SUPPLEMENTARY OUTCOME

APPENDIX J

List the 6 items of treatment required

a) Upper right second premolar requires a mesial-occlusal-distal restoration (MOD) (15)
b) Upper right lateral incisor has a fracture of the incisal edge which requires treatment (12)
c) Upper left second molar needs occlusal restoration (27)
d) Upper left third molar needs to be extracted (28)
e) Lower right first molar requires a buccal restoration (46)
f) Lower right second molar requires a distal-occlusal restoration (DO) (47)
List the 6 items of treatment previously received
a) Porcelain Bonded Crown (LL6) (36)
b) Mesial Occlusal filling (LL7) (37)
c) Tooth is Missing and gap is closed (LL5) (35)
d) Tooth is Missing and gap is closed (LR5) (45)
e) Mesial Occlusal Distal Lingual Amalgam filling (LR7) (47)
f) Upper Right Occlusal Distal filling (UR5) (15)

Tutor feedback
This section should be completed by the GDC registrant who is assessing all sections of the completed PER
and is normally based at the Training Centre. Constructive feedback will help the student to develop their
performance in the workplace.

Satisfactory ☒ Not Yet Satisfactory ☐

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Internal Moderation
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Meets NEBDN Requirements: Yes ☐ No ☐