TheNationalDentalExaminingBoardofCanadaLeBureauNationald’ExamenDentaireduCanada

EQUIVALENCY PROCESS

ASSESSMENT OF CLINICAL SKILLS

PROTOCOL

June 11 & 12, 2011

TheNationalDentalExaminingBoardofCanadaLeBureauNationald’ExamenDentaireduCanada

T A B L E O F C O N T E N T S

PAGE

CONTENT AND FORMAT 1

SCHEDULE 1

VALIDATION OF REGISTRATION 1

ASSESSMENT REQUIREMENTS 2

EQUIPMENT, INSTRUMENTS AND SUPPLIES 2

ASSESSMENT INSTRUCTIONS 3

REGULATIONS 5

RESULTS 6

REQUESTS FOR REVIEW 6

REPEATS 6

EVALUATION CRITERIA 7

GRADE DERIVATION GRID FOR INDIVIDUAL REQUIREMENTS 20

FINAL RESULT GRADE DERIVATION GRID 20

1

ASSESSMENT OF CLINICAL SKILLS

June 11 & 12, 2011

I CONTENT AND FORMAT

During the 2 day Assessment of Clinical Skills, participants will be evaluated on their performance of simulated dental procedures on manikins in a clinical setting. Each day participants will receive a 1. typodont mounted in a manikin on a dental chair. The typodont will be labelled with the

participant’s ID number. 2. detailed list of required procedures specifying tooth numbers and surfaces.

II SCHEDULE

DAY 1 Validation of registration 7:30 a.m. - 8:00 a.m. Orientation and instructions 8:00 a.m. - 8:30 a.m. Set up and practice session 8:30 a.m. - 9:00 a.m. Clinical procedures on simulated patients 9:00 a.m. - 4:30 p.m.

DAY 2 Instructions and set up 8:00 a.m. – 8:30 a.m. Clinical procedures on simulated patients 8:30 a.m. - 4:30 p.m.

III VALIDATION OF REGISTRATION

During the validation of registration participants will be issued an Identification (ID) card. To receive the ID card, participants will be required to show current government photo identification, (i.e. a current passport or driver’s licence), for comparison to the ID card. If participants do not provide government photo identification, participants will not be admitted. Participants must have the ID card visible at all times and must return the card to the Test Administrator at the end of the Assessment. Participants who fail to return their ID card may receive an “E” for all requirements in the Assessment.

2

IV ASSESSMENT REQUIREMENTS Participants will be required to perform the following procedures

Class II amalgam preparation. Anterior composite resin preparation. Full metal crown preparation. Ceramometal (porcelain fused to metal) crown preparation. Endodontic access preparation on a molar tooth. Fabricate a provisional crown restoration for a pre-prepared ceramometal (porcelain fused to metal) crown preparation on Day 2 of the Assessment. The original unprepared tooth in a typodont will be available on Day 1 of the Assessment. Restore a pre-prepared tooth with a direct Class II composite resin restoration. Restore a pre-prepared tooth with a direct Class IV composite resin restoration. Restore a pre-prepared tooth with a Class II amalgam restoration.

Apply a rubber dam.

Participants will also be evaluated on the following:

Infection control and material hygiene Record keeping.

V EQUIPMENT, INSTRUMENTS AND SUPPLIES

The dental clinic at the Assessment Centre will provide the following items: A typodont mounted in a manikin on a dental chair An overhead dental operating light An operator stool Amalgamators Saliva ejectors

3 Participants must supply ALL OTHER equipment, instruments and supplies needed to complete the required procedures, including but not limited to:

Handpieces and burs Curing lights All restorative materials including amalgam, composite resin and provisional crown materials Gloves, masks, protective eyewear and appropriate clinic attire Dental hand instruments Rubber dam, frames, clamps, forceps and dental floss Materials to place and finish restorative materials (matrix bands, matrix holders, wedges, polishing

supplies, etc)

Information regarding handpiece configuration (connectors) at each centre will be forwarded to participants prior to the Assessment. The dental clinic at the Assessment Centre will NOT be accessible prior to the Assessment.

