Kingdom of Saudi Arabia ‫ﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬+‫اﳌﻤﻠﻜﺔ اﻟﻌﺮ‬

Ministry of Education ‫وزارة اﻟﺘﻌﻠﻴﻢ‬

Al-Baha University ‫ﺟﺎﻣﻌﺔ اﻟﺒﺎﺣﺔ‬
Faculty of Dentistry ‫<ﻠﻴﺔ ﻃﺐ اﻷﺳﻨﺎن‬

ENDODONTICS
EXTERNAL CLINICAL
TRAINING LOG BOOK

STUDENT NAME:
UNIVERSITY ID NUMBER:
EMAIL:
CONTACT NUMBER:
 Restorative Dental Sciences Department
Endodontic Requirements:

• Five single root RCT

• Two molar RCT
• Two non-surgical root canal retreatment cases

ILOs:
By the end of the round the intern should be able to:

• Accurately diagnose the pulpal and periapical status

• Able to interpret the radiographic images
• Set appropriate treatment plan for each case
• Able to determine the case complexity
• To be familiar with the referral system
• Able to efficiently provide non-surgical root canal treatment
Clinical Conduction
1- Attendance: Punctuality in clinics is mandatory and the daily attendance will be monitored
closely. Students should abide by the official working hours in addition to the rules and
regulations prescribed by each training center they are attending.
2- Tardiness: The daily attendance is checked during morning and afternoon sessions by the
clinical supervisor.
3- Clinic Attire: Students must be committed in following the instructions pertaining to clinical
dress at working hours in each training center. Blue jeans and casual dress are not allowed in
clinical premises.
4- Professional Ethics: Students are expected to maintain respect and confidence of patients
through sincere and honest relationship. Physical treatment must be packed up with
psychological support and clinician has to be sympathetic and considerate. Courtesy,
cooperation, and harmonious interpersonal relationship must be highly observed among all
clinical staff to promote a wholesome working atmosphere in the clinic. Share in the practice of
economy through proper handling of machine, apparatus, equipment’s, and disposable materials
are highly appreciated.
5- Discipline: In case of unapproved absence, negligence, misconduct, incompetence,
insubordination, or any other act that the students’ superiors deem unacceptable, an incidence
shall be duly reported to the course director and decide the needed corrective actions according
to the regulations of Albaha college of dentistry.
 ENDODONTIC CLINICAL CASE FORM
Patient Name/MR #: Date: Tooth:
S. (SUBJECTIVE)
Chief Complaint:
History of present illness:

Nature of Pain: Non Moderate Severe

Quality: Dull Sharp Throbbing Constant
Onset: Stim Required Intermittent Spontaneous
Location: Localized Differ=Use Referred Radiating to:
Duration: Seconds Minutes Hours Constant
Initiated by: Cold Heat Sweet Spontaneous Palpation Mastication Supination Keeps Awake at Night
Relieved by: Cold Heat OTC- Meds NARC- Meds
………………………………………………………………………………………………………………………………………………………………………………………………..
O (OBJECTIVE)
Extra oral: Intraoral:
Facial Swelling: Yes No soft tissue: WNL
L. Nodes Swelling: Yes No Swelling: Yes No Location:
Sinus Tract: Yes No
Clinical Crown: Filling Caries Exposure Fracture
TOOTH COLD HEAT EPT PERC PALP MOB PERIODONTAL EXAM
MB B DB DL L ML RECESSION FURCATION

(NORMAL: N NO RESPONSE: 0 MILD: + MODERATE: ++ SEVERE: +++ LINGERED: L DELAYED: D)

Radiographic Findings
Alveolar bone: WNL Apical Lucency Ap/ Lat Opacity Crestal Bone Loss
Lamina dura: WNL Obscure Broken Widened
Roots: WNL Curvature Resorption Perforation Dilacerations Fracture Long Sinus/ IAN
Pulp chamber: WNL Calcification Pulp Stone Exposure Resorption Perforation
Pulp canal: WNL Calcification Bifurcated Resorption Prior-RCT Fracture Involvement Perforation
Crown: WNL Caries Restoration Crown Dens in Dent
Sinus tract trace to:
…………………………………………………………………………………………………………………………………………………………………………………………….....
A (ASSESSMENT)
Diagnosis: pulpal: WNL RP SEP AEP N Prior-RCT/Non Healing Pulpless
Periapical: WNL AAA CAA SAP AAP CO
Etiology: Caries Restoration Prior-RCT Iatrogenic Coronal Leakage Trauma Perio Elective Resorption VRF
Prognosis: Favorable Questionable Unfavorable
………………………………………………………………………………………………………………………………………………………………………………………………..
P(PLAN)
Endodontic: CARIES CONTROL RCT RETX I&D Apico Apexification/Genesis Perf/Resorption Repair
Periodontal: S/RP Crown Lengthen Root Amp Hemisection Extraction
Restorative: TEMP Post Space B/U P&C Onlay Crown Bleaching
BIOMECHANICAL DATA:
R R I I F M INSRTRUMENTATION OBTURATION
CANAL POINT WL FILE WL FILE TECHNIQUE TECHNIQUE

