Clinical Examination

No. Date Patient’s name Signature

 Scaling
No. Date Patient’s name Signature
 Oral hygiene instruction
No. Date Patient’s name Signature
 Composite resin restorations
No. Date Tooth/Class Patient Signature
 Restorations - GI
No. Date Tooth/Class Patient Signature
 Root canal preparation
No. Date Tooth Patient Signature
 Infected root canal preparation
No. Date Tooth Patient Signature
 Root canal obturation
No. Date Tooth Patient Signature
 Rubber dam placement
No. Date Tooth Patient Signature
 Assisting
No. Date Patient’s name Signature