VI ASSESSMENT INSTRUCTIONS

1. At the beginning of each day, the list of requirements will be distributed. Except for the application of the rubber dam, participants may perform the requirements in any order.

2. During the Assessment, participants must demonstrate competency in performing procedures in a clinical environment. Participants must work with the manikin in a manner that simulates patient treatment. Therefore, the manikin must be in an anatomically acceptable position. Any participant who refuses to work with the manikin in an anatomically acceptable position will be dismissed from the Assessment and receive an “E” for all requirements.

3. Participants are not permitted to remove teeth from typodonts, nor are they permitted to remove typodonts from the manikins.

4. Participants are not permitted to have extra typodont teeth in the Assessment area.

5. Participants must wear eye protection, masks and gloves.

6. Participants are encouraged to use magnification aids and to take breaks whenever needed.

7. Participants must manage excess amalgam appropriately and ensure that their work areas are left clean. Any participant who does not manage excess amalgam properly will be dismissed from the Assessment and receive an "E" for all requirements.

8. Participants who start or complete a procedure other than an identified requirement on an identified tooth will receive an “E” for that requirement.

9. Participants should identify all instruments and supplies in an indelible manner and place them in a locked container prior to leaving the room, even temporarily. The NDEB and the Assessment Centre will not be held responsible for instruments or personal supplies left in the room.

4 10. Participants are financially responsible for any damage caused to any supplied equipment.

11. All typodont teeth have simulated enamel, dentin and pulp. For the procedures requiring the

removal of carious lesions, there will also be simulated caries.

a) Simulated ENAMEL The simulated enamel is white in colour and is harder than the simulated dentin and simulated caries. It has been manufactured so that procedures may be performed using normal pressure with a dental bur and, if desired, finishing can be done using normal pressure with sharp hand instruments. Fractures may occur if excessive force and/ or dull instruments are used.

b) Simulated DENTIN The simulated dentin is yellow in color and is softer than the simulated enamel but is similar in hardness and in texture to the simulated caries.

c) Simulated CARIES The simulated caries in dentin is dark brown in color and is softer than the simulated enamel but is of similar hardness to the simulated dentin. In premolars and anterior teeth there is also a simulated cavitation (hole) in the simulated enamel. This simulated cavitation extends through the simulated enamel into the simulated dentin and should be included as part of the preparation. As a result of the manufacturing process, there may be a small space between the simulated enamel and the simulated dentin. This is not the simulated caries.

d) Simulated PULP The simulated pulp is red in colour and softer than the simulated dentin.

N.B.: The use of a metal hand instrument in the cavity preparation will leave a dark gray stain.

12. The FDI two digit tooth numbering system (below) is used for all Assessments.

FDI NUMBERING SYSTEM

PERMANENT DENTITION

1.8 1.7 1.6 1.5 1.4 1.3 1.2 1.1 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 4.8 4.7 4.6 4.5 4.4 4.3 4.2 4.1 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8

RIGHT LEFT

PRIMARY DENTITION

RIGHT LEFT

5.5 5.4 5.3 5.2 5.1 6.1 6.2 6.3 6.4 6.5 8.5 8.4 8.3 8.2 8.1 7.1 7.2 7.3 7.4 7.5

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VII REGULATIONS

1. Participants must be punctual for both days of the Assessment. Participants arriving late for an Assessment may not be admitted.

2. Family or friends must not accompany participants as space at the Assessment centre is provided ONLY for participants and staff.

3. Participants must not bring recording devices, radios, cameras, portable telephones, pagers or other electronic aids/devices into the Assessment room.

4. Participants may not use dictionaries, calculators or other informative material.

5. Food and/or drink (including water) are not allowed in the Assessment room unless special consideration for medical reasons has been granted by the office. The request must include a medical certificate signed by a physician indicating the diagnosis and accommodation measures required.

6. The ability of participants to read, interpret and comply with instructions and other written material

is part of the Assessment. Test Administrators and invigilators will not answer questions involving content.

7. Participants requiring special accommodation due to diagnosed medical conditions must request

special consideration in writing to the office within 2 weeks of receipt of confirmation of registration. The request must include a medical certificate signed by a physician indicating the diagnosis and accommodation measures required.

8. Participants must stop working and leave the Assessment room at the indicated ending time.

Participants who refuse to leave the Assessment room at the indicated ending time will be given an “E” for all requirements that day.

9. Participants must leave all assessment material at their station.

10. Participants who do not abide by the above Regulations will be given an “E” for all requirements that day.

11. A participant who considers themself disadvantaged either immediately before or during the Assessment by a personal circumstance beyond the participant’s control may, within one week of the event beyond the participant’s control occurring, request that a special consideration to void the results of the Assessment by permitting the participant to withdraw from the Assessment. The participant may also request special consideration for a refund of up to 50% of the Assessment fee.

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VIII RESULTS

Participants will receive a score for each requirement as determined by using the evaluation criteria for the requirement and the “Grade Derivation Grid”. The final result for each participant will be determined using the “Final Result” Grade Derivation Grid. The results of the Assessment of Clinical Skills will be posted on a secure website that will be accessible using the secure code provided at the time of initial registration. Posting of results will normally be done within 6 weeks and an e-mail notification of the posting will be sent to candidates. Results will also be sent to all Canadian universities offering a Qualifying Program or Degree Completion Program. Results will not be released by telephone, fax or e-mail. Results cannot be obtained from an educational institution or Provincial Licensing Authority.

IX REQUESTS FOR REVIEW

Within three months of the release of results, a person who has failed the Assessment of Clinical Skills may make submissions in writing to the Board setting out the grounds for requesting to have the results changed. Any such application for review must be accompanied by the filing fee as set by the Board from time to time. This submission must clearly identify the component(s) to be reviewed and must set out the grounds for requesting to have the score(s) changed. The Appeals Committee will review the participant’s submission, all related correspondence, score sheets and the participant’s submitted typodont teeth. Results of the assessment review will not be released by telephone, fax or e-mail.

X REPEATS A participant has the privilege of taking the Assessment of Clinical Skills three times.

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EVALUATION CRITERIA

8CLASS II AMALGAM PREPARATION The criteria below describe an ideal preparation for a tooth with minimal caries. Evaluation of preparations will consider the extent of caries present.

External outline form

Internal form Finish

A+ - Proximal and/or gingival margins clear adjacent teeth 0.5mm or less

- Gingival margin supragingival - Optimal buccal-lingual width based on location and extent of caries present

A+ - Optimum resistance and retention form based on location and extent of caries present with no unnecessary removal of internal tooth structure - Gingival and occlusal floors parallel to occlusal plane - All internal line angles rounded

A+ - Smooth cavosurface margins - All unsupported enamel removed - No debris or caries (infected dentin)

A - Proximal and/or gingival margins clear adjacent teeth 0.5 -1.0mm - Gingival margin supragingival - Minor overpreparation based on the location and extent of caries present

A - Acceptable resistance and retention form based on location and extent of caries present or minor excess removal of internal tooth structure but not compromising the tooth or restoration - Gingival and occlusal floors parallel to occlusal plane - All internal line angles rounded

A - Generally smooth cavosurface margins with small areas of roughness that will not compromise the tooth or restoration - All unsupported enamel removed - No debris or caries (infected dentin)

D - Proximal and/or gingival margins do not clear adjacent teeth: - Clearance of adjacent teeth by 1.0 to 1.5mm - Proximal walls flared creating acute cavosurface angle - Gingival margin at the gingiva - Significant over/under preparation - Unacceptable junction of occlusal isthmus with proximal box or isthmus area less than 1mm wide - Unacceptable buccal-lingual width based on location and extent of caries present - Minor damage to an adjacent tooth/teeth that can be corrected by enameloplasty - Gingival tissues unnecessarily traumatized

D - Inadequate resistance or retention form based on location and extent of caries present - Unnecessary removal of internal tooth structure - Gingival and occlusal floors not parallel to occlusal plane - Inappropriate pulpal depth of preparation

Too deep > 2mm < 3mm Too shallow < 1.5mm >1.0mm

- Inappropriate axial depth Too deep > 1.5mm Too shallow < 0.5mm

- Sharp internal line angles

D - Unacceptably rough cavosurface margins - Unsupported enamel that needs minor correction - Presence of debris

E - Clearance of adjacent teeth >1.5mm

- Gingival floor sub-gingival - Unacceptable overpreparation requiring alternative design - Damage to adjacent tooth/teeth requiring a restoration - Soft tissue mutilation

E - Grossly excessive removal of internal tooth structure requiring alternate design or root canal treatment - Unacceptable resistance or retention requiring alternate design - Inappropriate pulpal floor depth

>3.0mm <1.0mm

E - Grossly rough undermined or unsupported enamel - Caries (infected dentin) remaining

9 DIRECT CLASS III COMPOSITE RESIN PREPARATION The criteria below describe an ideal preparation for a tooth with minimal caries. Evaluation of preparations will consider the extent of caries present.

External outline form

Internal form Finish

A+ - Optimal extension based on location and extent of caries present - Gingival margin supragingival

A+ - Optimal resistance and retention form based on extent of caries present with no unnecessary removal of tooth structure - All internal line angles rounded

A+ - Smooth cavosurface margins - No debris or caries (infected dentin)

A - Minor overpreparation based on the location and extent of caries present - Gingival margin supragingival

A - Acceptable resistance and retention form based on extent of caries present or minor excess removal of internal tooth structure but not compromising the tooth or restoration - All internal line angles rounded

A - Generally smooth cavosurface margins with small areas of roughness that will not compromise the tooth or restoration - No debris or caries (infected dentin)

D - Unnecessary extension < 0.5mm on buccal or lingual surface - Unacceptable underpreparation based on location and extent of caries present - Gingival margin at gingival level - Minor damage to adjacent tooth that can be corrected by enameloplasty - Gingival tissues unnecessarily traumatized

D - Inadequate resistance or retention form based on location and extent of caries present - Inappropriate depth: Too deep >2mm <3mm - Unnecessary removal of internal tooth structure

D - Unacceptably rough cavosurface margins - Presence of debris

E - Unnecessary extension >0.5 mm on buccal or lingual surface - Cavitation not included in preparation - Gingival margin sub-gingival - Damage to adjacent tooth/teeth requiring restoration - Soft tissue mutilation

E - Grossly excessive removal of internal tooth structure requiring alternate design or root canal treatment - Unacceptable resistance or retention requiring alternate design - Inappropriate depth

>3.0mm

E - Caries (infected dentin) remaining

10FULL METAL CROWN PREPARATION

Path of withdrawal/

insertion

Resistance and retention R/R

Preservation of tooth vitality and structural durability of preparation and restoration

Finish and Margin

A+ - Optimal path of insertion - No undercuts

A+ - Optimal R/R - Occlusal reduction 1.5mm

- Axial convergence 6o to

10o

A+ - Optimal preparation has been performed to permit fabricaton of a functional restoration - Preparation is smooth and has no sharp areas - Adjacent teeth intact

A+ - Margin optimally placed, defined and identifiable - Margin smooth, continuous and has no steps - Margin 0.5mm - Positioned 0.5mm supragingival

A

-Adequate path of insertion - Minor undercuts that can be dealt with in lab

A - Adequate R/R - Axial reduction > 0.5mm <1mm - Occlusal reduction >1.5mm<2mm

- Axial convergence 10o to

15o

A

- Acceptable preparation has been performed to permit fabricaton of a functional restoration - Preparation is smooth and has no sharp areas - Adjacent teeth intact

A - Margin adequately placed, defined and identifiable - Margin smooth, continuous and has no steps - Margin 0.5-1mm - Positioned 0.5-1mm supraging.

D - Preparation does not allow fabrication or insertion without modification to preparation or adjacent tooth/teeth

D - Further preparation necessary to assure R/R - Occlusal reduction >2.0mm < 2.5mm - Axial convergence of

15o to 25

o

D

- Further preparation needed to attain above - Excessive reduction,

occlusal >2.0mm < 2.5mm axial >1.0 < 1.5mm

- Adjacent tooth/teeth damaged but correctable by enameloplasty

D - Incorrect margin placement, form, definition or dimension (correctable) - Positioned supraging. >1mm subging. <1mm - Unsupported enamel (lipping) - Presence of debris - Gingival tissue unnecessarily traumatized

E

- Major adjustment needed to preparation or adjacent tooth/teeth to allow restoration to be seated

E

- R/R seriously compromised - Occlusal reduction>2.5mm

- Axial convergence >25o

- Alternate tooth preparation needed to achieve R/R

E

- Underprepared so that restoration cannot be fabricated without significant further preparation -Excessive preparation so that alternate preparation design required or root canal needed,

occlusal > 2.5mm axial > 1.5mm

- Severe damage to adjacent tooth/teeth requiring restoration

E - Incorrect margin placement, form or dimension correctable only through auxiliary procedures - Margin subging. >1mm - Grossly unsupported enamel (lipping) - Soft tissue mutilation

11

CERAMOMETAL (PORCELAIN FUSED TO METAL) CROWN PREPARATION

Path of withdrawal/

insertion

Resistance and retention R/R

Preservation of tooth vitality and structural durability of preparation and restoration

Finish and margins

A+ - Optimal path of insertion - No undercuts

A+ - Optimal R/R - Reduction: - buccal 1.2mm - lingual 0.5mm - occlusal 2mm - Axial convergence: 6° to 10°

A+ - Optimal preparation has been performed to permit the fabrication of an esthetic and functional restoration - Preparation smooth and has no sharp areas - Adjacent teeth intact

A+ - Margin optimally placed, formed and identifiable - Margin smooth, continuous and has no steps - Buccal >1.2 < 1.5mm - Lingual 0.5mm - Positioned 0.5mm supragingival

A

- Adequate path of insertion - Presence of minor undercuts that can be dealt with in lab

A - Adequate R/R - Reduction: - buccal >1.2<1.5mm - lingual > 0.5< 1mm

- occlusal or incisal reduction >2mm < 2.5mm - Axial convergence: 10° to 15°

A

- Acceptable preparation has been performed to permit the fabrication of an esthetic and functional restoration - Preparation generally smooth and has no sharp areas -Adjacent teeth intact

A - Margin adequately placed, formed and identifiable - Margin smooth, continuous and has no step - Buccal >1.2 <1.5mm - Lingual >0.5 <1mm - Positioned >0.5 <1mm supragingival

D - Preparation will not allow restoration to be fabricated or inserted without minor modification to the preparation or adjacent tooth/teeth

D - Additional retention or resistance is needed - Overpreparation

buccal >1.5 <2.5mm lingual >1.0mm<1.5mm occlusal or incisal >2.5 <3.0mm

- Underprepared buccal < 1.2mm lingual <0.5mm occlusal or incisal < 2mm

- Axial convergence >15o <25o

D - Further preparation needed - Unnecessary over-preparation - Adjacent tooth/teeth damaged but correctable by enameloplasty

D - Incorrect margin placement, form, definition or dimension (correctable) - Buccal >1.5mm < 2.5mm - Lingual >1mm < 1.5mm - Margin < 1mm subgingival - Unsupported enamel (lipping) - Presence of debris - Gingival tissue unnecessarily traumatized

- Presence of debris

E - Major adjustment needed to preparation or adjacent tooth/teeth to allow restoration to be inserted

E - Grossly excessive reduction buccal > 2.5mm lingual > 1.5mm occlusal or incisal >3mm - Axial convergence >25o - Alternate tooth preparation needed to achieve R/R

E - Underprepared so that restoration cannot be placed without significant further preparation - Excessive preparation so that alternate preparation design required or root canal is needed - Adjacent tooth/teeth grossly damaged needing restoration

E - Incorrect margin placement, form, definition and dimension only correctable through auxilliary procedures - Buccal >2.5mm - Lingual >1.5mm - Grossly unsupported enamel (lipping) - Margin >1mm sub-gingival - Soft tissue mutilation

12

ENDODONTIC ACCESS PREPARATION

External outline form Internal form Finish

A+ - Optimal extension to obtain straight line access to all canals - Optimal removal of any unsupported structures - No over extension - Adequate extension to permit removal of pulp horns

A+ - Canals optimally uncovered and accessed to at least 2mm - Optimally tapered access preparation walls - Optimal orientation and alignment

A+ - Optimal smoothness of walls and cavosurface - No pulp material left in chamber - No debris

A - Adequate extension to obtain straight line access to all canals - Adequate removal of unsupported structures - Slight overextension - Adequate extension to permit removal of pulp horns

A - Canals adequately uncovered and accessed to at least 2mm - Adequately tapered access preparation walls - Correct orientation and alignment

A - Adequate smoothness of walls and cavosurface - Minor pulp material in chamber - Minor debris in chamber or canals

D - Enamel and/or dentin obstructs straight line access to canals - Some over extension, but not compromising long term viability of the tooth - Pulp horns remaining

D - Canals partially covered or not accessed to 2mm - Inadequately tapered walls including no taper - Incorrect orientation and alignment but not compromising long term viability - Gouging of walls - Marginal ridges undermined but not compromising long term viability

D - Inadequate smoothness of walls or cavosurface - Significant pulp material in chamber - Unacceptable debris in chamber or canals

E - Pulp chamber not accessed (roof remaining) - All canals not accessed - Excessive over-extension compromising long term viability of the tooth

E - Perforation of chamber floor or wall - Reverse taper to walls - Incorrect orientation and alignment compromising long term viability - Significant gouging compromising long term viability - Separated instrument remaining in canal

E - Walls or cavosurface excessively rough requiring significant removal of tooth structure to correct - Excessive pulp material in chamber - Debris obscuring chamber or canals

13 PROVISIONAL CROWN RESTORATION

Marginal contour and Adaptation

Morphology Occlusion

Polish

A+ - Margin not over/under extended - Margin not over/under contoured

A+ - Optimal contour for gingival health, esthetics and durability - Optimal interproximal contacts

A+ - Optimal occlusal contact

A+ - Optimal polish

A - Margin over/under extended < 0.5mm - Margin over/under contoured < 0.5mm

A - Acceptable contour for gingival health, esthetics and durability - Adequate interproximal contacts

A - Acceptable occlusal contact

A - Acceptable polish

D

- Margin over/under extended > 0.5mm < 1.0mm - Margin over/under contoured >0.5mm <1.0mm - Presence of material in sulcus or on adjacent teeth - Damage to tooth margin

D - Adjustment to contour required to achieve acceptability - No proximal contact but < 0.5mm open

D - Adjustment required to achieve stable occlusion <1mm

D - Unacceptable roughness or porosities

E

- Margin over/under extended >1.0mm - Margin over/under contoured >1.0mm - Needs major revision or fabrication of new provisional

E - Needs major revision or fabrication of new provisional - No proximal contact >0.5mm open - Provisional crown broken or cracked - Provisional cannot be removed from preparation

E - Adjustment required to achieve stable occlusion >1.0mm

E - Excessive roughness or porosities - Inappropriate material - Needs major revision or fabrication of new provisional

14

CLASS IV COMPOSITE RESIN RESTORATION

Surface quality and polish Margin integrity Contours and function A+ -Uniform smoothness

- Uniform polish matching tooth surface

A+ - Junction of tooth/ restoration not detectable with explorer

A+ - Physiologic tooth contours restored - Optimal proximal contact restored

A - Generally smooth with some areas of roughness - Polish acceptable but not uniform in all areas or not matching tooth surface in all areas

A - Junction of tooth/ restoration slightly detectable with explorer

A - Physiologic tooth contours restored - Adequate proximal contact restored

D - Surface very rough or exhibits deep scratches or voids but can be improved without replacement

D - Excess at margin <0.5mm - Deficiencies or voids at margin <0.5mm

D - Minor under/ overcontouring <0.5mm - Light proximal contact - Excessive occlusal contact Composite resin or debris in surrounding tissue - Minor damage to hard and/or soft tissue

E - Restoration must be replaced for reasons of unacceptable surface quality or voids

E - Excess at margin >0.5mm - Deficiencies or voids at margin >0.5mm

E - Major under/over contouring >0.5mm - No proximal contact - Lack of physiologic contours -Restoration or part of restoration fractured or loose -Restoration must be redone - Major damage to hard and/or soft tissue

15 CLASS II COMPOSITE RESIN RESTORATION

Surface quality and polish

Margin integrity Contours and function

A+ - Uniform smoothness - Uniform polish matching tooth surface

A+ - Junction of tooth/ restoration not detectable with explorer

A+ -Physiologic tooth contours of occlusal and proximal surfaces optimally restored - Optimal proximal contact restored

A - Generally smooth with some areas of roughness - Polish acceptable but not uniform in all areas or not matching the tooth surface in all areas

A - Junction of tooth/ restoration slightly detectable with explorer

A - Physiologic tooth contours of occlusal and proximal surfaces adequately restored - Adequate proximal contact restored

D - Surface very rough or exhibits deep scratches or voids but can be improved without replacement

D - Excess at margin <0.5mm - Deficiencies or voids at margin <0.5mm

D - Minor under/ over contouring <0.5mm - Light proximal contact - Marginal ridge disharmony >0.5mm<1mm - Poorly defined morphology - Composite resin or debris in surrounding tissue - Presence of debris - Excessive occlusal contact - Minor damage to hard and/or soft tissue

E - Restoration must be replaced for reasons of unacceptable surface quality due to deep scratches or voids

E - Excess at margin >0.5mm - Deficiencies or void at margin >0.5mm

E - Major under/over contouring >0.5mm - No proximal contact - Marginal ridge disharmony >1.0mm - Lack of physiologic contour - Restoration or part of the restoration fractured or loose - Restoration must be redone - Major damage to hard and/or soft tissue

16 CLASS II AMALGAM RESTORATION

Surface quality

Margin integrity Contours and function

A+ - Uniform smoothness A+ - Junction of tooth/restoration not detectable with explorer

A+ -Physiologic tooth contours of occlusal and proximal surfaces optimally restored - Optimal proximal contact restored

A - Generally smooth with some areas of roughness

A - Junction of tooth/restoration slightly detectable with explorer

A - Physiologic tooth contours of occlusal and proximal surfaces adequately restored - Adequate proximal contact restored

D - Surface very rough or exhibits deep scratches or voids but can be improved without replacement

D - Excess at margin <0.5mm - Deficiencies or voids at margin <0.5mm

D - Minor under/ over contouring <0.5mm - Marginal ridge disharmony >0.5mm <1mm - Poorly defined morphology - Light proximal contact - Excessive occlusal contact - Amalgam or debris in surrounding tissue - Minor damage to hard and/or soft tissue

E - Restoration must be replaced for reasons of unacceptable surface quality due to deep scratches or voids

E - Excess at margin >0.5mm - Deficiencies or voids at margin >0.5mm

E - Major under/over contouring > 0.5mm - Marginal ridge disharmony >1mm - No proximal contact - Restoration or part of the restoration fractured or loose - Restoration must be redone - Major damage to hard and/or soft tissue

17

RUBBER DAM APPLICATION

A+

- Correct clamp - Stable clamp - Clamp secured (dental floss) - Provides adequate access - Orientation provides patient comfort and unrestricted airway - Inverted on all isolated teeth - All punch holes in appropriate positions - Dam and frame optimally positioned

A

- Correct clamp - Stable clamp - Clamp secured (dental floss) - Provides adequate access - Orientation acceptable but patient comfort slightly compromised - Inverted on teeth in operative area - Minor deviations in punch hole locations

D

One or two of the following deficiencies - Unnecessary trauma to gingiva or teeth - Unstable clamp - Unsecured clamp (no dental floss) - Inadequate access provided - Not inverted in operative area - Dam not through all interproximal contact points - Orientation requires modification for patient comfort - Punch holes improperly positioned - Patient airway compromised - Rubber dam torn

E

Three or more of the above deficiencies OR - Dam not placed in allotted time - Improper position of dam and frame not allowing treatment on indicated tooth

18 RECORD OF PROCEDURES

A+

- Appropriate and accurate record of all procedures.

A

- One error on Record of Procedures.

D

- Two or three errors on Record of Procedures.

E

- More than three errors on Record of Procedures. - No entries on Record of Procedures.

REQUIREMENTS – Record Keeping Record all procedures performed on the “Record of Procedures Chart”. Assume that the patient has no changes in medical history. Complete the record assuming that appropriate local anesthesia has been administered for each procedure and that any prepared teeth were also restored during the session. The Record of Procedures must be completed for each day’s clinical procedures and remain in the Assessment room at all times including between Day 1 and Day 2. The Record of Procedures must be submitted for scoring at the end of Day 2. Example:

RECORD OF PROCEDURES

DATE

PROCEDURES

SIGNATURE

10/10/10 Reviewed medical history - no change Right inferior alveolar nerve block 1.8cc 2% lidocaine, 1:100,000 epinepherine. Tooth 4.6, MOD amalgam preparation and restoration with Tytin amalgam

10/10/10

Reviewed medical history - no change Buccal infiltration anesthesia 1.8cc 2% lidocaine 1:100,000 epinephrine Tooth 1.3 DL composite resin preparation and restoration with Z250, Shade B2 (etch/bond)

19

Examples of omissions/inaccurate record keeping include:

No date. No record of updating medical history. No record of type/amount/location of local anesthesia. Incorrect or incomplete record of procedures. Record not written in ink. Record non legible. No signature.

INFECTION CONTROL

A+

- No violations of infection control.

A

- One infection control violation.

D

- Two infection control violations.

E

- Three or more infection control violations.

Examples of unacceptable infection control and material hygiene procedures include: Gloves not worn. Gloves worn outside of the operatory. Gloves have holes or tears. Unacceptable infection control procedures involving gloves. Mask not worn or not worn appropriately. Use of contaminated instruments or materials. Hands not washed. Contamination of operating area. Eye protection not used. Hair not appropriately controlled. Inappropriate attire. Unacceptable amalgam handling and disposal. Unacceptable handling and disposal of sharps. No water used with high speed handpiece.

20

XI GRADE DERIVATION GRID FOR INDIVIDUAL REQUIREMENTS

Each requirement is evaluated in one (1), three (3) or four (4) criteria categories. Each category receives the lowest assigned grade of A+, A, D, or E. 1. Requirements with one criterion category

The grade assigned for these requirements will be determined as described in the evaluation criteria.

2. Requirements with three or four criteria categories

The grade assigned for these requirements will be determined by the grades assigned in the criteria categories. A grade of A+ will be assigned for a requirement if 2 or more A+ and no D or E is assigned in any category. A grade of A will be assigned for a requirement if no more than 1 D and no E is assigned in any criteria category. A grade of D will be assigned for a requirement if 2 D’s and no E are assigned in any category. A grade of E will be assigned for a requirement if 1 E or 3 or more D’s are assigned in any criteria category.

XII FINAL RESULT GRADE DERIVATION GRID (12 requirements)

In order to be successful in the Assessment of Clinical Skills on the 12 requirements, a participant must obtain:

8 or more A / A+ and no E OR 9 or more A / A+ and no more than 1 E

assessment of clinical skills 2010 final.doc