MEDICAMENT USED:
LOCAL ANESTHESIA
R. CANAL IRRIGATION
INTRACANAL MEDICATION
………………………………………………………………………………………………………………………………………………………………………………………………
POST OPERATIVE INSTRUCTIONS AND MEDICATIONS:

………………………………………………………………………………………………………………………………………………………………………………………………..
SUPERVISOR NAME: SIGNATURE:
 ENDODONTIC CLINICAL EVALUATION FORM

Student Name:
University Number:
Patient Name:
MR Number: Tooth number:

A) Armamentarium and protective measures E) Instrumentation

Incomplete (PPE). -7 Not flared -2
Incomplete sterlized instruments, devices or materials -3 Improper master file size -2
Grade …………/10 Master cone doesn’t fit WL -2
Apical perforation -2
B) Diagnosis and treatment planning Apical ledge -2
Unreported chief complaint -2 Transportation -2
Undocumented medical and dental Hx -2 Zipping -2
Incompletely investigated history of the chief complaint -2 Stripping perforation -3
Incomplete clinical tests -2 Broken instruments -2
Incomplete radiographic tests -2 Poor quality of radiographs -1
Incorrect diagnosis -5 Grade …………/20
Incorrect treatment planning -5
Grade …………/20 F) Obturation
Short -1
C) Isolation Over-extended -2
Improper use of rubber dam -1 Flush -1
Rubber dam not applied -9 Voids in the apical 3rd -2
Grade …………/10 Voids in the middle or coronal 3rd -1
GP in the access cavity -2
D) Access opening and working length Poor quality of radiographs -1
Under-extended access -1 Grade …………/10
Over-extended access -2
Improper location -2 G) Knowledge and competence:
Incomplete deroofing -1 Unsatisfactory attitude -4
Gouging -2 Deficiency in the basic Knowledge -2
Perforation (treatable) -2 Dependents -2
Perforation (affects the restorability) -4 Improper time managements -2
Under-extended WL -1 Grade …………/10
Over-extended WL -1
Improper file size -1
Poor quality of radiographic image -1
Improper reference point -2 Total mark …………………/100
Grade …………/20
Supervisor name:

Supervisor signature:
 Radiographic Images

1) Preoperative Radiographs:

2) Working Length Radiograph:

3) Master cone Radiograph:

4) Obturation Radiograph:
 ENDODONTIC CLINICAL CASE FORM
Patient Name/MR #: Date: Tooth:
S. (SUBJECTIVE)
Chief Complaint:
History of present illness:

Nature of Pain: Non Moderate Severe

Quality: Dull Sharp Throbbing Constant
Onset: Stim Required Intermittent Spontaneous
Location: Localized Differ=Use Referred Radiating to:
Duration: Seconds Minutes Hours Constant
Initiated by: Cold Heat Sweet Spontaneous Palpation Mastication Supination Keeps Awake at Night
Relieved by: Cold Heat OTC- Meds NARC- Meds
………………………………………………………………………………………………………………………………………………………………………………………………..
O (OBJECTIVE)
Extra oral: Intraoral:
Facial Swelling: Yes No soft tissue: WNL
L. Nodes Swelling: Yes No Swelling: Yes No Location:
Sinus Tract: Yes No
Clinical Crown: Filling Caries Exposure Fracture
TOOTH COLD HEAT EPT PERC PALP MOB PERIODONTAL EXAM
MB B DB DL L ML RECESSION FURCATION

(NORMAL: N NO RESPONSE: 0 MILD: + MODERATE: ++ SEVERE: +++ LINGERED: L DELAYED: D)

Radiographic Findings
Alveolar bone: WNL Apical Lucency Ap/ Lat Opacity Crestal Bone Loss
Lamina dura: WNL Obscure Broken Widened
Roots: WNL Curvature Resorption Perforation Dilacerations Fracture Long Sinus/ IAN
Pulp chamber: WNL Calcification Pulp Stone Exposure Resorption Perforation
Pulp canal: WNL Calcification Bifurcated Resorption Prior-RCT Fracture Involvement Perforation
Crown: WNL Caries Restoration Crown Dens in Dent
Sinus tract trace to:
…………………………………………………………………………………………………………………………………………………………………………………………….....
A (ASSESSMENT)
Diagnosis: pulpal: WNL RP SEP AEP N Prior-RCT/Non Healing Pulpless
Periapical: WNL AAA CAA SAP AAP CO
Etiology: Caries Restoration Prior-RCT Iatrogenic Coronal Leakage Trauma Perio Elective Resorption VRF
Prognosis: Favorable Questionable Unfavorable
………………………………………………………………………………………………………………………………………………………………………………………………..
P(PLAN)
Endodontic: CARIES CONTROL RCT RETX I&D Apico Apexification/Genesis Perf/Resorption Repair
Periodontal: S/RP Crown Lengthen Root Amp Hemisection Extraction
Restorative: TEMP Post Space B/U P&C Onlay Crown Bleaching
BIOMECHANICAL DATA:
R R I I F M INSRTRUMENTATION OBTURATION
CANAL POINT WL FILE WL FILE TECHNIQUE TECHNIQUE

