Crown fitting procedure on upper right central incisor.

I work in an NHS dental practice.

Patient details: Existing patient; Age 41; Male; Medical history (date completed
17.08.2013, date updated 11.05.2015, medical condition: hypercholesterolemia;
medication: Atorvastatin 80 mg; No smoking; No alcohol; Oral hygiene
satisfactory; Last visit 30.04.2015.
I wore my clean, short sleeved tunic and closed toed shoes.
I opened the window for fresh air and after that I washed my hands with soap
and water and dried them. I switched on the following equipment: light in the
office, computer, X-ray developing machine, compressor, suction unit, dental
chair, X-ray machine. After this, I went into the decontamination room, put on a
pair of gloves, switched on the non vacuum autoclave and filled the reservoir
with purified water. Then, I placed the instrument trays inside and started
sterilizing cycle without drying phase at 134C at 2.2bar for minim 3 minutes,
the cycle lasted 16 minutes. Next, I filled the water bottle with purified water and
connected to the chair.
I checked if the suction unit and the handles light were working.
Equipment checks: indicator lights checked-no errors reported.
I put on my Personal Protective Equipment (gloves, plastic apron, face mask and
safety glasses).
I ran the suction with non-foaming special cleaner for dental suction system
mixed with hot water and discharged the hand pieces and 3 in 1 syringe for 2
minutes.
I disinfected all surfaces with isopropanol alcohol based cleaner: aspirator unit
and spitton , dental chair, inspection light and handles, the dentist tool rack, Xray machine and all work surfaces in close proximity to the dental chair.
After this, I disposed off my Personal Protective Equipment (gloves, plastic apron,
face mask and safety glasses), washed my hands with soap and water and dried
them.
I prepared Personal Protective Equipment (safety glasses, disposable clinical
gloves and face mask) for dentist and a new face mask, new pair of gloves for
me.
I prepared for the patient: bib, goggles, mouthwash and tissues.
I put on the disposable protective headrest cover and covered the inspection
light handle.
After that ,I went to the reception ,took the patients Practice Record Form and
her Medical History Form and I gave these to him to fill them .After he finished ,I
went and made sure that everything was filled in correctly. After this I took the
Record Card and place it in the surgery clean zone.
I washed my hands with soap and water, dried them and put on a new pair of
gloves.

I connected to the dental chair a small suction tip, an air turbine handpiece with
conventional diamond burs and set up the 3 in 1 syringe.
I laid out the dentist's tray: examination kit (mouth mirror, contra-angled probe
and college tweezers),cotton wool rolls with a topical anaesthetic (xylocaine gel),
local anaesthetic non-aspirating syringe (lidocaine hydrochloride 2% with
adrenaline 1:80.000) with a short needle, flat plastic,Mitchell trimmer.I checked
the expiry date of local anaesthetic: 06/2016.
I laid out on my side: disinfectant , paper towels, face mirror,cotton wool
rolls,luting cement, mixing spatula, mixing pad. I removed my gloves.
I checked the necessary stock: local anaesthetic cartridges, short needles, cotton
rolls, disinfectant, permanent cement.
After that, the dentist asked me if I am ready to receive the patient. I went out to
the waiting room and invited the patient into the treatment room. I helped the
patient to make him comfortable in the dental chair by taking him coat and
handbag and place them securely on the door hanger .I asked him politely to sit
comfortable in the chair and I put on the patients Personal Protective Equipment
(bib, goggles).
Patient assistance:
-I invited the patient into the treatment room
-I helped the patient to make her comfortable in the dental chair by taking his
coat and handbag and place them securely on the door hanger
- I put on the patients Personal Protective Equipment (bib, goggles).
- reassure him and monitor him evolution throughout the procedure.
- encourage rinsing after local anaesthetic
- monitor the patient for any signs of distress
- refill mouthwash cup
- cleaned up the patient during the procedure and at the end of treatment.
-give hand mirror
- remove Personal Protective Equipment (bib, goggles).
- at the end of the procedure, I returned the patients coat and handbag and
following the dentist advice, I escorted him to the reception in order to book his
next appointment.

Clinician assistance:
- during the procedure I tried to pass the instruments and the materials to the
dentist in the requested order
-mixed permanent cement
- do the suction properly to improve visibility

- retracted soft tissues

- adjusting the inspection light

My role during the procedure was:

In the morning I switched on all the equipment needed light in the office,
computer, X-ray developing machine, compressor, suction unit, dental chair, Xray machine and the non vacuum autoclave).

I prepared the surgery to receive patients (I ran the suction with nonfoaming special cleaner for dental suction system mixed with hot water and
discharged the handpieces and 3 in 1 syringe for 2 minutes, I disinfected all
surfaces with isopropanol alcohol based cleaner: aspirator unit and spitton ,
dental chair, inspection light and handles, the dentist tool rack, X-ray machine
and all work surfaces in close proximity to the dental chair).
I prepared all the instruments and examination kit (mouth mirror, contraangled probe and college tweezers),cotton wool rolls with a topical anaesthetic
(xylocaine gel), local anaesthetic non-aspirating syringe (lidocaine hydrochloride
2% with adrenaline 1:80.000) with a short needle, flat plastic, Mitchell trimmer.I
checked the expiry date of local anaesthetic: 06/2016.

For this procedure and I made the stock check.

I prepared Personal Protective Equipment for me (gloves, plastic apron,

face mask and safety glasses), for the dentist (safety glasses, disposable clinical
gloves and face mask) and for the patient (bib, goggles).

I made sure that all the records were filed in correctly and up to date
(Practice Record Form and Medical History Form).

During the procedure I tried to pass the materials to the dentist in the
requested order, I assisted the dentist in adjusting the inspection light, I
disinfected the crown before placing it in patient's mouth, I mixed the permanent
cement 1 scoop - 1 drop ratio, consistency: creamy.

I assisted the patient by putting on / taking off her Personal Protective

Equipment, encourage to rinse after local anaesthetic, refilled mouthwash cup,
reassure him and monitor his evolution throughout the procedure, cleaned up the
patient during and at the end the procedure.

At the end of the procedure, following the dentist advice, I made sure that
the patient booked his next appointment.

After I finished the procedure and the patient has gone, I changed my
gloves and while wearing full Personal Protective Equipment (gloves, plastic
apron, face mask and safety glasses), I started to decontaminate the surgery. I
disconnected the suction tip and 3 in 1 tip and placed them into the tray. I
discharged the handpieces and 3 in 1 syringe for 30 seconds.
I disposed in clinical waste: the suction tips, 3 in 1 tip, patients cup, patients
tissue, used cotton wool rolls, protective headrest cover, the inspection light

handle cover. I disposed in the sharp waste: local anaesthetic cartridge, I

carefully unscrewed the needle from the local anaesthetic syringe.
I took the sealed container with the used instruments, the sealed dry container
with the used handpieces and the mesh clip burs holder in the decontamination
room and placed them in the dirty area of the room.

I returned to the surgery and started to disinfect all surfaces: aspirator unit
and spitton , dental chair, inspection light and handles, the dentist tool rack, Xray machine and all work surfaces in close proximity to the dental chair with
isopropanol alcohol based cleaner.

2. Aim of the Procedure:

Guidance Notes:
Students should state the overall aim of the process.
The aim of the procedure is to replace three-quarters of the natural crown
surface of the tooth to improve its function and aesthetics.

3. Reflective Account:

Guidance Notes:
Students should identify their strengths and weaknesses during the procedure
and describe any action they would take to address weaknesses in the future, if
required.
I consider that my weakness in this procedure was: I forgot to prepare the
articulating paper.
I will pay more attention to the details on future procedures.
I consider strength the fact that I thoroughly disinfected the crown before placing
it into the patients mouth.