Procedure to be carried out: Preparation of Fixed Prosthesis Procedure –

Porcelain Crown on Lower Right 5

Patient details: 41 years, male,

Social habits: no smoking, no drinking,

Medical history: No medical concerns, no allergies of any king

Last visit: 24th June 2024 for Routine Examination

Clinical area: NHS Dental Practice

Preparation of the clinical area for preparation of fixed prosthesis procedure

(crown):

I am wearing my scrubs, I have short nails, I am not wearing any jewellery, I washed
my hands in line with HTM 01-05 regulations, as stated in the handwashing poster
found above each handwashing sink and after that I used rinse-free hand
disinfection gel on my hands and wrists. I am wearing Personal Protective
Equipment (PPE) that I put in the following order: first I put on the plastic apron and
tied at the waist, second, I put on the disposable face mask and made sure it covers
my nose, mouth and chin, then I got the visor and lastly the disposable nitrile
powder-free examination gloves.

I made sure that surgery is kept dry and adequately ventilated at all times to
eliminate exposure of airborne materials, toxic hazards and improve the comfort of
dental staff and patients. Temperature, humidity, and ventilations systems are
regularly maintained/checked following HTM 03-01 specialised ventilation for
healthcare premises guidance. Natural light combination with ambient lighting is
used to establish a comfortable environment in a way that helps the patients feel
confident and calm.

I switched on and visually checked all the equipment required for the procedure
according to the manufacturer’s guidelines:

 Air compressor, which is located downstairs, I switched on the power by

pressing the switch button on the wall, and then pulled on the safety valve to
test it which released a hiss of escaping air. After I had done that, I watched
the pressure gauge, waiting for the needle to stop moving. This signifies that
the air inside has reached optimum pressure.
 X-ray Machine, I switched on the power by pressing the red switch button on
the wall, and visually checked if the equipment works within diagnostic
reference levels (DRL), checked if warning lights and alarms functioning
correctly, checked if isolation switch is working, and I checked if the arm is not
loose and moving, and if the head is in good working condition with the
collimator on, recording the findings in the Log in record sheet.
 Dental chair- I switched on the power by pressing the green switch button
from the bottom of the dental chair unit, and I filled a reservoir bottle with
freshly made distilled water and water lines decontamination solution
 ( tosylchloramide sodium solution), in a concentration of 10ml solution to
990ml distilled water, according to manufacturer guidelines, for preventing the
biofilm in dental unit waterlines I attached it to the chair securely and flushed
all dental unit water lines (DUWL) like 3 in1 syringe, slow and fast speed hand
pieces and scale and polish, for 2 minutes and flushed again for 30 seconds
between each patient (HTM01-05). This is done to remove stagnant water
and to also reduce the microbiological count within the water lines and to
prevent cross contamination. I am aware that Legionella and Pseudomonas
bacteria can be spread through the handpieces to the patient or staff and can
cause mild to severe illness.
 The Suction line was switched on together with the dental chair, and now
used my finger to completely cover the Regulator Port to check the suction
strength.
 Amalgamator- I switched on the power by pressing the switch button on the
wall, hearing the beep sound confirming that the amalgamator is on.
 Light cure- I switched the power on and checked it was working by removing
the light cure and placing it back on the charging unit watching the charging
light come on.
 switched on the computer from the plug and pressed the on/off button at the
bottom of the screen which then brought power to the computer and logged
into the system.

All the equipment was in good working condition for the day.

All staff in our practice are responsible for checking and setting up the
Decontamination room every morning, by turning all the equipment on - the lights
pressing the swich on, the extractor fan, that is very important because ensures a
good ventilation taking out the air from the room and bringing in fresh air, the
illuminated magnifier by pressing the switch on, and the Autoclave type N that I filled
with freshly distilled water and I run an autoclave test cycle using TST strip to test
the sterilising conditions. Before the cycle starts, I do the safety checks looking if the
door seal is intact and checking for the door pressure interlock and door closed
interlock. During this cycle the air is sucked out of the vacuum chamber which
creates a steam which allows it to contact all surfaces, including any hollow
instruments. The autoclave heats to 134 degrees Celsius and holds a bar pressure
of 2.25 for 3 minutes. A full cycle length is 15 minutes, and I knew the test was
successful when the yellow circle present on the TST strip had turned to purple once
the cycle had complete. I write down all the findings in the Log sheet, and signed
with my initials, together with the cycle number, the Autoclave model and serial
number. There are no other automatic cleaners in my practice. I scrubbed the dirty
instruments washing sink and the instruments rinsing sink with cream cleaner paste,
the taps as well, making sure there is no limescale deposits, and then I cleaned them
with warm water. I sprayed all the flat work surfaces with disinfectant spray 2 in 1
anti -microbial non- alcoholic surface cleaner and wiped them with paper towels.