MEDICAMENT USED:
LOCAL ANESTHESIA
R. CANAL IRRIGATION
INTRACANAL MEDICATION
………………………………………………………………………………………………………………………………………………………………………………………………
POST OPERATIVE INSTRUCTIONS AND MEDICATIONS:

………………………………………………………………………………………………………………………………………………………………………………………………..
SUPERVISOR NAME: SIGNATURE:
 ENDODONTIC CLINICAL EVALUATION FORM

Student Name:
University Number:
Patient Name:
MR Number: Tooth number:

A) Armamentarium and protective measures E) Instrumentation

Incomplete (PPE). -7 Not flared -2
Incomplete sterlized instruments, devices or materials -3 Improper master file size -2
Grade …………/10 Master cone doesn’t fit WL -2
Apical perforation -2
B) Diagnosis and treatment planning Apical ledge -2
Unreported chief complaint -2 Transportation -2
Undocumented medical and dental Hx -2 Zipping -2
Incompletely investigated history of the chief complaint -2 Stripping perforation -3
Incomplete clinical tests -2 Broken instruments -2
Incomplete radiographic tests -2 Poor quality of radiographs -1
Incorrect diagnosis -5 Grade …………/20
Incorrect treatment planning -5
Grade …………/20 F) Obturation
Short -1
C) Isolation Over-extended -2
Improper use of rubber dam -1 Flush -1
Rubber dam not applied -9 Voids in the apical 3rd -2
Grade …………/10 Voids in the middle or coronal 3rd -1
GP in the access cavity -2
D) Access opening and working length Poor quality of radiographs -1
Under-extended access -1 Grade …………/10
Over-extended access -2
Improper location -2 G) Knowledge and competence:
Incomplete deroofing -1 Unsatisfactory attitude -4
Gouging -2 Deficiency in the basic Knowledge -2
Perforation (treatable) -2 Dependents -2
Perforation (affects the restorability) -4 Improper time managements -2
Under-extended WL -1 Grade …………/10
Over-extended WL -1
Improper file size -1
Poor quality of radiographic image -1
Improper reference point -2 Total mark …………………/100
Grade …………/20
Supervisor name:

Supervisor signature:
 Radiographic Images

1) Preoperative Radiographs:

2) Working Length Radiograph:

3) Master cone Radiograph:

4) Obturation Radiograph:
 ENDODONTIC CLINICAL CASE FORM
Patient Name/MR #: Date: Tooth:
S. (SUBJECTIVE)
Chief Complaint:
History of present illness:

Nature of Pain: Non Moderate Severe

Quality: Dull Sharp Throbbing Constant
Onset: Stim Required Intermittent Spontaneous
Location: Localized Differ=Use Referred Radiating to:
Duration: Seconds Minutes Hours Constant
Initiated by: Cold Heat Sweet Spontaneous Palpation Mastication Supination Keeps Awake at Night
Relieved by: Cold Heat OTC- Meds NARC- Meds
………………………………………………………………………………………………………………………………………………………………………………………………..
O (OBJECTIVE)
Extra oral: Intraoral:
Facial Swelling: Yes No soft tissue: WNL
L. Nodes Swelling: Yes No Swelling: Yes No Location:
Sinus Tract: Yes No
Clinical Crown: Filling Caries Exposure Fracture
TOOTH COLD HEAT EPT PERC PALP MOB PERIODONTAL EXAM
MB B DB DL L ML RECESSION FURCATION

(NORMAL: N NO RESPONSE: 0 MILD: + MODERATE: ++ SEVERE: +++ LINGERED: L DELAYED: D)

Radiographic Findings
Alveolar bone: WNL Apical Lucency Ap/ Lat Opacity Crestal Bone Loss
Lamina dura: WNL Obscure Broken Widened
Roots: WNL Curvature Resorption Perforation Dilacerations Fracture Long Sinus/ IAN
Pulp chamber: WNL Calcification Pulp Stone Exposure Resorption Perforation
Pulp canal: WNL Calcification Bifurcated Resorption Prior-RCT Fracture Involvement Perforation
Crown: WNL Caries Restoration Crown Dens in Dent
Sinus tract trace to:
…………………………………………………………………………………………………………………………………………………………………………………………….....
A (ASSESSMENT)
Diagnosis: pulpal: WNL RP SEP AEP N Prior-RCT/Non Healing Pulpless
Periapical: WNL AAA CAA SAP AAP CO
Etiology: Caries Restoration Prior-RCT Iatrogenic Coronal Leakage Trauma Perio Elective Resorption VRF
Prognosis: Favorable Questionable Unfavorable
………………………………………………………………………………………………………………………………………………………………………………………………..
P(PLAN)
Endodontic: CARIES CONTROL RCT RETX I&D Apico Apexification/Genesis Perf/Resorption Repair
Periodontal: S/RP Crown Lengthen Root Amp Hemisection Extraction
Restorative: TEMP Post Space B/U P&C Onlay Crown Bleaching
BIOMECHANICAL DATA:
R R I I F M INSRTRUMENTATION OBTURATION
CANAL POINT WL FILE WL FILE TECHNIQUE TECHNIQUE

