Log -RESTO

CLINICAL EXPERIENCE LOG - RESTORATIVE DENTISTRY

Patients Name Supervisors name Type of Cases / Procedures
Clinical Competency

: : :

Registration Number Date patient first seen Date case completed

Date

: : :
Notes (in brief)

*Please tick () where applicable *Observe (O) / Management Assist (A) / Conduct (C) O A C History: Present complaint Medical Dental Examination: General Extraoral Intraoral Occlusal analysis Clinical investigation(s): X-ray/EPT/Bite test etc Diagnosis Treatment plan Informed consent

Patient clerking

Patient management

Oral hygiene instruction / education Class I, II, III, IV, V Direct composite veneers

Direct Restorations

Clinical Competency

Management

*Observe (O) / Assist (A) / Conduct (C) O A C

Date

Notes (in brief)

Others (Specify): Onlays metal crown Full metal crown Porcelain-fused to metal crown Indirect composite veneers Fixed prosthodontics Porcelain veneer All ceramic crown Fixed-fixed bridge Cantilever bridge Resin-retained bridge Anteriors Posteriors Root canal retreatment Root canal treatment Management of complex endodontic cases Eg: Curved roots, Perforation, Separated instruments (Specify):

*Please tick () where applicable

*Observe (O) / Assist (A) / Conduct (C) O A C Notes (in brief)

Log -RESTO

Clinical Competency

Management Bleaching discoloured endodontically treated teeth

Date

Bleaching

External bleaching of discoloured vital teeth Sectional dentures / Cobalt-chrome partial dentures Partial Dentures with precision attachment (eg: magnetic attachment) Complete denture (Difficult cases) Overdenture Others Eg: Obturators, Oro-maxillo facial prostheses (Specify): Moderate to severe tooth wear Extensive root caries

Removable prosthodontics or prosthetics (Complex cases)

Management of complex cases

Combination of fixed and removable prostodontics Others (Specify):

Name of FYDO/SYDO Supervisors signature Name & Official Stamp of Supervisor

: Dr.Hafizul Izwan Mohd Zahari : : Date : ..