs all tasks with minimal with close the tasks with close the tasks with
simulating the natural tissues without supervision supervision supervision close supervision
2.Wax finishing and polishing relative to supervision
the lips, cheeks and tongue
Remarks:
XX. Final Denture Delivery Independently Performs all tasks Performs all tasks Performs majority of Performs few of
1.Evaluation of the denture in terms of performs all tasks with minimal with close the tasks with close the tasks with
functional, esthetic and phonetic without supervision supervision supervision close supervision
considerations supervision
2.Patients expectations and satisfaction
Remarks:

Points/grades Equivalent
96-100- 1.0 92-95- 1.25 87-91- 1.50 83-86- 1.75 78-82-2.00 74-77- 2.25 69-73- 2.50 65-68- 2.75
60-64- 3.00 53-59- 3.50 46-52- 4.00 45 below- 5.00

Total Score : _________________________

Grade : _____________________________

CI’s Signature : _______________________

Date : ___________________________

Pilot Form as of June 2018

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