MEDICAMENT USED:
LOCAL ANESTHESIA
R. CANAL IRRIGATION
INTRACANAL MEDICATION
………………………………………………………………………………………………………………………………………………………………………………………………
POST OPERATIVE INSTRUCTIONS AND MEDICATIONS:

………………………………………………………………………………………………………………………………………………………………………………………………..
SUPERVISOR NAME: SIGNATURE:
 ENDODONTIC CLINICAL EVALUATION FORM

Student Name:
University Number:
Patient Name:
MR Number: Tooth number:

A) Armamentarium and protective measures E) Instrumentation

Incomplete (PPE). -7 Not flared -2
Incomplete sterlized instruments, devices or materials -3 Improper master file size -2
Grade …………/10 Master cone doesn’t fit WL -2
Apical perforation -2
B) Diagnosis and treatment planning Apical ledge -2
Unreported chief complaint -2 Transportation -2
Undocumented medical and dental Hx -2 Zipping -2
Incompletely investigated history of the chief complaint -2 Stripping perforation -3
Incomplete clinical tests -2 Broken instruments -2
Incomplete radiographic tests -2 Poor quality of radiographs -1
Incorrect diagnosis -5 Grade …………/20
Incorrect treatment planning -5
Grade …………/20 F) Obturation
Short -1
C) Isolation Over-extended -2
Improper use of rubber dam -1 Flush -1
Rubber dam not applied -9 Voids in the apical 3rd -2
Grade …………/10 Voids in the middle or coronal 3rd -1
GP in the access cavity -2
D) Access opening and working length Poor quality of radiographs -1
Under-extended access -1 Grade …………/10
Over-extended access -2
Improper location -2 G) Knowledge and competence:
Incomplete deroofing -1 Unsatisfactory attitude -4
Gouging -2 Deficiency in the basic Knowledge -2
Perforation (treatable) -2 Dependents -2
Perforation (affects the restorability) -4 Improper time managements -2
Under-extended WL -1 Grade …………/10
Over-extended WL -1
Improper file size -1
Poor quality of radiographic image -1
Improper reference point -2 Total mark …………………/100
Grade …………/20
Supervisor name:

Supervisor signature:
 Radiographic Images

1) Preoperative Radiographs:

2) Working Length Radiograph:

3) Master cone Radiograph:

4) Obturation Radiograph:
 ENDODONTIC CLINICAL CASE FORM
Patient Name/MR #: Date: Tooth:
S. (SUBJECTIVE)
Chief Complaint:
History of present illness:

Nature of Pain: Non Moderate Severe

Quality: Dull Sharp Throbbing Constant
Onset: Stim Required Intermittent Spontaneous
Location: Localized Differ=Use Referred Radiating to:
Duration: Seconds Minutes Hours Constant
Initiated by: Cold Heat Sweet Spontaneous Palpation Mastication Supination Keeps Awake at Night
Relieved by: Cold Heat OTC- Meds NARC- Meds
………………………………………………………………………………………………………………………………………………………………………………………………..
O (OBJECTIVE)
Extra oral: Intraoral:
Facial Swelling: Yes No soft tissue: WNL
L. Nodes Swelling: Yes No Swelling: Yes No Location:
Sinus Tract: Yes No
Clinical Crown: Filling Caries Exposure Fracture
TOOTH COLD HEAT EPT PERC PALP MOB PERIODONTAL EXAM
MB B DB DL L ML RECESSION FURCATION

(NORMAL: N NO RESPONSE: 0 MILD: + MODERATE: ++ SEVERE: +++ LINGERED: L DELAYED: D)