Back in surgery room, I sprayed all the flat work surfaces with disinfectant spray 2 in
1 anti -microbial non- alcoholic surface cleaner and wiped them with paper towels.
For the dental chair, dental light, control panels and for the bracket table that holds 3
in 1, slow and faster speed hand pieces and scale and polishing handle, I used anti-
microbial surface cleaning pre-saturated and alcohol-free wipes following
manufactures guidelines (we don’t apply disposable covers to the dental chair
handles and headrest in the surgery room I worked this day, but we do it in other
surgery rooms were the dental chair have any sign of wear or tear, and I am aware
that the best practice according to HTM 01-05 guidelines Best Practice there should
be disposable covers applied to the aspirator tubes, control panels and handles
dental light). Computer keyboard is covered with protective silicone cover. I clean
these areas in between each patient with anti-microbial cleaning wipes following
manufactures instructions. I prepared the dirty instruments box, which is lockable,
rigid and puncture proof by spraying it with disinfectant spray 2 in 1 anti -microbial
non- alcoholic surface cleaner and wiped it with paper towels.

The patient is an existing patient, and I opened his file records, where I could see
that his last visit was on 24th June 2024 for routine examination, and the patient
asked the best option to replace a missing composite filling on his lower premolar, on
which the dentist explained the options of different types of crowns and onlay. On his
signed treatment plan, I can see that, for today he will need a porcelain crown
preparation on LR5. I checked the last radiograph taken and displayed it on the
screen for the dentist to have another look at it, before the procedure, to assess the
tooth and the surrounding bone. I opened patient's medical history to check for any
allergies or red flag warnings, to inform the dentist accordingly. Any change in
patient's medical history was documented and electronically signed and dated at the
reception, as for each patient. The patient has no existing health problems or
allergies of any kind, and I made the dentist aware of this. The planned procedure is
confirmed with the dentist. I made sure I have got the consent from the patient as a
trainee dental nurse to use the information about the treatment for my RoE records.
Patients consent was gained for a trainee dental nurse to assist the clinician prior to
treatment.
On the dentist side I placed the tray with: mirror, straight probe, college tweezers,
excavator, ball burnisher, flat plastic, slow and fast speed handpiece, handle needle-
holder, anaesthetic safety holder, short (blue) needle hypodermic syringe and
lignospan/ lidocaine hydrochloride 2% (1: 80, 000 adrenaline) cartridge batch
no.B12825AA exp 08/2025 (following the dentist guidance, after checking patient's
medical history), cotton wool rolls, cotton pellets, 3in 1 disposable tip. On the nurse
side I placed: the topical anaesthetic gel (5% lidocaine), vinyl polysiloxane
impression material (putty soft regular type 0) -base and catalyst, spoons for putty,
vinyl polysiloxane impression material- regular body, regular set (type 2), auto
mixing gun dispenser, mixing tips, shade guide, lab docket, impression plastic bag,
disposable triple tray posterior, auto-curing temporary crown material, light cure, a
disposable aspirator tube, a cup of fresh mint mouthwash, box with soft tissues,
mirror.
A disinfecting bath been prepared prior to procedure. I changed my gloves and
prepared PPE for the dentist and for the patient, as follow: for the dentist prepared
disposable nitrile powder-free examination gloves, plastic apron, disposable face
mask and visor, and for patient prepared the safety googles and bib.
I politely invited the patient into the surgery room and asked them to have a seat on
the dental chair. I provided the safety googles and covered her with the bib, always
making sure and asked if the patient is comfortable to start the procedure. After got
the consent from the patient to start the procedure, I put a small amount of topical
anaesthetic gel (5% lidocaine) on a cotton roll and handed to the dentist to numb the
oral tissue prior to infiltration anaesthesia injection, to reduce the sensation of pain.
In the meantime I removed the anaesthetic safety holder and the long needle
hypodermic syringe from their sterile package, the anaesthesia cartridge as well, and
handed over to the dentist for the anaesthetic injection to be delivered, and after
manufacturer’s recommended waiting time (after 3 to 5 minutes, the numbing agent
will take full effect), when the patient felt confident to carry on, the dentist delivered
the inferior dental (ID) block injection. After manufacturer's recommended waiting
time, when the patient said she feels no pain sensation while dentist is checking the
gingiva using straight probe, the dentist asked the patient consent to begin the
procedure. The tooth had previously a root canal treatment, and a composite resin
restorative procedure afterwards, in order for the core of the tooth to be resistant
enough to sustain the crown. Now, using the fast speed handpiece, the dentist filed
the tooth down slightly in all dimensions to make space for the crown. After the
taper of the tooth walls been prepared, and there were no sharp edges to make
sure teeth gets a good impression and ultimately a great fitting crown, it was
necessary to take an impression on which the lab will make the crown. On this
occasion, the dentist used two materials for the impression, so I inserted the first
light body wash impression material cartridge into the mixing gun dispenser, and
handed to the dentist, who, after cleaned and dried the patient’s teeth with
cotton rolls, he applied the fluid material on and around the tooth prepared for
the crown. In the meantime, after I got consent from the dentist, I used the
spoons of different colours to take base and catalyst of the same volume
(covering the lids immediately after this ), and mixed them together with
fingertips, and knead them for at least 30 seconds, till they were evenly
blended. Then, I divided the amount of material in two equal parts, and I
placed it on the triple tray, on the upper and lower side subsequently.
After the dentist received the impression tray from me, he inserted it in
the patient’s mouth, and now the heavier material forces the lighter material
all around the tooth and the two are bonded together during the setting process,
for a more accurate impression. The dentist advice the patient to relax and
breath through the nose, while he waits for about 5 minutes for the material to
set. After it is set, the dentist removed the impression tray and inspected it
thoroughly to check that it has accurately recorded the whole of the crown
preparation and teeth either side. Now the dentist helped the patient to choose
the right shade of the crown, using the shade guide that I just give it to him. After
the dentist gave me the tray from patient’s mouth, it has been disinfected
accordingly, and then sealed in an airtight plastic bag. The lab ticket was filled with
Dentist's name, patient's name and age, patient's id number, shade, dental practice
address, additional features, date of delivery for fitting and disinfected, and the ticket
was attached to the front of the sealed bag. The dentist used the mixing gun
dispenser with auto-curing temporary crown material cartridge to cover the filled
tooth, and he shaped the material around the tooth using flat plastic instrument,
creating a temporary crown for the patient, while I set the material using the curing
light. Temporary crowns serve as placeholders for the permanent crowns, providing
the necessary support and stability for the surrounding teeth. They help maintain
proper occlusion (bite alignment) during the interim period until the final crown is
ready. After the temporary crown was set, the dentist used fast speed handpiece to
shape and adjust the temporary crown. When the patient answered that he feels it
smooth, and the occlusion was alright, I asked him to rinse his mouth, and if I can
remove the bib and have the googles back.

