Supplementary Outcome Appendix K
Supplementary Outcome Appendix K
APPENDIX K
Record all of the following information on the forensic chart below using the tiles provided.
a) 18 is partially erupted j) 26 is to be extracted
b) 17 has an occlusal restoration k) 28 is un-erupted
c) 16 has an occluso-palatal restoration, needs replacing l) 38 is missing
d) 14 is missing and the gap has closed m) 37 has an occlusal cavity
e) 13 has a porcelain jacket crown in place n) 34 has a full gold crown
f) 12 has a fracture of the incisal edge o) 32 has a disto-labial restoration
g) 21 needs a disto-palatal restoration p) 41 has a disto-labial cavity
h) 24 is root filled with an occlusal restoration q) 44 has a mesial-occlusal-buccal cavity
i) 25 has a mesial-occlusal-distal cavity r) 85 is retained
Tiles
Please note these can be rotated if required.
6. Tutor feedback
This section should be completed by the GDC registrant who is assessing all sections of the completed PER
and is normally based at the Training Centre. Constructive feedback will help the student to develop their
performance in the workplace.
Satisfactory ☐ Not Yet Satisfactory ☐
Tutor Name:
Date: Click here to enter a date.
GDC Number:
Internal Moderation
Internal Moderator Name:
Date Sampled: Click here to enter a date.
GDC Number:
Meets NEBDN Requirements: Yes ☐ No ☐