Radiographic Findings
Alveolar bone: WNL Apical Lucency Ap/ Lat Opacity Crestal Bone Loss
Lamina dura: WNL Obscure Broken Widened
Roots: WNL Curvature Resorption Perforation Dilacerations Fracture Long Sinus/ IAN
Pulp chamber: WNL Calcification Pulp Stone Exposure Resorption Perforation
Pulp canal: WNL Calcification Bifurcated Resorption Prior-RCT Fracture Involvement Perforation
Crown: WNL Caries Restoration Crown Dens in Dent
Sinus tract trace to:
…………………………………………………………………………………………………………………………………………………………………………………………….....
A (ASSESSMENT)
Diagnosis: pulpal: WNL RP SEP AEP N Prior-RCT/Non Healing Pulpless
Periapical: WNL AAA CAA SAP AAP CO
Etiology: Caries Restoration Prior-RCT Iatrogenic Coronal Leakage Trauma Perio Elective Resorption VRF
Prognosis: Favorable Questionable Unfavorable
………………………………………………………………………………………………………………………………………………………………………………………………..
P(PLAN)
Endodontic: CARIES CONTROL RCT RETX I&D Apico Apexification/Genesis Perf/Resorption Repair
Periodontal: S/RP Crown Lengthen Root Amp Hemisection Extraction
Restorative: TEMP Post Space B/U P&C Onlay Crown Bleaching
BIOMECHANICAL DATA:
R R I I F M INSRTRUMENTATION OBTURATION
CANAL POINT WL FILE WL FILE TECHNIQUE TECHNIQUE

MEDICAMENT USED:
LOCAL ANESTHESIA
R. CANAL IRRIGATION
INTRACANAL MEDICATION
………………………………………………………………………………………………………………………………………………………………………………………………
POST OPERATIVE INSTRUCTIONS AND MEDICATIONS:

………………………………………………………………………………………………………………………………………………………………………………………………..
SUPERVISOR NAME: SIGNATURE:
 ENDODONTIC CLINICAL EVALUATION FORM

Student Name:
University Number:
Patient Name:
MR Number: Tooth number:

A) Armamentarium and protective measures E) Instrumentation

Incomplete (PPE). -7 Not flared -2
Incomplete sterlized instruments, devices or materials -3 Improper master file size -2
Grade …………/10 Master cone doesn’t fit WL -2
Apical perforation -2
B) Diagnosis and treatment planning Apical ledge -2
Unreported chief complaint -2 Transportation -2
Undocumented medical and dental Hx -2 Zipping -2
Incompletely investigated history of the chief complaint -2 Stripping perforation -3
Incomplete clinical tests -2 Broken instruments -2
Incomplete radiographic tests -2 Poor quality of radiographs -1
Incorrect diagnosis -5 Grade …………/20
Incorrect treatment planning -5
Grade …………/20 F) Obturation
Short -1
C) Isolation Over-extended -2
Improper use of rubber dam -1 Flush -1
Rubber dam not applied -9 Voids in the apical 3rd -2
Grade …………/10 Voids in the middle or coronal 3rd -1
GP in the access cavity -2
D) Access opening and working length Poor quality of radiographs -1
Under-extended access -1 Grade …………/10
Over-extended access -2
Improper location -2 G) Knowledge and competence:
Incomplete deroofing -1 Unsatisfactory attitude -4
Gouging -2 Deficiency in the basic Knowledge -2
Perforation (treatable) -2 Dependents -2
Perforation (affects the restorability) -4 Improper time managements -2
Under-extended WL -1 Grade …………/10
Over-extended WL -1
Improper file size -1
Poor quality of radiographic image -1
Improper reference point -2 Total mark …………………/100
Grade …………/20
Supervisor name:

Supervisor signature:
 Radiographic Images

1) Preoperative Radiographs:

2) Working Length Radiograph:

3) Master cone Radiograph:

4) Obturation Radiograph:
 ENDODONTIC CLINICAL CASE FORM
Patient Name/MR #: Date: Tooth:
S. (SUBJECTIVE)
Chief Complaint:
History of present illness:

Nature of Pain: Non Moderate Severe

Quality: Dull Sharp Throbbing Constant
Onset: Stim Required Intermittent Spontaneous
Location: Localized Differ=Use Referred Radiating to:
Duration: Seconds Minutes Hours Constant
Initiated by: Cold Heat Sweet Spontaneous Palpation Mastication Supination Keeps Awake at Night
Relieved by: Cold Heat OTC- Meds NARC- Meds
………………………………………………………………………………………………………………………………………………………………………………………………..
O (OBJECTIVE)
Extra oral: Intraoral:
Facial Swelling: Yes No soft tissue: WNL
L. Nodes Swelling: Yes No Swelling: Yes No Location:
Sinus Tract: Yes No
Clinical Crown: Filling Caries Exposure Fracture
TOOTH COLD HEAT EPT PERC PALP MOB PERIODONTAL EXAM
MB B DB DL L ML RECESSION FURCATION

(NORMAL: N NO RESPONSE: 0 MILD: + MODERATE: ++ SEVERE: +++ LINGERED: L DELAYED: D)

