Week 1 Lab Sheet...Station 1-f: Intro to Sterilization Room Grade: _ (20 pts.) Instructor Initial: _ ***This grade sheet must be completed prior to the student leaving class

Week1LabSheet

Grade:__________/100

InstructorInitial:__________





StudentName:__________________________________

Date:___________________

LECTURESTATIONS:

Station1-a:OverviewofDentalAssistingVideo

Grade:____________(5pts.)

Station1-b:ClinicalOfficeTour

Grade:____________(15pts.)

LABSTATIONS:

Station1-c:IntrotoInfectionControl&PPE

Grade:____________(20pts.)Station1-d:IntrotoAlginateMixing&TypodontImpression

Grade:____________(20pts.)

Station1-e:ToothNumbering&Morphology

Grade:____________(20pts.)

Station1-f:IntrotoSterilizationRoom

Grade:____________(20pts.) InstructorInitial:__________

***Thisgradesheetmustbecompletedpriortothestudentleavingclass.Thestudentmustleaveknowinghis/hergrade.Anystudentwhoexhibitsapoorattitude,unprofessionalorunethicalbehavior,orpoorparticipationmayhaveupto100pointsdeductedfromhis/herlabgrade.Pointdeductionissolelyuptotheinstructor’sdiscretion.

Week2LabSheet

StudentName:_______________________________

Date:___________________ Grade:___________________/100

LECTURESTATIONS:

Station2-a:InfectionControlVideo


Station2-b:DentalProcedureVideo


LABSTATIONS:

Station2-c:UpperImpressions


Station2-d:PourUpUpperImpressions


Station2-e:IntrotoSterilizationProcedure


Station2-f:IdentifyInstrumentsPart1(RestorativeSetup)


Station2-g:InstrumentTransfer&MoistureControl


Station2-h:InfectionControl&PPEPart2



Week3LabSheet

StudentName:____________________________________

Date:___________________ Grade:_______________/100

LECTURESTATIONS:

Station3-a:Charting


Station3-b:DentalVocabularyGame


LABSTATIONS:

Station3-c:LowerAlginateImpressions(Completethisstationwithoutaninstructor)


Station3-d:PourUpLowerImpressions(Completethisstationwithoutaninstructor)


Station3-e:InstrumentTransfer&MoistureControl


Station3-f:RubberDamDemonstration&EndoTraySetup


Station3-g:FingerRestExercise


Station3-h:IdentifyInstruments(Endodontic)


Station3-i:PaperCharting



Week4LabSheet

StudentName:________________________________________________________

Date:___________________ Grade:______________/100

LECTURESTATIONS:

Station4-a:LabPrescriptionsforCrown


Station4-b:DentalCodeGamePart1


Station4-c:IntrotoDigitalCharting


LABSTATIONS:

Station4-d:Trimming&PolishingModels(5extrapointstothestudentwiththebestmodel)


Station4-e:InstrumentTransfer&MoistureControl(Completethisstationwithoutaninstructor)

Grade:____________(10pts.) InstructorInitial:_________

Station4-f:ShadeGuide&BiteRegistration


Station4-g:DentalExam&PaperCharting


Station4-h:PeriodontalProbing


Station4-i:IdentifyInstruments(CrownandBridgeSetup)


Station4-j:SpeedGun


Station4-k:HandpieceReview


Station4-l:DigitalChartingPart1


Week5LabSheet

StudentName:_____________________________________________

Date:___________________ Grade:______________/100

EXTRACREDIT:(Studentscanturninacopyoftheirresumeforextracredit)

Grade:_____________(5pts.) InstructorInitial:___________

LECTURESTATIONS:

Station5-a:DentalMaterialsReview(Theteamthatwinswillgetanextra5points)


Station5-b:DentalCodeGamePart1(Theteamthatwinswillgetanextra5points)


LABSTATIONS:

Station5-c:1Bitewing&1PA


Station5-d:PanoDemonstration


Station5-e:CompositeProcedurePart1


Station5-f:IdentifyInstrumentsPart1(RestorativeSetup)(Completethisstationwithoutaninstructor)


Station5-g:UpperImpressions(Completethisstationwithoutaninstructor)


Station5-h:PourUpUpperImpressions(Completethisstationwithoutaninstructor)


Station5-i:SpeedGun


Station5-j:DigitalChartingPart2


Week6LabSheet

StudentName:____________________________________________________________

Date___________________ Grade________________/100

LECTURESTATIONS:

Station6-a:BloodbornePathogenVideo


Station6-b:PhoneSkillsTraining


LABSTATIONS:

Station6-c:4Bitewings


Station6-d:Permanent&TemporaryCements


Station6-e:PremolarTemporary


Station6-f:LowerAlginateImpressions(Completethisstationwithoutaninstructor)


Station6-g:PourUpLowerImpressions(Completethisstationwithoutaninstructor)


Station6-h:IdentifyInstruments(OralSurgery)


Station6-i:Crown&BridgeProcedure


Station6-j:SpeedGunSuperBowl(5extracreditpointstothestudentwiththefastesttime)


Station6-k:DigitalChartingPart3


Week7LabSheet

StudentName:_______________________________________________________

Date:___________________ Grade:________________/100

LECTURESTATIONS:

Station7-a:SpecialistReview


Station7-b:DentalCodeGamePart3


LABSTATIONS:

Station7-c:Anesthetic&Syringe


Station7-d:CompositeProcedurePart2


Station7-e:FinishTrimming&PolishingModels(Studentwiththebestmodelwillgetanextra5

points)


Station7-f:InstrumentTransfer&MoistureControl(Completethisstationwithoutaninstructor)


Station7-g:EndoInstruments&PlacingRubberDamonManikin


Station7-h:Multi-TipScramble


Station7-i:PremolarTempSolo(Completethisstationwithoutaninstructor)




Station7-k:HumanPlacementofRadiographs


Week8LabSheet

StudentName:____________________________________________________________

Date:___________________ Grade:________________/100

LECTURESTATIONS:

Station8-a:PowerPointInstruments(Thewinningteamgets5pointsextracredit)


Station8-b:DentalMaterialsGamePart2


LABSTATIONS:

Station8-c:InstrumentTransfer&MoistureControl(Completethisstationwithoutaninstructor)


Station8-d:InstructorSelectedStation


Station8-e:UpperImpressionsforBleachTray(Completethisstationwithoutaninstructor)


Station8-f:PourUpperBleachTray


Station8-g:RightSideofFMX


Station8-h:HandpieceReview


Station8-i:Multi-TipScramble(Completethisstationwithoutaninstructor)




Week9LabSheet

StudentName:________________________________________________________

Date:___________________ Grade:_________________/100

LECTURESTATIONS:

Station9-a:InterviewVideos


LABSTATIONS:

Station9-b:MockJobInterview


Station9-c:AnteriorPA’sofAFMX


Station9-d:IdentifyInstruments(Crown&BridgeSetup)


Station9-e:OralHygieneInstructions


Station9-f:LowerImpressionsforBleachTray(Completethisstationwithoutaninstructor)


Station9-g:PourLowerBleachTray(Completethisstationwithoutaninstructor)


Station9-h:Multi-TipScramble(Completethisstationwithoutaninstructor)


Station9-iDigitalChartingPart6


226

Week 10 Lab Sheet

Student Name: ____________________________________________________________

Date: ___________________ Grade: _________________/100

LECTURE STATIONS:

Station 10-a: BLS

Grade: ____________ (10 pts.) Instructor Initial: __________

LAB STATIONS:

Station 10-b: Identify Instruments Part 1 (Restorative Setup)


Station 10-c: Blood Pressure & Pulse


Station 10-d: Medical Emergencies


Station 10-e: Trim & Fabricate Bleach Trays


Station 10-f: Human Placement of Radiograph Sensor


Station 10-g: Multi-Tip Scramble Super Bowl (The student with the fastest time will receive 5 points extra credit. Complete this station without an instructor)


Station 10-h: Digital Charting Part 7


Station 10-i: Instrument Transfer & Moisture Control (Complete this station without an instructor)


Week11LabSheet

StudentName:________________________________________________________

Date:___________________ Grade:________________/100

LECTURESTATIONS:

Station11-a:DentalPictionary(Thewinningteamwillreceiveanextra5pointsextracredit)


LABSTATIONS:

Station11-b:LeftSideofFMX


Station11-c:CompositeProcedurePart3


Station11-d:Crown&BridgeProcedure


Station11-e:InstrumentSuperBowl(Studentwiththehighestscoreineachgroupwillreceiveanextra5points)


Station11-f:MolarTemporary(Completethisstationwithoutaninstructor)


Station11-g:DigitalChartingPart8


Station11-h:Class-SelectedStation


Station11-i:PlacingSealants


Week12LabSheet

StudentName:________________________________________________________

Date:___________________ Grade:_________________/100

EXTRACREDITFORFINAL:

TwoInterviewsExtraCredit(Ifthestudenthasobtainedtwointerviews)


JobExtraCredit(Ifthestudentobtainsajobinthedentalfield)


LABSTATIONS:

Station12-a:FinalFMX


Station12-b:FinalTemporaryMolar


Station12-c:FinalInstrumentNaming


Station12-d:FinalCharting


Station12-e:VerbalQuiz


Station12-f:FinalDiagnosticModels


PermanentDentition

PrimaryDentition

� ��

Rx

LABORATORY USE ONLY

By _____________ Mail ______________

PORCELAIN FUSED TO METAL❑ Non-Precious* ❑ Noble ❑ WHN❑ Captek YHN ❑ OcclusalGold YHN

COMPOSITE RESTORATIONS❑ Lava Ultimate ❑ Composite

❑ Fiber Reinforcement

PLAYSAFE MOUTHGUARDS❑ Jr ❑ Lt ❑ Lt Pro ❑ Med* ❑ Hvy ❑ Hvy Pro

❑ Helmet Strap Specify color(s) on Rx

❑ Name ________________________________________________

GL-421-081213

SNORING/SLEEP APNEA APPLIANCES(Upper and lower models with protrusive bite required)

❑ Silent Nite sl* ❑ EMA ❑ TAP ❑ TAP 3 ❑ TAP 3 Elite

INCLUSIVE CUSTOM ABUTMENTS❑ Titanium* ❑ Zirconia w/ Ti-Base ❑ All-Zirconia

Specify implant system, brand and diameter on Rx IF NO OCCLUSAL CLEARANCE

❑ Call doctor ❑ Spot opposing

❑ Metal occlusion ❑ Metal island

❑ Make this a permanent note inmy master file

©2013 Glidewell Laboratories

FULL-CAST RESTORATIONS

ZIRCONIA/ALL-CERAMIC RESTORATIONS ❑ BruxZir Solid Zirconia* ❑ Prismatik CZ❑ Lava Zirconia ❑ NobelProcera Zirconia

❑ IPS e.max crown ❑ IPS e.max veneer

❑ Obsidian Crown ❑ Obsidian Veneer

❑ Lava Plus ❑ Vivaneers No-Prep VeneersIndicate stump or present tooth shade for all-ceramics

PONTIC DESIGN

❑ ❑ ❑* ❑ ❑

VITALLIUM METAL PARTIALS❑ Vitallium 2000* ❑ Vitallium 2000 Plus ❑ tcs/Vitallium ❑ Valplast/Vitallium❑ Titanium ❑ Wironium ❑ tcs/Wironium ❑ Lab select complete design❑ Frame try-in ❑ Frame w/occlus. rim ❑ Frame w/setup try-in ❑ Finish

CROWN & PARTIAL COMBINATION CASES❑ Future Partial: ___Vitallium ___Valplast ___tcs ___Attachments❑ Fabricate RPD to fit restoration

MAJOR CONNECTORMaxillary Mandibular

❑ Lab select ❑ Lab select

❑ _____________ ❑ ______________

Rest Areas Tooth #

❑ Lab select ________________

❑ _____________ ________________

Clasp Options Tooth #

❑ Lab select ___________________

❑ Metal ___________________

❑ Estheticlasp ___________________

❑ Thermoflex ___________________

❑ _______________ ___________________

DENTURES/FLIPPERS/FLEXIBLE PARTIALS❑ Denture ❑ Dupe denture ❑ Flipper ❑ Clear Flip❑ DuraFlex ❑ tcs ❑ Valplast ❑ Reflex❑ Custom tray ❑ Occlusion rim ❑ Wax setup try-in ❑ Finish

❑ Premium Brand Teeth (extra charge applies)

Shade ________ Brand _______________ Mould ________

❑ Kenson Teeth (included at no extra charge)

Shade ______________ Mould _______________________

Acrylic shade: ❑ Std G1� Ethnic: ❑ Med G3� ❑ Dark G4TCS Flexible Partial shade: ❑ Lt Pink ❑ Std Pink

❑ Lt/Dark Pink ❑ Dark Pink

❑ Name on appliance _________________________________________(Additional charge)

Tooth setup ❑ Ideal ❑ Characterized ❑ Study model❑ Male ❑ Female Age ________

PROVISIONAL RESTORATIONS❑ BioTemps Provisionals❑ Transition C&B (No Reinforcement)

Abutment #(s)________________________________

Pontic #(s)___________________ Total units_____

❑ Splinted* ❑ Cement-on implant❑ Individual units ❑ Screw-retained implant

Reinforcement: ❑ None ❑ Wire* ❑ Fiber ❑ Metal

Amount of prep reduction: ❑ 1 mm* ❑ 2 mm

❑ Perio treatment: Prepare tooth below gingival

on tooth #(s) ____________ by __________mm

❑ Pontic site healing: Prepare ovate socket

on tooth #(s) ____________ by __________mm

*Standard unless specified otherwise

Signature _________________________________________________________ License # _____________________________(see reverse for limited warranty details)

NIGHTGUARDS/RETAINERS❑ Upper ❑ Lower ❑ Scan/Save File

❑ Comfort H/S (hard/soft)* ❑ Comfort (hard)❑ Semi-Hard Nightguard ❑ Soft Nightguard❑ Astron CLEARsplint ❑ Processed Acrylic

❑ Clear-Lock Retainer ❑ set of 3 ❑ set of 6 ❑ Clear Ortho ❑ Hawley ❑ Astics Clear-Wire

❑ Noble-Cast 42 YN (2% Au)

❑ Noble-Cast 45 YN (40% Au)

❑ Noble-Cast 60 YHN (57% Au)*❑ Noble-Cast 67 YHN (64% Au)

❑ OcclusalGold YHN (73% Au)

❑ JRVT YHN (77% Au)

❑ Non Precious

❑ White Noble

❑ WHN (45% AU)

❑ Post & Core

FINAL CERAMIC SHADE

OCCLUSAL STAINING❑ None ❑ Light* ❑ Medium ❑ Dark

Indicate Shade Here

PRESENT TOOTH OR STUMP SHADE

Indicate Shade Here

MARGIN AND METAL DESIGN

❑❑❑❑* ❑

❑❑❑* ❑

Labial Butt 360° Butt Junction Junction ❑ ❑ ❑* ❑

GLIDEWELLLABORATORIES4141 MacArthur Blvd. • Newport Beach, CA 92660

800-854-7256 • Fax 800-411-9722www.glidewelldental.com Enclosed with case: ❑ Impressions ❑ Models ❑ Bite ❑ Photos ❑ Other: ___________________________

• UNIVERSAL Rx • Dr. Name _________________________________________________ Phone #__________________________

Acct. # ____________________________________ Patient Name ____________________________________

Address/E-mail _____________________________ Deliver by 5 p.m. on ____________________________

First Last

All Restorations Made in the USA

❑ Please scan and save this BioTemps or diagnostic wax-up case for final ceramic work

See Reverse for Working Times

Page 74

IN-LAB WORKING TIMES

ALL-CERAMIC/COMPOSITECROWNS

1–1.5 mmLabialLingualInterproximal

LabialLingualInterproximal

1–1.5 mm

Occlusal 1.5–2 mm

Incisal 1.5–2 mm

PREPARATION GUIDELINESPREPARATION GUIDELINES

PFM — PORCELAIN LABIAL OR 360° MARGIN

A. 1.5 to 2 mm occlusal reduction B. Round all sharp line angles, occlusal edges and eliminate

undercuts. C. Proximal and occlusal walls should have 6–8 degrees taper.

INLAY ONLAYALL-CERAMIC/COMPOSITE VENEERS

PFM POSTERIOR

1.25 mm gingival reduction using rounded shoulder margin design

Please allow full working time for each product selected. Working times are NOT guaranteed and do NOT include weekends or holidays. Rush service available on most products but must be prescheduled (see below).

Partials & Dentures Metal Frames ............................................... 5 days Metal Frame with teeth and wax .................. 9 days Metal Partial to completion .......................... 9 days Occlusion rims/Custom tray ........................ 2 days Denture setup try-in ..................................... 5 days Denture try-in to finish ................................. 6 days Denture soft liner/Denture acrylic

repair or reline ..............................................3 days Valplast/tcs setup teeth in wax ..................... 5 days Valplast/tcs start to completion .................... 7 days PlaySafe mouthguards/Silent Nite sl .......... 4 days TAP/TAP 3/EMA ........................................... 5 days Comfort H/S Bite Splint ............................... 4 days Nightguards/Bleach trays/Retainers .......... 4 days

PFMs/Diagnostic Wax-Up ......................... 5 days PFMs w/ attachments ................................ 7 daysInclusive Custom Abutments .................... 8 days All-ceramic/Zirconia restorations ............. 5 days NobelProcera Zirconia ............................... 8 days Full-cast restorations ................................. 5 days Composite restorations ............................. 3 days Fiber-reinforced composites ..................... 5 days BioTemps Provisionals ............................... 5 days With cast-metal substructure ..................... 6 days With cast-metal substructure over implant . 6 days Screw-retained over implant....................... 6 days Smile Transitions appliance ...................... 5 days Transition Crowns & Bridges .................... 6 daysLava ............................................................. 5 daysObsidian ...................................................... 5 days

IN-LAB WORKING TIMES

All rush cases must be prescheduled by calling 800-944-7874 before the case is shipped. Time of pickup and delivery may affect turnaround time.

PFM ANTERIOR

TERMS AND WARRANTY INFORMATION

FOR LAB USE ONLY TELEPHONE CALL RECORD

DR. __________________________________ ACCT. # ________________

PATIENT NAME ________________________________________________

RE: ___________________________________________________________

_______________________________________________________________

_______________________________________________________________

RESULT _______________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

DATE DUE IN OFFICE __________________________________________

DATE OF CALL ________________ INITIALS _______________________

________________ _______________________

We honor VISA, MASTERCARD, AMEX and DISCOVER.TERMS: Cost of collection of any account will be paid by the customer. All accounts are payable within 30 days of statement date. Accounts not paid within the stated terms will be subject to COD status and a late charge of 2 percent of the unpaid balance. Prices subject to change without notice.

LIMITED WARRANTY/LIMITATION OF LIABILITY. Glidewell Laboratories (“the lab”) warrants that all dental devices (a “device”) are made according to your specification and approval in the belief that the device will be useful and MAKES NO OTHER WARRANTIES INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Subject to the return of a device that is placed and then fails, the lab will repair or replace the device without charge for the cost of materials and workmanship or refund the original price paid, at the lab’s option, as follows: (1) screw-retained titanium abutments (excluding abutments with angulations greater than 20 degrees), up to 20 years (if the failure is caused by the failure of the dental implant a replacement Inclusive® titanium dental implant will be provided upon request at no extra charge); (2) porcelain to metal, all porcelain, all metal, single-unit inlay, onlay and crown composite resin final prosthetics (excluding mutually opposing implant-supported full arch bridges), milled implant bars, and screw-retained zirconia abutments (excluding abutments with angulations greater than 20 degrees), up to seven years; (3) composite resin bridges (excluding Maryland and inlay/onlay bridges) up to five years; (4) Transition Crowns and Bridges® up to two years; (5) dentures and partials including screw-retained dentures but excluding immediate dentures and partials up to one year if the failure is due to defects in materials or workmanship; (6) thermoformed appliances and splints if the failure is due to defects in materials or workmanship, provisionals, composite resin Maryland and inlay/onlay bridges, up to six months; (7) Smile Transitions™ cosmetic appliances up to sixty days; (8) immediate dentures and partials, flippers, retainers, surgical and radiographic guides, and all other dental devices up to thirty days if the failure is due to defects in materials or workmanship. You agree to pay all other costs of adjustment, repair and replacement of a device. Except where prohibited by law, the lab WILL NOT BE LIABLE FOR ANY LOSS OR DAMAGES ARISING FROM THE USE OF A DEVICE, WHETHER DIRECT, INDIRECT, SPECIAL, INCIDENTAL OR CONSEQUENTIAL, regardless of the theory asserted, including warranty, contract, negligence or strict liability and if such disclaimer is not permitted by law, the duration of any implied warranty is limited to 90 days from the date of delivery. In the event of a dispute and absent an amicable resolution the parties mutually agree to waive class actions in favor of mandatory individual arbitration of claims under this limited warranty in and in accordance with the laws of California. The lab does not guarantee the performance of independent carriers.

Only $7 shipping per box EACH way (Contiguous U.S. only; shipping charge varies for Alaska, Hawaii and Puerto Rico).

Page 75

151 151 23 ; 17 23 ; 17 151

10S ; 88R 10S ; 88L 150 150 1 ; 150

Dental Forceps Chart

151 151 23 ; 17 23 ; 17 151

10S ; 88R 10S ; 88L 150 150 1 ; 150

Dental Forceps Chart

Documents

Week 1 Lab Sheet...Station 1-f: Intro to Sterilization Room Grade: _____ (20 pts.) Instructor Initial: _____ ***This grade sheet must be completed prior to the student leaving class

Week 1 Lab Sheet...Station 1-f: Intro to Sterilization Room Grade: _ (20 pts.) Instructor Initial: _ ***This grade sheet must be completed prior to the student leaving class