Form - Pit & Fissure Placement Product Evaluation

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KEY FOR GRADING USING PRODUCT EVALUATION (For Instructors Only)

NUMERICAL SCORE – PERCENTAGE:

• 10 – Pass (Excellent)
• 7 – Pass
• 5 – Fail (Critical Errors)
• 3 – Fail (Critical Errors/No Concept)

*A 7.5 or higher must be received for each of the four teeth per patient in order to pass the clinical experience and/or examination.

PREPARATION AND ETCHANT:

Preparation of Field and Etchant

1. Teeth are free of stains and plaque
2. Coronal polish/teeth pre-cleaning
3. Isolation of selected area
4. Etching solution application
5. Etching solution removal

SEALANT PLACEMENT:

Sealant Application

1. Mixing/ preparation of sealant dispensing procedure
2. Application
3. Occlusal coverage
4. Occlusal thickness
5. Polymerization time
6. Occlusal adjustment