Radiographic Findings
Alveolar bone: WNL Apical Lucency Ap/ Lat Opacity Crestal Bone Loss
Lamina dura: WNL Obscure Broken Widened
Roots: WNL Curvature Resorption Perforation Dilacerations Fracture Long Sinus/ IAN
Pulp chamber: WNL Calcification Pulp Stone Exposure Resorption Perforation
Pulp canal: WNL Calcification Bifurcated Resorption Prior-RCT Fracture Involvement Perforation
Crown: WNL Caries Restoration Crown Dens in Dent
Sinus tract trace to:
…………………………………………………………………………………………………………………………………………………………………………………………….....
A (ASSESSMENT)
Diagnosis: pulpal: WNL RP SEP AEP N Prior-RCT/Non Healing Pulpless
Periapical: WNL AAA CAA SAP AAP CO
Etiology: Caries Restoration Prior-RCT Iatrogenic Coronal Leakage Trauma Perio Elective Resorption VRF
Prognosis: Favorable Questionable Unfavorable
………………………………………………………………………………………………………………………………………………………………………………………………..
P(PLAN)
Endodontic: CARIES CONTROL RCT RETX I&D Apico Apexification/Genesis Perf/Resorption Repair
Periodontal: S/RP Crown Lengthen Root Amp Hemisection Extraction
Restorative: TEMP Post Space B/U P&C Onlay Crown Bleaching
BIOMECHANICAL DATA:
R R I I F M INSRTRUMENTATION OBTURATION
CANAL POINT WL FILE WL FILE TECHNIQUE TECHNIQUE

MEDICAMENT USED:
LOCAL ANESTHESIA
R. CANAL IRRIGATION
INTRACANAL MEDICATION
………………………………………………………………………………………………………………………………………………………………………………………………
POST OPERATIVE INSTRUCTIONS AND MEDICATIONS:

………………………………………………………………………………………………………………………………………………………………………………………………..
SUPERVISOR NAME: SIGNATURE:
 ENDODONTIC CLINICAL EVALUATION FORM

Student Name:
University Number:
Patient Name:
MR Number: Tooth number:

A) Armamentarium and protective measures E) Instrumentation

Incomplete (PPE). -7 Not flared -2
Incomplete sterlized instruments, devices or materials -3 Improper master file size -2
Grade …………/10 Master cone doesn’t fit WL -2
Apical perforation -2
B) Diagnosis and treatment planning Apical ledge -2
Unreported chief complaint -2 Transportation -2
Undocumented medical and dental Hx -2 Zipping -2
Incompletely investigated history of the chief complaint -2 Stripping perforation -3
Incomplete clinical tests -2 Broken instruments -2
Incomplete radiographic tests -2 Poor quality of radiographs -1
Incorrect diagnosis -5 Grade …………/20
Incorrect treatment planning -5
Grade …………/20 F) Obturation
Short -1
C) Isolation Over-extended -2
Improper use of rubber dam -1 Flush -1
Rubber dam not applied -9 Voids in the apical 3rd -2
Grade …………/10 Voids in the middle or coronal 3rd -1
GP in the access cavity -2
D) Access opening and working length Poor quality of radiographs -1
Under-extended access -1 Grade …………/10
Over-extended access -2
Improper location -2 G) Knowledge and competence:
Incomplete deroofing -1 Unsatisfactory attitude -4
Gouging -2 Deficiency in the basic Knowledge -2
Perforation (treatable) -2 Dependents -2
Perforation (affects the restorability) -4 Improper time managements -2
Under-extended WL -1 Grade …………/10
Over-extended WL -1
Improper file size -1
Poor quality of radiographic image -1
Improper reference point -2 Total mark …………………/100
Grade …………/20
Supervisor name:

Supervisor signature:
 Radiographic Images

1) Preoperative Radiographs:

2) Working Length Radiograph:

3) Master cone Radiograph:

4) Obturation Radiograph:
 ENDODONTIC CLINICAL CASE FORM
Patient Name/MR #: Date: Tooth:
S. (SUBJECTIVE)
Chief Complaint:
History of present illness:

Nature of Pain: Non Moderate Severe

Quality: Dull Sharp Throbbing Constant
Onset: Stim Required Intermittent Spontaneous
Location: Localized Differ=Use Referred Radiating to:
Duration: Seconds Minutes Hours Constant
Initiated by: Cold Heat Sweet Spontaneous Palpation Mastication Supination Keeps Awake at Night
Relieved by: Cold Heat OTC- Meds NARC- Meds
………………………………………………………………………………………………………………………………………………………………………………………………..
O (OBJECTIVE)
Extra oral: Intraoral:
Facial Swelling: Yes No soft tissue: WNL
L. Nodes Swelling: Yes No Swelling: Yes No Location:
Sinus Tract: Yes No
Clinical Crown: Filling Caries Exposure Fracture
TOOTH COLD HEAT EPT PERC PALP MOB PERIODONTAL EXAM
MB B DB DL L ML RECESSION FURCATION

(NORMAL: N NO RESPONSE: 0 MILD: + MODERATE: ++ SEVERE: +++ LINGERED: L DELAYED: D)