The patient was constantly monitored and reassured through the entire procedure. I
helped the patient to clean his face with paper tissue and after I checked that the
patient was clean and tidy, without water or traces on his face, I escorted him to the
Reception, and ensured he is having one more appointment in no less than two
weeks time for fitting the crown.

I am wearing my scrubs, I have short nails, I am not wearing any jewellery, I washed
my hands in line with HTM 01-05 regulations, as stated in the handwashing poster
found above each handwashing sink and after that I used rinse-free hand
disinfection gel on my hands and wrists. I am wearing Personal Protective
Equipment (PPE) that I put in the following order: first I put on the plastic apron and
tied at the waist, second, I put on the disposable face mask and made sure it covers
my nose, mouth and chin, then I got the visor and lastly the disposable nitrile
powder-free examination gloves.

I prepared the disinfection bath, using one scoop (approximately 20g) of impression
disinfectant powder (composition: sodium percarbonate, citric acid monohydrate,
sodium alkyl aryl sulphonate, sulphate anhydrous, tetrasodium bisphosphonate,
sodium nitrite), in 980 ml warm tap water and mixed for 60 seconds, according to
manufacture's guidelines.

After the dentist pass me the impression tray from the patient's mouth, I
took it to the dirty zone sink, and rinse under running cold water to
remove saliva and debris. Then, I fully immersed the trays into the
disinfection bath solution, and kept there for 10 minutes, according to
manufacturer's guidelines. I changed my gloves, and after the waiting
time, I take the impression tray and rinse one more under running tap
water, to remove any remaining disinfecting solution. I do not wrap the
elastomer impression with a damp paper towel because the
elastomer material does not dehydrate so it does not change its
dimension if it dries, but I sealed in an airtight plastic bag. At this point,
I changed my gloves again. On the lab ticket attached to the front of the plastic
bag, I stated that the impression trays been disinfected, alongside with Dentist's
name, patient's name and age, patient's id number, shade, dental practice address,
additional features, date of delivery for fitting, and the ticket was attached to the front
of the sealed bag. The work was then taken to reception where it was placed in the
external lab collection box, and also logged on practice’s spreadsheet record.

A dental crown is a tooth-shaped "cap" that is placed over a tooth to cover it, to
restore its shape and size, strength, and improve its appearance. The crowns, when
cemented into place, fully encase the entire visible portion of a tooth that lies at and
above the gum line. Preparing teeth for crowns typically involves removing
substantial quantities of enamel and dentine and as a consequence it is not a
conservative technique. The aim of the preparation, in addition to creating space to
accommodate the intended crown, is to prepare a shape appropriate to retain and
support the crown. A dental crown may be needed in the following situations: to
protect a weak tooth (for instance, from decay) from breaking or to hold together
parts of a cracked tooth, to restore an already broken tooth or a tooth that has been
severely worn down, to cover and support a tooth with a large filling when there isn't
a lot of tooth left, to hold a dental bridge in place, to cover a dental implant, or to
make a cosmetic modification.