2.13 Fabrication of Custom Tooth Whitening Trays
Protocol: The learner must successfully construct a maxillary and/or mandibular custom whitening tray.
Criteria:
| Student completed procedure protocol accurately | Successful (S) |
| Student did not complete procedure protocol accurately | Unsuccessful (U) |
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Procedure Protocol |
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Complete armamentarium assembled |
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Study cast trimmed and labeled according to protocol |
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Blocking agent applied smoothly |
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Blocking agent applied on correct teeth |
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Margins of the tray trimmed according to protocol |
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Edges are smooth and neat |
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Trays are clean, free of debris, and disinfected |
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Trays are stored appropriately with patients name |
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Use mouth mirror to inspect patient’s oral cavity |
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Shade selection obtained and recorded |
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Tray fits accurately in patient’s mouth |
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Correct instruction provided for whitening product use |
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Procedure documented in patient’s chart |
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Safety measures followed |
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Infection control protocols followed |
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Demonstrates professionalism and appropriate communication skills |