Radiographic Findings
Alveolar bone: WNL Apical Lucency Ap/ Lat Opacity Crestal Bone Loss
Lamina dura: WNL Obscure Broken Widened
Roots: WNL Curvature Resorption Perforation Dilacerations Fracture Long Sinus/ IAN
Pulp chamber: WNL Calcification Pulp Stone Exposure Resorption Perforation
Pulp canal: WNL Calcification Bifurcated Resorption Prior-RCT Fracture Involvement Perforation
Crown: WNL Caries Restoration Crown Dens in Dent
Sinus tract trace to:
…………………………………………………………………………………………………………………………………………………………………………………………….....
A (ASSESSMENT)
Diagnosis: pulpal: WNL RP SEP AEP N Prior-RCT/Non Healing Pulpless
Periapical: WNL AAA CAA SAP AAP CO
Etiology: Caries Restoration Prior-RCT Iatrogenic Coronal Leakage Trauma Perio Elective Resorption VRF
Prognosis: Favorable Questionable Unfavorable
………………………………………………………………………………………………………………………………………………………………………………………………..
P(PLAN)
Endodontic: CARIES CONTROL RCT RETX I&D Apico Apexification/Genesis Perf/Resorption Repair
Periodontal: S/RP Crown Lengthen Root Amp Hemisection Extraction
Restorative: TEMP Post Space B/U P&C Onlay Crown Bleaching
BIOMECHANICAL DATA:
R R I I F M INSRTRUMENTATION OBTURATION
CANAL POINT WL FILE WL FILE TECHNIQUE TECHNIQUE

MEDICAMENT USED:
LOCAL ANESTHESIA
R. CANAL IRRIGATION
INTRACANAL MEDICATION
………………………………………………………………………………………………………………………………………………………………………………………………
POST OPERATIVE INSTRUCTIONS AND MEDICATIONS:

………………………………………………………………………………………………………………………………………………………………………………………………..
SUPERVISOR NAME: SIGNATURE:
 ENDODONTIC CLINICAL EVALUATION FORM

Student Name:
University Number:
Patient Name:
MR Number: Tooth number:

A) Armamentarium and protective measures E) Instrumentation

Incomplete (PPE). -7 Not flared -2
Incomplete sterlized instruments, devices or materials -3 Improper master file size -2
Grade …………/10 Master cone doesn’t fit WL -2
Apical perforation -2
B) Diagnosis and treatment planning Apical ledge -2
Unreported chief complaint -2 Transportation -2
Undocumented medical and dental Hx -2 Zipping -2
Incompletely investigated history of the chief complaint -2 Stripping perforation -3
Incomplete clinical tests -2 Broken instruments -2
Incomplete radiographic tests -2 Poor quality of radiographs -1
Incorrect diagnosis -5 Grade …………/20
Incorrect treatment planning -5
Grade …………/20 F) Obturation
Short -1
C) Isolation Over-extended -2
Improper use of rubber dam -1 Flush -1
Rubber dam not applied -9 Voids in the apical 3rd -2
Grade …………/10 Voids in the middle or coronal 3rd -1
GP in the access cavity -2
D) Access opening and working length Poor quality of radiographs -1
Under-extended access -1 Grade …………/10
Over-extended access -2
Improper location -2 G) Knowledge and competence:
Incomplete deroofing -1 Unsatisfactory attitude -4
Gouging -2 Deficiency in the basic Knowledge -2
Perforation (treatable) -2 Dependents -2
Perforation (affects the restorability) -4 Improper time managements -2
Under-extended WL -1 Grade …………/10
Over-extended WL -1
Improper file size -1
Poor quality of radiographic image -1
Improper reference point -2 Total mark …………………/100
Grade …………/20
Supervisor name:

Supervisor signature:
 Radiographic Images

1) Preoperative Radiographs:

2) Working Length Radiograph:

3) Master cone Radiograph:

4) Obturation Radiograph:
 ENDODONTIC CLINICAL CASE FORM
Patient Name/MR #: Date: Tooth:
S. (SUBJECTIVE)
Chief Complaint:
History of present illness:

Nature of Pain: Non Moderate Severe

Quality: Dull Sharp Throbbing Constant
Onset: Stim Required Intermittent Spontaneous
Location: Localized Differ=Use Referred Radiating to:
Duration: Seconds Minutes Hours Constant
Initiated by: Cold Heat Sweet Spontaneous Palpation Mastication Supination Keeps Awake at Night
Relieved by: Cold Heat OTC- Meds NARC- Meds
………………………………………………………………………………………………………………………………………………………………………………………………..
O (OBJECTIVE)
Extra oral: Intraoral:
Facial Swelling: Yes No soft tissue: WNL
L. Nodes Swelling: Yes No Swelling: Yes No Location:
Sinus Tract: Yes No
Clinical Crown: Filling Caries Exposure Fracture
TOOTH COLD HEAT EPT PERC PALP MOB PERIODONTAL EXAM
MB B DB DL L ML RECESSION FURCATION

(NORMAL: N NO RESPONSE: 0 MILD: + MODERATE: ++ SEVERE: +++ LINGERED: L DELAYED: D)

Radiographic Findings
Alveolar bone: WNL Apical Lucency Ap/ Lat Opacity Crestal Bone Loss
Lamina dura: WNL Obscure Broken Widened
Roots: WNL Curvature Resorption Perforation Dilacerations Fracture Long Sinus/ IAN
Pulp chamber: WNL Calcification Pulp Stone Exposure Resorption Perforation
Pulp canal: WNL Calcification Bifurcated Resorption Prior-RCT Fracture Involvement Perforation
Crown: WNL Caries Restoration Crown Dens in Dent
Sinus tract trace to:
…………………………………………………………………………………………………………………………………………………………………………………………….....
A (ASSESSMENT)
Diagnosis: pulpal: WNL RP SEP AEP N Prior-RCT/Non Healing Pulpless
Periapical: WNL AAA CAA SAP AAP CO
Etiology: Caries Restoration Prior-RCT Iatrogenic Coronal Leakage Trauma Perio Elective Resorption VRF
Prognosis: Favorable Questionable Unfavorable
………………………………………………………………………………………………………………………………………………………………………………………………..
P(PLAN)
Endodontic: CARIES CONTROL RCT RETX I&D Apico Apexification/Genesis Perf/Resorption Repair
Periodontal: S/RP Crown Lengthen Root Amp Hemisection Extraction
Restorative: TEMP Post Space B/U P&C Onlay Crown Bleaching
BIOMECHANICAL DATA:
R R I I F M INSRTRUMENTATION OBTURATION
CANAL POINT WL FILE WL FILE TECHNIQUE TECHNIQUE

MEDICAMENT USED:
LOCAL ANESTHESIA
R. CANAL IRRIGATION
INTRACANAL MEDICATION
………………………………………………………………………………………………………………………………………………………………………………………………
POST OPERATIVE INSTRUCTIONS AND MEDICATIONS:

………………………………………………………………………………………………………………………………………………………………………………………………..
SUPERVISOR NAME: SIGNATURE:
 ENDODONTIC CLINICAL EVALUATION FORM

Student Name:
University Number:
Patient Name:
MR Number: Tooth number:

A) Armamentarium and protective measures E) Instrumentation

Incomplete (PPE). -7 Not flared -2
Incomplete sterlized instruments, devices or materials -3 Improper master file size -2
Grade …………/10 Master cone doesn’t fit WL -2
Apical perforation -2
B) Diagnosis and treatment planning Apical ledge -2
Unreported chief complaint -2 Transportation -2
Undocumented medical and dental Hx -2 Zipping -2
Incompletely investigated history of the chief complaint -2 Stripping perforation -3
Incomplete clinical tests -2 Broken instruments -2
Incomplete radiographic tests -2 Poor quality of radiographs -1
Incorrect diagnosis -5 Grade …………/20
Incorrect treatment planning -5
Grade …………/20 F) Obturation
Short -1
C) Isolation Over-extended -2
Improper use of rubber dam -1 Flush -1
Rubber dam not applied -9 Voids in the apical 3rd -2
Grade …………/10 Voids in the middle or coronal 3rd -1
GP in the access cavity -2
D) Access opening and working length Poor quality of radiographs -1
Under-extended access -1 Grade …………/10
Over-extended access -2
Improper location -2 G) Knowledge and competence:
Incomplete deroofing -1 Unsatisfactory attitude -4
Gouging -2 Deficiency in the basic Knowledge -2
Perforation (treatable) -2 Dependents -2
Perforation (affects the restorability) -4 Improper time managements -2
Under-extended WL -1 Grade …………/10
Over-extended WL -1
Improper file size -1
Poor quality of radiographic image -1
Improper reference point -2 Total mark …………………/100
Grade …………/20
Supervisor name:

Supervisor signature:
 Radiographic Images

1) Preoperative Radiographs:

2) Working Length Radiograph:

3) Master cone Radiograph:

4) Obturation Radiograph:
 #
Date
Procedures

Performed
independently

Preformed w.
assistance

Assisted

Observed
supervisor
Name/Signature of clinical
 #
Date
Procedures

Performed
independently

Preformed w.
assistance

Assisted

Observed
supervisor
Name/Signature of clinical
 #
Date
Procedures

Performed
independently

Preformed w.
assistance

Assisted

Observed
supervisor
Name/Signature of clinical
 #
Date
Procedures

Performed
independently

Preformed w.
assistance

Assisted

Observed
supervisor
Name/Signature of clinical
 Student Final Training Evaluation Form

Student Name:

University ID number:

End of Training Date:

Evaluation Criteria Mark

Clinical performance /50
Adherance to instructions and regulations /20
Attendance /10
Professional attitude /20
Total /100

Comments:

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Clinical supervisor/s:

Head of Department: