DENTAL EXAMINATION CANDIDATE MANUAL

Class of 2020

A National Dental Examination

As administered by:

Central Regional Dental Testing Service, Inc. 1725 SW Gage Blvd.

Topeka, Kansas 66604 (785) 273-0380 www.crdts.org

Please read this candidate manual prior to attending the candidate orientation and bring it with you to the orientation and the examination.

Copyright © 2020 Central Regional Dental Testing Service, Inc.

Table of Contents

INTRODUCTION and GENERAL INFORMATION Purpose ..........................................................................................................................................1 CRDTS, CRDTS Member States, CRDTS Recognizing Jurisdictions ................................................1 CRDTS Mission Statement .............................................................................................................1 Ethical Statement ..........................................................................................................................2 “CRDTS Status” ..............................................................................................................................3 Examination Completion and Obtaining Licensure .......................................................................3 Test Development, Examination Overview ...................................................................................4 Examiners ......................................................................................................................................4 Curriculum Integrated Format versus Traditional Format ............................................................4 CONTENT OVERVIEW .........................................................................................................................6 Part II: Endodontics Examination ..................................................................................................6 Part III: Fixed Prosthodontics Examination ...................................................................................6 Part IV: Periodontal Examination ..................................................................................................6 Part V: Restorative Examination ...................................................................................................7 SCORING SYSTEM ...............................................................................................................................7 SCHEDULE/DATES: Curriculum Integrated Format ......................................................................................................12 Parts II & III: Manikin-based Endodontic and Fixed Prosthodontic Examinations ........................12 Parts IV & V: Patient-based Periodontic and Restorative Examinations ......................................13 Traditional Format ..........................................................................................................................14 STANDARDS FOR THE CONDUCT OF THE EXAMINATION ..................................................................17 GENERAL GUIDELINES FOR CLINICAL EXERCISES ...............................................................................20

THE EXAMINATION

PART II: ENDODONTICS EXAMINATION PART III: FIXED PROSTHODONTICS EXAMINATION..........................................................................22 General Requirements ..................................................................................................................22 Requirements Specific to the Part II: Endodontic Examination ....................................................24 Requirements Specific to the Part III: Fixed Prosthodontics Examination ....................................25 Criteria Specific to the Part II: Endodontic Examination Anterior Endodontic Procedure: Access Opening ..........................................................................................................27 Canal Instrumentation ...............................................................................................28 Root Canal Obturation ...............................................................................................29 Posterior Endodontic Procedure Access Opening ONLY ...............................................................................................30 Treatment Management .................................................................................................................. 31 Criteria Specific to the Part III: Fixed Prosthodontic Examination

Porcelain-Fused-To-Metal Crown Preparation: Cervical Margin and Draw ........................................................................................ 32 Walls, Taper and Finish Line .................................................................................... 33 Cast Gold Crown Preparation: Cervical Margin and Draw ........................................................................................34 Walls, Taper and Finish Line ....................................................................................35 Bridge Factor ....................................................................................................................36 Ceramic Crown Preparation: Cervical Margin and Draw ........................................................................................37 Walls, Taper and Finish Line ....................................................................................38 Prosthodontic Manikin Procedures – Treatment Management .....................................39 PART IV: PERIODONTAL EXAMINATION PART V: RESTORATIVE EXAMINATION ..........................................................................................40 General Requirements ................................................................................................................40 Requirements Specific to the Part IV: Periodontal Examination ................................................44 Criteria Specific to the Part IV: Periodontal Examination ...........................................................47 Requirements Specific to the Part V: Restorative Examination ..................................................51 Patient/Treatment Selection and Approval .....................................................................51 Radiographs .....................................................................................................................52 Modification Requests .....................................................................................................53 Isolation dam Requirements ............................................................................................56 Class II Procedures ...........................................................................................................57 Indirect Pulp Cap ......................................................................................................59 Class III Procedures ..........................................................................................................60 Criteria Specific to the Part V: Restorative Examination Amalgam Preparation: External Outline Form ..............................................................................................61 Internal Form ...........................................................................................................62 Critical Errors ............................................................................................................63

Amalgam Finished Restoration: Margin Integrity and Surface Finish .........................................................................64 Contour, Contact and Occlusion ..............................................................................65 Posterior Composite Preparation: External Outline Form ..............................................................................................66 Internal Form ...........................................................................................................67 Posterior Composite Finished Restoration: Margin Integrity and Surface Finish .........................................................................68 Contour, Contact and Occlusion ..............................................................................69 Posterior Composite Slot Preparation: External Outline Form ..............................................................................................70 Internal Form ...........................................................................................................71 Posterior Composite Slot Finished Restoration: Margin Integrity and Surface Finish .........................................................................72 Contour, Contact and Occlusion ..............................................................................73

Composite: Anterior Class III Preparation: External Outline Form .............................................................................................. 74 Internal Form ........................................................................................................... 75 Composite: Anterior Class III Finished Restoration: Margin Integrity and Surface Finish ......................................................................... 76 Contour, Contact and Occlusion .............................................................................. .77 Restorative Treatment Management .............................................................................. .78 EXAMINATION CHECK-OUT PROCEDURE......................................................................................... .79 APPLICATION REQUIREMENTS ......................................................................................................... .80

Application Deadlines .......................................................................................................... .80 Examination/Application Fees ............................................................................................. .80 Required Documentation.......................................................................................................81

ADMINISTRATIVE POLICIES ................................................................................................................82 Curriculum Integrated Format .....................................................................................................82

Site Selection ..........................................................................................................................82 Traditional Format ........................................................................................................................83 Site Selection ...........................................................................................................................83 Re-examination ............................................................................................................................83 Remediation .................................................................................................................................84 Release of Scores ..........................................................................................................................85 COMPLAINT REVIEW PROCESS ..........................................................................................................86 POLICY FOR TESTING OF DISABLED CANDIDATES ..............................................................................87 CONTACTS - TESTING SITES, STATE BOARDS OF DENTISTRY .............................................................88 CHECKLIST OF REQUIRED MATERIALS AND INSTRUMENTS ..............................................................89 GLOSSARY ....................................................................................................................................90 MEDICAL HISTORY ..............................................................................................................................99 TREATMENT CONSENT .......................................................................................................................101 AMALGAM PROGRESS FORM ............................................................................................................102 POSTERIOR COMPOSITE PROGRESS FORM .......................................................................................103 COMPOSITE PROGRESS FORM ...........................................................................................................104 ENDODONTIC PROGRESS FORM ........................................................................................................105 PROSTHODONTIC PROGRESS FORM ..................................................................................................106 PERIODONTAL PROGRESS FORM .......................................................................................................107 PERIODONTAL TREATMENT SELECTION SCREENING WORKSHEET ...................................................109 PERIODONTAL TREATMENT SELECTION SUBMISSION FORM ...........................................................111 MODIFICATION REQUEST FORM........................................................................................................112

INDEX .................................................................................................................................................113

CRDTS Curriculum Integrated Format Examination

Class of 2020 – AT A GLANCE

SCHEDULED EXAMINATION DATES

Manikin-Based (Total 1 day)

Part II: Endodontics Exam Part III: Fixed Prosthodontics Exam

First Opportunity (Max of 3 attempts)

First Retest Opportunity

Second Retest Opportunity

September/November (at Candidate’s School)

December-April

May/June (at select schools only)

Patient-Based (Total 1 day)

Part IV: Periodontal Exam Part V: Restorative Exam

First Opportunity (Max of 2 attempts)

First Retest Opportunity

February – April (at Candidate’s School)

May/June (at select schools only)

Visit our website: www.crdts.org for specific examination/deadline date(s)

Complete applications and fees must be received on or before deadline dates in order to be processed.

FEES Initial Examinations Package Parts II – IV: $2,350

Individual Retest Examination(s): As outlined within this Manual

RELEASE OF SCORE REPORTS

Manikin & Patient Examinations: Scores will be reported within 1-2 days after the candidate’s respective examination is completed. Manikin exams evaluated off-site will be reported 1-2 days after grading.

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CENTRAL REGIONAL DENTAL TESTING SERVICE

DENTAL CANDIDATE'S MANUAL

This manual has been designed to assist in your preparation to be a participant in a clinical examination. Outlined below are general directives and information for the conduct of the examination.

Purpose: The purpose of this examination is to assess the candidate’s professional knowledge, skills, abilities and judgment (KSAJ’s) as applied in clinical treatment procedures that are a representative sample of the services that are provided in the practice of general dentistry, based on the criticality of the procedure to the patient’s systemic and oral health and the frequency with which that service is provided in general practice.

CRDTS: The Central Regional Dental Testing Service, Inc. (hereinafter abbreviated as CRDTS) is an independent testing agency which administers clinical competency examinations in dentistry and dental hygiene in behalf of its member and participating states. Regional testing agencies contract with individual state boards of dentistry to administer the clinical examination required for licensure in those states. Regional testing agencies do not have the authority to license individuals or to implement policy that goes beyond the laws of its member states. Regional testing agencies should not be confused with state boards of dentistry. CRDTS Member States: The States of Alabama, Arkansas, California*, Georgia, Hawaii*, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, New Mexico, North Dakota, Oklahoma, South Carolina, South Dakota, Texas (Hygiene), Washington, West Virginia, Wisconsin and Wyoming have joined in the formation of CRDTS as member states. *Accepts CRDTS Hygiene Only

Jurisdictional Authority: State Boards of Dentistry are each established by state law as the regulatory agencies of the dental profession, accountable to the state legislature and charged with protection of the public. Although all state laws are somewhat different, there are commonalities in their responsibilities to regulate the profession through licensure requirements, to interpret and enforce the dental practice act, to discipline those licensees who practice unethically or illegally, and to assess the competence of applicants for licensure in their jurisdictions through theoretical and clinical examinations. In order to fulfill their mandate to evaluate competence, the CRDTS’ member State Boards have joined together to develop and administer fair, valid and reliable clinical examinations in dentistry and dental hygiene.

CRDTS Recognizing Jurisdictions: In addition to the member states listed above, several non-member states also recognize the results of the CRDTS examination. There are often restrictions, limitations or additional requirements so candidates are encouraged to contact the State Board where they wish to seek licensure in order to verify the correct licensure requirements at the time of their application, because licensing requirements and recognizing jurisdictions may have changed. Results from the CRDTS examination are automatically distributed to the secretaries of all the member State Boards which are listed above, as well as those non-member states which recognize CRDTS’ results and have requested routine receipt of examination results. As the testing agency responsible for administering the examination, CRDTS has provided to the Boards of the recognizing states information sufficient to establish that a score of 75 or more on each part of the examination may represent an acceptable demonstration of competence to practice dentistry. However, each State Board of Dentistry is responsible for determining whether a candidate has fulfilled its standards and requirements for licensure. The State Boards’ determinations are controlled by state law; the requirements may not be uniform. Each licensing jurisdiction may use the examination results to the extent authorized by its statutes.

Mission Statement: To provide the dental examination community with test construction and administrative standardization for national uniform dental and dental hygiene clinical licensure examinations. The schedule of these examinations, when delivered in the Curriculum Integrated Format, allows for early identification of deficiencies or weaknesses within clinical skill sets and provides

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opportunities for remediation in an educational environment. These examinations will demonstrate integrity and fairness in order to assist State Boards with their mission to protect the health, safety and welfare of the public by assuring that only competent and qualified individuals are allowed to practice dentistry and dental hygiene. Ethical Responsibilities: Licensure as a dental health professional, and the public trust, respect and status that accompanies it, is both a privilege and a responsibility. Implicit in a State Board’s charge to protect the public is the responsibility to ensure that practitioners are not only competent, but also ethical. In addition to the American Dental Association’s Code of Ethics, there are codes of professional conduct within state laws, and the requirements of many State Boards for periodic continuing education courses in ethics for maintenance and renewal of licenses. During the examination process, there are policies, rules and standards of conduct that are part of the candidate’s responsibility; the candidate is expected to read the entire Candidate’s Manual, and comply with all those rules and requirements.

The dental practitioner is entrusted with the oral health and welfare of a patient, and it is imperative that such trust be respected by candidates and that service to the patient’s needs and well-being are always put first. In every step of the examination process, CRDTS has established policy and examination protocol to ensure that the welfare of patients is safeguarded.

1. CRDTS will provide a consent form that documents the treatment the patient will receive, the fact that the candidate is not a licensed dentist, and a statement that the services provided during the exam may not complete their treatment plan or totally fulfill their oral health needs. The consent form must be executed before the patient can be accepted.

2. CRDTS will provide a medical history form that screens for systemic conditions or medical considerations that might put the patient at risk during the examination or require premedication in order for them to participate. The medical history must be completely filled out and appropriate precautions taken before the patient can be accepted.

3. Once a preparation has been cut to “ideal” dimensions, any modifications that are necessary must be properly documented, and reviewed by an examiner before being carried out.

4. If an exposure should occur, or treatment is suspended or terminated for any reason, CRDTS will complete a Follow-Up Form to document what additional treatment is necessary, who will provide it, and who will be financially responsible. The patient is provided a copy of this form; and the candidate must come to the exam with a “follow-up” plan about how the patient will be provided a continuum of care after the exam, if such care should be needed.

5. In the event of a treatable exposure when the candidate can place a pulp cap and continue the exam, the patient will be given a form that advises them of what has happened and what additional treatment may be required in the future.

6. When patients are checked-in, examiners will review the medical history, consent form and treatment selection to see if it is appropriate, meets the criteria and is justified radiographically and clinically. Throughout the examination, examiners will be monitoring patients to see that they suffer no unnecessary discomfort.

The Curriculum Integrated Format (CIF) addresses many of the ethical concerns that have been raised in recent years about the use of patients in clinical examinations. CIF is designed to ensure that candidates have time and opportunity to recruit patients of record who are part of a continuum of care with an appropriately sequenced treatment plan. It is the responsibility of candidates to solicit patient participation in an ethical manner. The candidate should fully inform a prospective patient about the purpose, the process and the importance of a board examination, including the time involved, and the number of individuals who will be examining them. Copies of health histories and treatment consent forms should be downloaded from the internet at www.crdts.org and used to screen a patient’s health

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condition and plan an appropriate response to any medical issues that may impact the patient’s well-being during and after the examination. The patient should be fully informed about their entire treatment plan, advised of alternative options or courses of treatment that might be advantageous to them, and how the procedure(s) to be completed during the examination are sequenced in a plan “with due consideration given to the needs, desires and values of the patient.” The patients should also be advised of any benefits that may reasonably be expected as a result of participation. In the process of soliciting and screening patients, candidates should remain in compliance with the ethical considerations promulgated by the ADA Council on Ethics, Bylaws and Judicial Affairs and refrain from the following:

1. Reimbursements between candidates and patients in excess of that which would be considered reasonable for remuneration for travel, lodging, meals or loss of hourly wages.

2. Remuneration between licensure applicants or dental practitioners for acquiring patients. 3. Utilizing patient brokering companies. 4. Delaying treatment beyond that which would be considered acceptable in a typical treatment plan

(e.g. delaying treatment of a carious lesion for 24 months). 5. Allowing themselves to be “extorted” by individuals who agree to participate in the examination

and then refuse to come at the appointed time unless they are paid a fee.

Board examinations are conducted for the sole purpose of protecting the public by assessing the competence of those who seek to practice dentistry. It is hoped that the professional and ethical management of patients by both CRDTS and the candidates throughout the examination process will leave the volunteer patients in better oral health with an increased respect for the dental profession’s diligence in maintaining high standards of competence.

CRDTS Status: “CRDTS Status” is achieved when a candidate has successfully completed all parts to this examination with a score of 75 or more. Candidates achieving “CRDTS Status” enjoy the privilege of being considered eligible for licensure in any of the CRDTS recognizing jurisdictions listed in this manual. Examination Completion and Obtaining Licensure: There are three agencies with which applicants are involved in the process of completing their CRDTS' examination and obtaining licensure.

1. Central Regional Dental Testing Service, Inc. (CRDTS) - a testing service as described above; the results of a CRDTS examination can be submitted to any recognizing state when applying for licensure. COMPLETION OF THE CRDTS' EXAMINATION ALONE WILL NOT QUALIFY ANY CANDIDATE FOR LICENSURE. OTHER REQUIREMENTS WITHIN EACH OF THE STATES MUST BE MET.

2. Testing Site - a school which makes its clinical facility available for a CRDTS examination. The site may have its own forms or specific procedures which may be required of the candidate in order to participate in an examination at that site. In addition, the candidate must have cash or check as required by the respective institution, payable to that testing center (not CRDTS) for materials and equipment used during the examination. Payment must be made before the examination; and proof of payment must be provided at the conclusion of the exam. No scores will be released without satisfactory payment.

3. State Board of Dentistry - the agency to which a candidate must individually apply for licensure in a jurisdiction. Candidates must inform themselves of the requirements of the state(s) in which they wish to be licensed and complete an application with the individual jurisdiction(s).

The candidate should address questions to the appropriate agency. The CRDTS Administrative Office in Topeka, KS will provide all information relevant to the examination requirements and procedures. The testing site can respond to questions regarding facilities, equipment and testing site fees. (The testing site is not responsible for recruiting board patients or making their facilities available on any days other than examination dates.) Questions regarding licensure or state requirements should be addressed to the appropriate State Board of Dentistry.

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Test Development: In all aspects of test development, administrative protocol and evaluation methodologies, CRDTS strives to be aligned with and guided by:

• Standards for Educational and Psychological Testing, published jointly by the American Educational Research Association, the American Psychological Association and the National Council on Measurement in Education

• AADB’s Guidance for Clinical Licensure Examinations in Dentistry

• Annual Statistical Analysis of each section of the exam along with summary statistics of candidate performance by school of graduation

• Statistical profiles for examiners’ self-assessment

• Technical Reports by measurement specialists

• Periodic Occupational Analyses

In particular, the dental examination is developed and revised by the CRDTS Dental Examination Review Committee (ERC). The Dental ERC is comprised of representatives from each of CRDTS’ Member States, as well as dental educators and special consultants. With both practitioners and educators involved, the Committee has considerable content expertise from which to draw. The Committee also relies on practice surveys, current curricula, and standards of competency to assure that the content and protocol of the examination is current and relevant to practice. Determining the examination content is also guided by such considerations as patient availability, logistical constraints and the potential to ensure that a skill can be evaluated reliably.

Examination Overview: The examination consists of individual, skill-specific parts. Each examination part is listed below:

Part I: National Dental Board Examination – Parts I & II* Manikin-Based Examination Part II: Endodontics Part III: Prosthodontics Patient-Based Examination Part IV: Periodontics Part V: Restorative *CRDTS will not require additional documentation for these scores.

Examiners: Candidates will be evaluated by examiners from the jurisdictions which comprise CRDTS. These examiners may be members of their State Board of Dentistry, or may have been selected by their Board to serve as examiners. There may also be examiners from other states. In addition, there are frequently observers at CRDTS’ exams who may be faculty members from other schools, new CRDTS’ examiners or examiners from other states. Such observers are authorized to participate in calibration and monitor all portions of the examination and may evaluate patients from time to time; however, they do not assign grades or participate in the grading process. Curriculum Integrated Format (CIF): This format is the pre-graduation licensure examination offered to senior dental students and graduate students of record. The Curriculum Integrated Format affords candidates the opportunity to successfully demonstrate critical clinical competence in basic clinical procedures required by CRDTS’ recognizing jurisdictions for licensure. The progressive sequencing of this format provides the opportunity, when necessary, for students to have easy access to remediation within the dental school curriculum as well as for timely issuance of licenses upon graduation. Curriculum Integrated Format versus Traditional Format: Both of these examination formats are identical in content, criteria and scoring. The major difference between the two formats is in the time-sequencing of how the examination is administered. The Traditional Format examination is administered in its entirety over the course of three days to all eligible candidates near the end of the academic year. The Curriculum Integrated Format examination is administered in segments over the course of several months to eligible dental students during their senior year or graduate program in dental school. If you are a dental student of record (Seniors, Juniors – limited basis, graduate student) and have verified that your dental school is participating in the Curriculum Integrated Format, then you are considered an

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Integrated Candidate. Dental students of record from other schools or from schools choosing not to participate in the Curriculum Integrated Format as well as practitioners seeking licensure are considered Traditional Candidates. There are separate application policies and deadlines for each format so please review those portions carefully to be sure you’ve received the correct information and documents. Examination Dates: Specific examination and deadline dates for participating dental schools can be found on the CRDTS website (www.crdts.org) and are also available through the Site Coordinator at each school.

Administrative/Application Policies and Rules are located online at www.crdts.org and at the end of this Manual.

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CONTENT, CRITERIA & SCORING SYSTEM - OVERVIEW CONTENT: PARTS I, II, III, IV & V PART I: NATIONAL DENTAL BOARD EXAMINATION – PARTS I & II * *CRDTS does not require any additional documentation for Part I

PART II: ENDODONTICS EXAMINATION – 100 POINTS

CONTENT FORMAT

1. Endodontic access opening only on tooth #14, a multi-rooted artificial tooth.

2. Endodontic access, canal instrumentation and obturation on tooth #8, a single-canal artificial tooth.

- Performed on a Manikin - Time: 3.0 hours

PART III: FIXED PROSTHODONTICS EXAMINATION – 100 POINTS

CONTENT FORMAT

1. Preparation of tooth #5, a single-layered artificial tooth, for a porcelain fused to metal crown as one abutment for a 3-unit bridge. (The bridge is not fabricated for this examination.) 2. Preparation of tooth #3, a single-layered artificial tooth, for a cast gold metal crown as the other abutment for the same 3-unit bridge. Both preparations must be parallel to each other. 3. Preparation of tooth #9, a single-layered artificial tooth for a full ceramic crown.

- Performed on a Manikin - Time: 4.0 hours

PART IV: PERIODONTAL EXAMINATION - 100 POINTS

CONTENT FORMAT 1. Treatment Selection – Patient selection & Calculus detection 2. Oral Assessment 3. Probing Depth Measurements/Gingival Recession 4. Subgingival Calculus Removal 5. Supragingival Deposit Removal 6. Tissue and Treatment Management

- Performed on a Patient

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PART V: RESTORATIVE EXAMINATION - 100 POINTS

CONTENT FORMAT

1. Class II Amalgam –Preparation 2. Class II Amalgam – Restoration

OR 1. Class II Composite –Preparation 2. Class II Composite – Restoration

OR 1. Class II Slot Composite- Preparation 2. Class II Slot Composite - Restoration

AND 3. Class III Composite –Preparation 4. Class III Composite - Restoration

- Performed on a Patient

*Information from this point forward will be included for Parts II – V only.

SCORING SYSTEM

The examination scoring system was developed in consultation with three different measurement specialists; the scoring system is criterion-based and was developed using an analytical model. The examination is conjunctive in that its content is divided into separate Parts containing related skill sets and competence must be demonstrated in each one of the Parts. A compensatory scoring system is used within each Part to compute the final score for each Part, as explained below.

Only State Boards of Dentistry are legally authorized to determine standards of competence for licensure in their respective jurisdictions. However, in developing the examination, CRDTS has recommended a score of 75 to be a demonstration of sufficient competence; and participating State Boards of Dentistry have agreed to accept that standard. In order to achieve “CRDTS status” and be eligible for licensure in a participating state, candidates must achieve a score of 75 or more in each Part of the examination.

Each examination score is based on 100 points. If all sections of an examination are not taken, a score of “0” will be recorded for that specific examination.

PARTS II – V: SCORING SYSTEM FOR MANIKIN AND PATIENT-BASED RESTORATIVE PROCEDURES

CRDTS and other testing agencies have worked together on a national level to draft and refine the performance criteria for each procedure in this examination. For the majority of those criteria, gradations of competence are described across a 4-level rating scale. Those criteria appear in this manual and are the basis of the scoring system. Those four rating levels may be generally described as follows:

SATISFACTORY The treatment is of good to excellent quality, demonstrating competence in clinical judgment, knowledge and skill. The treatment adheres to accepted mechanical and physiological principles permitting the restoration of the tooth to normal health, form and function. MINIMALLY ACCEPTABLE The treatment is of acceptable quality, demonstrating competence in clinical judgment, knowledge and skill to be acceptable; however, slight deviations from the mechanical and physiological principles of the satisfactory level exist which do not damage the patient nor significantly shorten the expected life of the restoration. MARGINALLY SUBSTANDARD The treatment is of poor quality, demonstrating a significant degree of incompetence in clinical judgment, knowledge or skill of the mechanical and physiological principles of restorative dentistry, which if left unmodified, will cause damage to the patient or substantially shorten the life of the restoration.

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CRITICALLY DEFICIENT The treatment is of unacceptable quality, demonstrating critical areas of incompetence in clinical judgment, knowledge or skill of the mechanical and physiological principles of restorative dentistry. The treatment plan must be altered and additional care provided, possibly temporization in order to sustain the function of the tooth and the patient’s oral health and well-being.

In Parts II, III and V, a rating is assigned for each criterion in every procedure by three different examiners evaluating independently. Based on the level at which a criterion is rated by at least two of the three examiners, points may be awarded to the candidate. In any instance that none of the three examiners’ ratings are in agreement, the median score is assigned. However, if any criterion is assigned a rating of critically deficient by two or more of the examiners, no points are awarded for that procedure or for the Examination Part, even though other criteria within that procedure may have been rated as satisfactory. A description of Parts II, III and V and the number of criteria that are evaluated for the procedures in each of those Parts appears below: Part II: ENDODONTICS EXAMINATION – 100 Points The Endodontics Examination is a manikin-based examination which consists of two procedures: an access opening on an artificial posterior tooth and an access opening, canal instrumentation and obturation on an artificial anterior tooth. The criteria for these procedures are combined and scored in total: Anterior Endodontics/Posterior Access Opening 17 Criteria

Part III: FIXED PROSTHODONTICS – 100 Points The Prosthodontics Examination is a manikin-based examination which consists of three procedures completed on artificial teeth: a cast gold crown preparation as a terminal abutment for a 3-unit bridge, a porcelain-fused-to-metal crown preparation as an abutment for a bridge, plus an evaluation of the line of draw for the bridge abutment preparations, and an all ceramic crown preparation on an anterior central incisor. Cast Gold Crown 10 Criteria Porcelain-Fused-to-Metal Crown Preparation 10 Criteria Ceramic Crown Preparation 11 Criteria Part V: RESTORATIVE EXAMINATION – 100 Points The patient-based Restorative Clinical Examination consists of four procedures as specified below; for the posterior procedure, candidates may choose to place a Class II Amalgam or a Class II Composite: Class II Amalgam Preparation 12 Criteria Class II Amalgam Finished Restoration 8 Criteria* OR Class II Composite Preparation 11 Criteria Class II Composite Finished Restoration 8 Criteria* OR Class II Composite Slot Preparation 9 Criteria Class II Composite Slot Preparation 8 Criteria*

Class III Composite Preparation 7 Criteria Class III Composite Finished Restoration 9 Criteria*

* 1 category split into 2 for clarity; scored as 1 criteria To compute the score for each individual procedure, the number of points the candidate has earned for each criterion is totaled, divided by the maximum number of possible points for that procedure and the results are multiplied by 100. This computation converts scores for each procedure to a basis of 100

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points. Any penalties that may have been assessed during the treatment process are deducted after the total score for the Examination Part has been converted to a basis of 100 points. If no critical deficiency has been confirmed by the examiners, the total score for each of Parts II, III and V is computed by adding the number of points that the candidate has earned across all procedures in that Part, and that sum is divided by the number of possible points for all procedures in that Part. If a critical deficiency has been confirmed by the examiners, an automatic failure is recorded for both the procedure and the Examination Part. An example for computing scores that include no critical deficiency is shown below for Part III:

PROCEDURE # CRITERIA POINTS EARNED

POINTS POSSIBLE

COMPUTED SCORE

Cast Gold Crown Preparation 10 Criteria 30 40 75.00 Porcelain-Fused-to-Metal Crown 10 Criteria 34 40 85.00 Ceramic Crown Preparation 11 Criteria 38 44 86.36

TOTALS for PART III 31 Criteria 102 124 82.25 Although there are three Parts that are scored separately for restorative clinical skills, within each Part a compensatory system is used to compute the final score for that Part, as long as there is no critical deficiency. For Parts III and V, the computed score for each procedure is not averaged, but instead is numerically weighted by the ratio of its number of scorable criteria to the total number of scorable criteria in the Part. For example, the Cast Gold Crown Preparation has a total of 10 scorable criteria which represents 40 possible points out of the total of 124 possible points for Part III. As shown in the example above, the candidate earned 102 out of 124 possible points for the three procedures in Part III for a final score of 82.25 points. If any penalties were assessed, the points would be deducted as percentage points from the final score for Part III.

PART IV: PERIODONTAL EXAMINATION – 100 Points

1. Calculus Detection-8 Points • 4 items • 2 points awarded for each surface of correctly identified calculus

2. Periodontal Measurements/Gingival Recession– 12 Points

• 12 probing depths evaluated on two teeth • 0.75 points for each correctly measured probing depth • 4 gingival recession measurements taken on facial and lingual aspects of two teeth • 0.75 points for each correctly measured area of gingival recession

3. Scaling/Subgingival Calculus Removal – 66 Points • 12 subgingival surfaces • 5.5 points awarded for each of the 12 required surfaces that are acceptably debrided

of subgingival calculus 4. Supragingival Deposit Removal – 12 Points

1. Evaluation of all teeth chosen for evaluation; max of 6 errors 2. 2 points awarded for each of the teeth that are free of all supragingival accretions

PENALTY DEDUCTIONS Throughout the examination, not only clinical performance will be evaluated, but also the candidate’s professional demeanor will be evaluated by Clinic Floor Examiners. A number of considerations will weigh in determining the candidate's final grades and penalties may be assessed for violation of examination standards, as defined within this manual, or for certain procedural errors as described below:

Any of the following may result in a deduction of points from the score of the entire examination Part or dismissal from the exam in any of the clinical procedures:

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1. Violation of universal precautions or infection control; gross asepsis; operating area is grossly unclean, unsanitary or offensive in appearance; failure to dispose of potentially infectious material and clean the operatory after individual examinations

2. Poor Professional Demeanor--unkempt, unclean, or unprofessional appearance; inconside-rate or uncooperative with other candidates, examiners or testing site personnel

3. Poor Patient Management--disregard for patient welfare or comfort; inadequate anesthesia

4. Improper management of significant history or pathosis 5. Inappropriate request for extension or modification 6. Unsatisfactory completion of required modifications 7. Improper Operator/Patient/Manikin position 8. Improper record keeping 9. Improper treatment selection

Periodontal Treatment Selection Penalty Points a. Penalty points are assessed for Treatment Selections that do not meet the described

criteria b. 7 penalty points for 1st rejection c. 7 penalty points for 2nd rejection d. 2 points for Intra/Extraoral assessment e. No additional penalty points deducted for subsequent rejections but an acceptable

Treatment Selection must be submitted within the allotted time limits Restorative Treatment Selection Penalty Points a. Penalty points are assessed for Treatment Selections that do not meet the described

criteria b. 5 penalty points for 1st rejection on either procedure c. No additional penalty points deducted for subsequent rejections but an acceptable

Treatment Selection must be submitted within the allotted time limits 10. Improper liner placement 11. Inadequate isolation - The isolation dam is inappropriately applied, torn and/or leaking,

resulting in debris, saliva and/or hemorrhagic leakage in the preparation, rendering the preparation unsuitable for evaluation or the subsequent manipulation of the restorative material.

12. Administration of anesthesia before approval of Medical History by Clinic Floor examiners 13. Corroborated errors for Tissue Management on all Periodontal procedures – Penalty points

are assessed for any unwarranted areas of tissue trauma caused by the candidate to extra/intra oral tissues resulting in injury to the patient which are inconsistent with the procedures performed.

a. 5 points for each area b. Critical Error: A tissue trauma critical error, resulting in failure of the

examination, will be assessed if any of the following exist: i. Damage to 3 or more areas of gingival tissue, lips or oral mucosa located

anywhere within or near the Treatment Selection ii. An amputated papillae

iii. An exposure of the alveolar process iv. A laceration or damage that requires suturing or perio packing v. An unreported broken instrument tip found in the sulcus

vi. One or more ultrasonic burns requiring follow-up treatment 14. Corroborated errors for Treatment Management criteria on all Restorative procedures

The following infractions will result in a loss of all points for the entire examination Part: 1. Temporization or failure to complete a finished restoration 2. Violation of Examination Standards, Rules or Guidelines 3. Treatment of teeth or surfaces other than those approved or assigned by examiners 4. Gross damage to an adjacent tooth 5. Failure to recognize an exposure 6. Unavoidable mechanical exposure which is poorly managed or irreparable 7. Unjustified or irreparable mechanical exposure 8. Critical Lack of Diagnostic/Clinical Judgment Skills – This penalty would be applied when the

prognosis of the treatment and/or the patient’s well-being is seriously jeopardized. Examples include but are not limited to:

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a. Inability to differentiate between caries and a pulpal exposure b. Inability to carry out instructions for modifications that any competent

practitioner should be able to complete c. Failure to recognize the need for a critical alteration of the preparation beyond

the assigned surfaces, such as a fracture or defect that must be eliminated by the extension of the preparation

The penalties or deficiencies listed above do not imply limitations, since obviously some procedures will be classified as unsatisfactory for other reasons, or for a combination of several deficiencies. Corroborated errors for the treatment management criteria for each Restorative procedure – Manikin and Patient-based will be deducted as penalty points. If any restorative procedure is unacceptable for completion during the examination, any preparations must be temporized, the patient must be adequately informed of any deficiencies, and a "Follow-up Form" must be completed.

Professional Conduct – All substantiated evidence of falsification or intentional misrepresentation of application requirements, collusion, dishonesty, or use of unwarranted assistance during the course of the examination shall automatically result in failure of the entire examination by any candidate. In addition, there will be no refund of examination fees and that candidate cannot apply for re-examination for one full year from the time of the infraction. Any of the following will result in failure of the entire examination:

a. Falsification or intentional misrepresentation of application requirements b. Cheating (Candidate will be dismissed immediately) c. Any candidate demonstrating complete disregard for the oral structures, welfare of the

patient and/or complete lack of skill and dexterity to perform the required clinical procedures

d. Misappropriation of equipment (theft) e. Receiving unwarranted assistance f. Alteration of examination records and/or radiographs

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SCHEDULE & DATES —CURRICULUM INTEGRATED FORMAT EXAM

Parts II & III: Manikin-based Endodontics & Fixed Prosthodontics Exams – 1 Day Initial Offering: September/November: (Initial offering of the Endodontics and Fixed Prosthodontics Examinations are at the candidate’s school of attendance on a specified date(s) agreed to by CRDTS and the Dean of the testing dental school)

Retest opportunities allowed: Two 1st Retest Date: December/January 2nd Retest Date: May/June (See complete examination/deadline dates on the cover of this manual and at www.crdts.org)

Candidates will be informed as to the date on which they are to complete the Endodontics Examination and the Fixed Prosthodontics Examination. In the event that these examinations are administered on a number of different days at a specific examination site, candidates may be assigned to groups to indicate which day they are to perform these examinations. Should this be the case, candidates will be informed of their group assignment in advance of the examination date. The examination schedule follows: Candidate Question & Answer Session Candidates are expected to review the appropriate Candidate Orientation online at www.crdts.org. There will be a question and answer session the day before the examination begins. Please review your confirmation materials for this schedule. Candidates must bring a government-issued photo ID and this Candidate’s Manual. Check-in will begin 15 minutes prior to the scheduled Q & A session.

Parts II - V: Curriculum Integrated Format Schedule

FIRST PHASE PARTS II & III

SECOND PHASE PARTS IV & V

TIME

MANIKIN

TIME RESTORATIVE

PERIO

8:00 Group A (B) Setup

8:00 Group B

Group A

8:30 8:30 – 12:30 Prosthodontics

1:00 1:00 – 4:00 Endodontics

4:00 EXAM STOPS 5:00 EXAM COMPLETED

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FIRST PHASE

CANDIDATES TIME ASSIGNMENT

Group A

8:00 A.M. to 8:30 A.M. 8:30 A.M. to 12:30 P.M. 12:30 P.M. to 12:45 P.M. 1:00 P.M. to 4:00 P.M. 4:00 P.M. to 4:15 P.M.

Part III: Fixed Prosthodontic Examination Set-Up and Starting Checks Fixed Prosthodontic Procedures (4.0 hours) Dismantle and turn in fixed prosthodontic modules Part II: Endodontic Examination

Endodontic Examination Procedures (3.0 hours) Dismantle and turn in endodontic modules

SECOND DAY (if necessary) To accommodate additional candidates, it may be necessary to add a second day to the schedule. Candidates assigned to this day will be assigned to Group B and will follow the same time schedule as Group A listed above. Candidates are informed of their group assignment in advance of the examination date.

FLEX-TIME SCHEDULE: Time blocks have been designated for each portion of the manikin procedures. Every candidate is allowed a maximum of 4 hours for the Prosthodontic Exam and 3 hours for the Endodontic Exam. Should candidates complete their prosthodontic procedures early, prior to 12:30 pm, they can take a short break and then begin their endodontic procedures by checking in with the Clinic Floor Examiner who will assign a three-hour start and finish time. This Flex-time schedule will only be available prior to 12:30 pm. Beginning endodontic procedures early does NOT increase the maximum time allowed as indicated above.

When utilizing the Flex-Time Schedule, candidates will adhere to the required procedures as outlined in this manual regarding completion of the Part III – Prosthodontic Exam and initiating Part II – Endodontic Exam.

Parts IV & V: Patient-based Periodontal & Restorative Exams – 1 Day Initial Offering: February – Early April (Initial offering of the Periodontal and Restorative Examinations at the candidate’s school of attendance on a specified date(s) agreed to by CRDTS and the Dean of the testing dental school.)

Retest opportunities allowed: One Retest Dates: May/June (at designated schools only)

Candidate Question & Answer Session Candidates are expected to review the appropriate Candidate Orientation online at www.crdts.org. There will be a question and answer session the day before the examination begins. Please review your confirmation materials for this schedule. Candidates must bring a government-issued photo ID and this Candidate’s Manual. Check-in will begin 15 minutes prior to the scheduled Q & A session.

FIRST DAY Candidates will have from 8-5 P.M. to complete the two Restorative and Periodontal Treatment procedures. Group A will begin their Periodontal procedures at 8:00 AM and Group B will begin their Restorative procedures at 8:00 AM as outlined below:

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CANDIDATE TIME ASSIGNMENT

Group A

Group B

8:00 A.M.

8:00 A.M.

Begin Periodontal Examination Restorative Examination Begin Restorative Examination Periodontal Examination

SECOND DAY (if necessary) To accommodate additional candidates, it may be necessary to add a second day to the schedule. Candidates assigned to this day will be assigned to Groups C & D and will follow the same time schedule as listed above for Groups A & B listed above. Candidates are informed of their group assignment in advance of the examination date. Patient-based Deadlines:

1. All Periodontal and Restorative treatment selections must be submitted no later than 3:30 PM 2. Periodontal treatment selection resubmissions must be presented by 4:00 PM 3. All patients must be in line to be signed in for final evaluation of restorative preparations by

4:00 PM on the same day they were started 4. All patients with finished restorations or periodontal procedures must be in line to be signed in

for evaluation by 5:00 PM on the same day they were started

SCHEDULE & DATES —TRADITIONAL FORMAT EXAM Parts II - V: Traditional Format Date(s): From Application Confirmation as scheduled by candidate Retest opportunities allowed: Two as scheduled by candidate Parts II - V: Traditional Format Schedule Candidate Question & Answer Session Candidates are expected to review the appropriate Candidate Orientation online at www.crdts.org. There will be a question and answer session the day before the examination begins. Please review your confirmation materials for this schedule. Candidates must bring a government-issued photo ID and this Candidate’s Manual. Check-in will begin 15 minutes prior to the scheduled Q & A session.

Candidates will be informed of their group assignment in advance of the examination date. The examination schedule follows:

FIRST DAY SECOND DAY TIME RESTORATIVE

PERIO

MANIKIN

TIME RESTORATIVE

PERIO

MANIKIN

8:00 Group D

Group C

Groups A, B Setup

8:00 Group B

Group A

Groups C, D Setup

8:30 – 12:30 Prosthodontics

8:30 – 12:30 Prosthodontics

1:00 – 4:00 Endodontics

1:00 – 4:00 Endodontics

4:00 5:00

Groups A, B— EXAM STOPS Groups C, D— EXAM STOPS

4:00 5:00

Groups C, D—EXAM COMPLETED Groups A, B—EXAM COMPLETED

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Parts II & III: Manikin-based Endodontics & Fixed Prosthodontics Exams

CANDIDATES TIME ASSIGNMENT Day 1: Groups A & B Day 2: Groups C & D

8:00 A.M. to 8:30 A.M. 8:30 A.M. to 12:30 P.M. 12:30 P.M. to 12:45 P.M. 1:00 P.M. to 4:00 P.M. 4:00 P.M. to 4:15 P.M.

Part III: Fixed Prosthodontic Examination Set-Up and Starting Checks Fixed Prosthodontic Procedures (4.0 hours) Dismantle and turn in fixed prosthodontic modules Part II: Endodontic Examination

Endodontic Examination Procedures (3.0 hours) Dismantle and turn in endodontic modules

FLEX-TIME SCHEDULE: Time blocks have been designated for each portion of the manikin procedures. Every candidate is allowed a maximum of 4 hours for the Prosthodontic Exam and 3 hours for the Endodontic Exam. Should candidates complete their prosthodontic procedures early, prior to 12:30 pm, they can take a short break and then begin their endodontic procedures by checking in with the Clinic Floor Examiner who will assign a three-hour start and finish time. This Flex-time schedule will only be available prior to 12:30 pm. Beginning endodontic procedures early does NOT increase the maximum time allowed as indicated above.

When utilizing the Flex-Time Schedule, candidates will adhere to the required procedures as outlined in this manual regarding completion of the Part III – Prosthodontic Exam and initiating Part II – Endodontic Exam.

Parts IV & V: Patient-based Periodontal & Restorative Exams Candidates will have from 8AM - 5 P.M. to complete the two Restorative and Periodontal Treatment procedures. Designated groups will begin their Periodontal and Restorative procedures as outlined below: CANDIDATE TIME ASSIGNMENT

Day 1: Group C Day 2: Group A Day 1: Group D Day 2: Group B

8:00 A.M.

8:00 A.M

Begin Periodontal Examination Restorative Examination Begin Restorative Examination Periodontal Examination

Patient-based Deadlines: 5. All Periodontal and Restorative treatment selections must be submitted no later than 3:30 PM 6. Periodontal treatment selection resubmissions must be presented by 4:00 PM 7. All patients must be in line to be signed in for final evaluation of restorative preparations by

4:00 PM on the same day they were started 8. All patients with finished restorations or periodontal procedures must be in line to be signed in

for evaluation by 5:00 PM on the same day they were started

Daily Time Schedule Each candidate must adhere to the published time schedule. 1. Q & A and Admission. All candidates will check in for Admission and a Q & A session the day

before the examination for specific instruction and distribution of examination materials by the Chief Examiner.

In order to receive an examination packet and be admitted to the orientation, the candidate must present a government-issued photo ID (ex: driver’s license or student ID). Candidates who are retaking one or more examination(s) on one specific day must attend the session or check-in with a

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CFE on the day of the exam and adhere to the appropriate time schedules outlined later in this manual. Candidates who do not have the required identification will not be admitted to the examination.

2. The Fixed Prosthodontics Examination begins at 8:00 A.M. on the assigned day. Between 8:00 to 8:30 A.M. the Clinic Floor Examiner (CFE) must verify that the manikin head is properly assembled, and any defective equipment or materials identified and corrected or replaced. At 8:30 A.M. treatment begins for all candidates. There is no extension of time due to starting treatment after 8:30 A.M. Candidates will have until 12:30 P.M. (4.0 hours) to complete the required prosthodontic procedures, at which time they must dismantle and turn in their prosthodontic modules and examination forms.

3. The Endodontics Examination begins at 1:00 PM on the assigned day. There is no extension of time due to starting treatment after 1:00 P.M. The Clinic Floor Examiner must verify that the tooth for the endodontic fill has been measured and the CFE has secured in the typodont, the manikin head is properly assembled. Candidates will have until 4:00 P.M. (3.0 hours) to complete the required endodontic procedures, at which time they must dismantle and turn in their endodontic modules and examination forms.

4. The Periodontal and Restorative Examinations: Candidates will have from 8AM – 5 P.M. to complete the two Restorative and Periodontal Treatment procedures. For Candidates taking only one procedure or exam part, the following time allotments apply: Periodontal procedures- 3 hours; One Restorative procedure-3 hours; Two Restorative procedures- 6 hours.

If multiple patients are used:

Restorative Procedures: the operatory may not be prepped for a new patient until the procedures for the previous patient have been completed, evaluated, the patient has been dismissed from the examiner station and instructions from examiners, if any, have been completed and checked by a CFE. Periodontal Procedures: the operatory may be prepped for a new patient for a restorative procedure as soon as the periodontal patient has been sent to the examiner station for the final evaluation.

Each procedure requires a separate evaluation in the Evaluation Station and deadlines are published in this manual at which the patient must be in line at the Exam desk for the various final evaluation procedures. Candidates will not be allowed to begin their second preparation if the lesion has not been accepted 30 minutes prior to the preparation submission deadlines outlined above.

Please refer to ADMINISTRATIVE POLICY SECTION for schedules/deadlines that apply to retake examinations.

Time Management In scheduling patients and planning the utilization of time, the candidate should consider the fact that the time allowed for the entire examination includes the time during which the patient(s) will be at the evaluation station for grading. In order to minimize wait times in the evaluation station, candidates in Groups B and D may begin and complete their Periodontal procedures after their first Restorative restoration is complete. This will reduce wait times in the evaluation station and prevent a backlog for evaluation at the end of the day. The minimum time patients will be in the evaluation station is 30 minutes per procedure—possibly longer, depending on the time of day. Times may vary according to the procedure being evaluated, the testing site and the number of candidates.

If patients with restorative preparations are not in line for final evaluation by the required time, the prepared teeth will need to be temporized. If patients with finished restorations are not in line by the required deadline, the restorations will not be graded. The restoration will either be requested to be

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removed and the tooth preparation temporized by the candidate as directed by the Chief Examiner or be allowed to remain as a temporary restoration. The Chief Examiner will advise the candidate as to the decision and will also inform the patient. A follow-up form must be completed.

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STANDARDS FOR THE CONDUCT OF THE EXAMINATION As a participant in an examination to assess professional competency, each candidate is expected to maintain professional standards. The candidate’s conduct and treatment standards will be observed during the examination and failure to maintain appropriate conduct and/or standards may result in point penalties and/or dismissal from the exam.

Each candidate will be expected to conduct himself/herself in an ethical, professional manner and maintain a professional appearance at all times. Candidates are prohibited from using any study or reference materials during the examination. Any substantiated evidence of dishonesty; such as collusion, use of unauthorized assistance or intentional misrepresentation during application, pre-examination or during the course of the examinations shall automatically result in dismissal from and failure of the entire examination and forfeiture of all examination fees for the current examination.

DISHONESTY CLAUSE: Candidates failed for dishonesty shall be denied re-examination for one full year from the time of the infraction. Additionally, all State Boards will be notified of the situation. In some states, candidates failed for dishonesty may be permanently ineligible for licensure. Therefore, candidates should address these matters with the state(s) where they desire licensure prior to retaking the examination. The standards itemized below apply to all relevant portions of the examination. Failure to adhere to these standards will result in failure of the procedure in progress and/or the entire examination. Standards for Parts II – V: Manikin and Patient-based Examinations 1. Anonymity. The anonymous testing procedures for the examination shall exclude the possibility that

any person who is involved with the grading of the examination may know, learn of, or establish the identity of a candidate, or relate or connect the patient or work-product graded or to be graded to a particular candidate. The candidate’s name and school information should not appear on any examination forms, materials, or instruments. Grading examiners will be physically isolated from the candidates in a separate area of the clinic and the movement of patients from the clinical area to the grading area shall be controlled by the use of testing agency messengers/assistants. All examination forms and materials are identified by the candidates’ identification number which is assigned prior to the examination.

2. Approved Communication. All approved communication must be in English. Candidates may communicate with their patient in another language but communication between candidates and Examination Officials must be in English.

3. Assigned Operatories. The candidate shall work only in the assigned clinic, operatory or laboratory spaces.

4. Assigned Procedures. The candidate must perform only the treatment and/or procedures assigned. Performing other treatment or procedures is strictly prohibited.

5. Auxiliary Personnel: Use of Assistants. Auxiliary personnel are not permitted to assist at chairside during the manikin examinations. Auxiliary personnel are permitted to assist at chairside during periodontal and restorative examinations. Assistants must be 18 years of age. Dentists, dental hygienists and dental therapists (any graduate, licensed or unlicensed), final year dental, dental hygiene or dental therapy students may not act as chairside assistants during the restorative and periodontal examinations.

a. Assistants will be required to insert either a valid photo ID or a copy thereof into a provided badge to be worn during the examination.

b. For each clinical procedure the candidate must list the name of his/her assistant on the Progress Form.

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c. Candidates are responsible for the conduct of their auxiliaries during the examination.

d. Auxiliaries are not permitted to advise, evaluate or perform the expanded duties normally provided by a dentist

6. Check-Out Procedures. The items specified below should be enclosed in the original Candidate packet envelope and provided to the examination representative at the completion of the examination: • Identification badge • Legal Consent/Medical History forms for all patients • Progress Forms with labels placed • Radiographs (attached or on a disk from school)

7. Clinic Attire. Clinic attire that meets CDC and OSHA standards must be worn in clinic areas. No bare arms or legs, or open-toed shoes are allowed in the clinic areas. Lab coats, lab jackets, and/or long-sleeved protective garments are all acceptable. Color and style are not restricted. There must be no personal or school identification on clinic attire other than the candidate identification badge.

8. Electronic Equipment. The use of cellular telephones, pagers, CD’s, radios (with or without earphones) and other electronic equipment by candidates, patients and assistants is prohibited within the clinic and scoring areas. All cellular telephones must be off and stored with personal belongings. In addition, the use of electronic recording devices by the candidate, an auxiliary, or a patient during any part of the examination; or the taking of photographs during the evaluation or treatment procedures is prohibited.

9. Equipment Failure. In case of equipment failure, the Chief Examiner must be notified immediately so the malfunction may be corrected.

10. Equipment: Use/Misappropriation/Damage. No equipment, instruments, or materials shall be removed from the examination site without written permission of the owner. Nonpayment of fees for rental of space or equipment will be treated as misappropriation of equipment. Willful or careless damage of typodonts, manikins or shrouds may result in failure and any repair or replacement costs must be paid by the candidate before examination results will be released.

11. Evaluation Procedures. Candidate performance will be evaluated by three independent examiners. Candidates are not assigned specific examiners.

12. Examination Completion and Start/Finish Times. All procedures of the examination shall be completed within the specified time frame in order for the examination to be considered complete. Any examination procedures performed outside the assigned time schedule will be cause for the examination to be considered incomplete and will result in failure. Treatment procedures may not be initiated prior to the established starting time(s) and must be completed by the established finish time(s). Violation of this Standard will result in failure of the examination.

13. Examination Guidelines. Violation of the published standards, guidelines and requirements for the examination will result in failure.

14. Examination Materials. CRDTS examination materials distributed by the testing agency may NOT be removed from the examining area, nor may the forms be reviewed by unauthorized personnel.

15. Extraneous materials. Only those materials distributed or authorized by CRDTS may be brought to the examining area. Authorized materials include only your Candidate’s Manual which may include hand written notes on the pages provided; additional pages, texts or documents are prohibited. Impressions, registrations, overlays, stents, or clear plastic shells of any kind as well as models or pre-preparations are not permitted to be brought to the examination site. Use of unauthorized materials will result in failure of the entire examination.

16. Failure to Follow Directions. Failure to follow directions and instructions from examiners will be considered unprofessional conduct. Unprofessional conduct and improper behavior is cause for dismissal from the examination and will result in failure of the examination. Additionally, the candidate shall be denied re-examination by CRDTS for one full year from the time of the infraction.

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17. Feedback Forms: Patient/Candidate. Candidates and their patients have an opportunity to provide input about the examination. In an effort to continually improve our examination, feedback from the perspective of both the candidates and patients is one of the best ways to gather this information. The Feedback Forms for candidates and patients will be included in the candidate’s packet. They are not required but will be collected separately from the candidate’s packet to ensure that the candidate’s examination results will in no way be affected by any feedback the candidate or the candidate’s patients might have. Candidates and patients are encouraged to complete the forms honestly and thoughtfully before checking out.

18. Identification Badges. During the examinations, candidate ID badges must be worn at all times.

19. Infection Control Standards. During all patient treatment procedures and during manikin clinical procedures, the candidate, as well as the assisting auxiliary, must follow the most current recommended infection control procedures as published by the CDC. The operatory and/or operating field must remain clean and sanitary in appearance. (www.cdc.gov/oralhealth/infectioncontrol/guidelines)

20. Instruments and Equipment. All necessary materials and instruments for the clinical procedures, other than the operating chair, light and dental unit must be provided by the candidate. All equipment must be compatible with the testing site attachments. Arrangements for rental handpieces and/or other equipment may be made through the testing site. Sonic/ultrasonic instruments are permissible, but they must be furnished by the candidate along with the appropriate connection mechanisms. Air-abrasive polishers are NOT permissible. It is the responsibility of the candidate to arrange for his/her own handpiece, sonic/ultrasonic and all other equipment necessary to complete the clinical examination. It is suggested that all candidates check well in advance with the Site Coordinator of the school selected for the equipment requirements at the testing site.

The following instruments and equipment are specifically required and must be provided by the candidate for this examination: - Unscratched, clear, front-surface, non-disposable, #4 or #5 mouth mirror - Metal periodontal probe – 1mm marks - #11/12 explorer for the Periodontal Examination - a sharp #23 explorer OR other similar Shepherd’s Hook-type explorer - Acadental ModuPRO™ (Integrated Modular Typodont and Modules) - Patient eye protection (personal eyewear is acceptable) - Patient napkin holder (chain, self-adhesives, clips, etc.) - Blood pressure measuring device

- Instrument tray for transporting instruments

Candidates are expected to provide the required instruments, in good condition. A penalty (10 points) may be applied for any instruments submitted in poor condition after 1 request by examiners to provide adequate instrument(s) i.e., clouded, scratched mirrors, excessively dull or bent explorers, etc. Clinic Floor Examiners will approve any instrument submissions thereafter, no further penalty will apply, only loss of time.

21. Interpreters. Candidates can employ the services of an interpreter when their patient does not speak English or is hearing impaired and their hearing loss cannot be corrected. (This is particularly important when the patient has a history of medical problems or is on medications.) Faculty members, dentists and dental hygienists (licensed or unlicensed), third or fourth year dental students, and final year dental hygiene students may not act as interpreters during the periodontal and restorative examinations. Candidates are responsible for the conduct and remuneration of their interpreter during the examination.

22. Local Anesthesia.Injectable local anesthetics may be administered to patients for the Periodontal and Restorative Examinations. Candidates must request and receive approval for the administration of local anesthetics prior to each separate administration. Inhalation, Kovonase (applied nasally) or intravenous analgesia/anesthetics are not permitted for the examinations.

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23. New Technology. New and innovative technologies are constantly being developed and marketed in dentistry. However, until such time as these innovations become the standard of care and are readily available to all candidates at all testing sites, the use of such innovative technologies will not be allowed in this examination unless expressly written as allowed elsewhere in this manual.

24. Radiographs. Appropriate radiographs must meet the requirements as published in the examination guidelines. Any alteration of radiographs will result in failure of the examination.

25. Submission of Examination Records. All required records must be turned in at the Examiner Desk before the examination is considered complete.

26. Test Site Fees. Schools may charge a rental fee for use of instruments, clinic facilities, supplies and disposables. This fee is independent of the examination fee and is not collected by the testing agency. Testing site fees vary from school to school. If not paid in advance, candidates should have cash or a check, as may be required by the respective testing site, for materials and equipment used during the examination. Specific information regarding site fees will be included in the candidate’s Confirmation email.

27. Tissue Management. There shall be no unwarranted damage to either hard or soft tissue during patient-based procedures or to simulated hard or soft tissues during manikin-based procedures. Incompetent or careless management of tissue will result in a score reduction.

28. Tooth Identification. The tooth numbering system 1-32 will be used throughout the examination. In this system, the maxillary right third molar is number 1 and mandibular left third molar is number 17.

29. Treatment Consent. In order for a patient to be acceptable for the clinical portions of the examination, the candidate must complete a “Treatment Consent Form” for each patient. The forms are included in the candidate’s application packet and may be completed prior to the examination date; however, they must be presented to the examiners at the time of patient check-in. Patients under the age of legal consent for the state in which the examination is being given must have the Consent Form signed by the parent or guardian. This form must be completed for each clinical patient.

30. Treatment Selection. Candidates must make treatment selection decisions independently (without the help of faculty and/or colleagues). The candidate must provide a treatment selection that fulfills examination requirements for each procedure. Treatment selections must be presented during the time allotted in the examination schedule, with sufficient time available to complete the treatment by the examination deadlines.

Standards that are specific to each examination (Parts II – V) are listed under each of the appropriate examination sections listed below.

GENERAL GUIDELINES FOR CLINICAL EXERCISES 1. Progress Forms: At the examination, color-coded Progress Forms will be issued which will contain a

record of the treatment, examiner signatures for all completed portions of the examination, and progress notes from the candidate to examiner as appropriate to the course of treatment. A black ball-point pen shall be used for all notations on the Progress Forms. Pre-operative radiographs must also be available for viewing for the Anterior and Posterior procedures.

2. Unauthorized Personnel: Only authorized personnel will be allowed in the examining and clinic areas. Only the patient, the candidate, the chairside assistant and the interpreter (if necessary) are allowed in the operatory during patient treatment sections. No visitors are allowed.

3. Performance Standards: The candidate’s clinical performance on all sections will be rated according to specific criteria. The performance criteria and the standards by which the examination is conducted are provided to the candidate within this manual.

4. Penalty Deductions: Throughout the examination, the candidate's professional conduct and clinical performance will be evaluated. A number of considerations will weigh in determining the candidate's

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final grades and penalties may be assessed for violation of examination standards and/or for certain procedural errors, as defined and described within this manual.

6. Reasons for Dismissal: In addition to the standards of conduct expectations, the following list is

provided as a quick reference guide for candidates. While the following is not an all-inclusive listing, it does provide examples of behaviors that may result in dismissal/failure of the examination:

• Using unauthorized equipment at any time during the examination process. • Altering patient records or radiographs. • Performing required examination procedures outside the allotted examination time. • Failure to follow the published time limits and/or complete the examination within the

allotted time. • Receiving assistance from another practitioner including but not limited to; another candidate,

dentist, University/School representative(s), etc. • Exhibiting dishonesty. • Failure to recognize or respond to systemic conditions that potentially jeopardize the health of

the patient and/or total disregard for patient welfare, comfort and safety. • Unprofessional, rude, abusive, uncooperative, or disruptive behavior to other candidates,

patients and/or exam personnel. • Misappropriation or thievery during the examination. • Noncompliance with anonymity requirements. • Noncompliance with established guidelines for asepsis and/or infection control. • For the purpose of the board licensure examination, candidates found charging patients for

services performed. • Use of unauthorized documents or materials in patient care or evaluation areas. • Use of cellular telephones, pagers or other electronic equipment in patient care areas. • Use of electronic recording devices by the candidate, an auxiliary, or a patient during any part

of the examination; or the taking of photographs during the evaluation or treatment procedures.

7. Patient’s Agreement to Partial Treatment Plan: It must be recognized that in many instances the treatment that is provided during a clinical examination represents only a portion of the care that is appropriate for the patient within a comprehensive treatment plan. The patient must be advised that only a portion of their individual treatment plan can be completed during the clinical Board examination and that further restorative and periodontal care will likely be required either before or after the examination is completed. Periodontal patients should be informed that subgingival treatment will occur on selected teeth, therefore, timely completion of their periodontal treatment is recommended. The patient will also be apprised of incomplete treatment in the Treatment Consent Form they are asked to sign prior to the examination.

8. Follow-Up Care: In the event that treatment provided during the examination cannot be satisfactorily completed, (such as an exposure requiring endodontic treatment), arrangements must be made for the patient to receive follow-up care. A Follow-Up Form will be provided so a record is maintained of the patient's needs. The candidate should give prior consideration to what arrangements might need to be made for his/her patients to receive follow-up care. Such arrangements would include who will provide the treatment and who will be financially responsible.

9. Authorized Photography: At some selected test sites, oral photographs may be taken randomly during the examination by an authorized photographer retained by CRDTS. The purpose is to capture a broad representation of actual procedures which can be used for examiner calibration exercises. The photographs will include no identification of either the patients or candidates. An announcement will be made or a notice will be distributed to inform patients and candidates when photographs are authorized at a site.

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PART II: ENDODONTICS EXAM – 100 Points PART III: FIXED PROSTHODONTICS EXAM – 100 Points The Endodontics Examination and Fixed Prosthodontics Examination are each stand alone examinations that will be administered on the same day. The Endodontics Examination consists of two procedures and the Fixed Prosthodontics Examination consists of three procedures, as follows:

PART II: ENDODONTICS EXAMINATION 1. Endodontic access opening only on tooth #14, a multi-rooted artificial tooth 2. Endodontic access, canal instrumentation and obturation on tooth #8, a single-canal artificial tooth PART III: FIXED PROSTHODONTICS EXAMINATION 1. Preparation of tooth #5, a single-layered artificial tooth, for a porcelain fused to metal crown as one

abutment for a 3 unit bridge. (The bridge is not fabricated for this examination) 2. Preparation of tooth #3, a single-layered artificial tooth, for a cast gold metal crown as the other

abutment for the same 3-unit bridge. Both preparations must be parallel to each other 3. Preparation of tooth #9, a single-layered artificial tooth for a full ceramic crown

GENERAL REQUIREMENTS 1. Typodont Requirements: The manikin examination may be completed only on an Acadental

ModuPRO™ (Integrated Modular Typodont), using magnetic endodontic modules and prosthodontic modules. It is the candidate’s responsibility to provide the required ModuPRO™ items (listed below) for the manikin section of the examination. This includes the articulating hinge if the typodont is going to be chair-mounted, Carrier Trays, modules for endodontic procedures and modules for the fixed prosthodontics procedures.

The ModuPRO™ typodont and other required ModuPRO™ supplies may be purchased by the candidate at any time prior to the examination through the school or through Acadental directly at www.acadental.com. In order to have the modules properly interlocked and stabilized, it is required that six modules—three mandibular and three maxillary—be mounted in the carrier trays at all times the candidate is operating. For the endodontic procedures, the four modules that do NOT contain the endodontic teeth (#8 and #14) may be either endodontic or prosthodontic modules. For the prosthodontic procedures, all six modules must be prosthodontic modules in order to ensure consistent contact.

2. Manikin Requirements and Mounting: A mounted manikin with full facial shroud should be provided by the testing site for insertion of the typodont. The manikin heads must accommodate the Acadental ModuPRO™ which can be adapted to a chair-mounted post or a high-tech simulation lab unit. If the typodonts are to be chair-mounted, they must have an articulating hinge attached. If a simulation lab is being used, the typodonts must be adapted with appropriate connectors. Please check with the site regarding equipment provided.

3. Putty Matrix: Candidates will fabricate polyvinyl siloxane (PVS) putty matrices during the exam, prior to the crown preparations. These matrices should extend gingivally to cover the gingival shroud on both buccal (posterior) / facial (anterior) and lingual surfaces. Matrices must include one complete tooth mesial and distal to the prepared teeth. Putty matrices can be fabricated using prefabricated plastic full or sectional trays or by hand provided the end result is 5 separate pieces sectioned bucco- (posterior) /facio- (anterior) lingually over the center of each prepared tooth and also sectioned over #7 if using one-piece original matrix. All five matrices pieces must have the candidate’s number recorded on

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them and must be returned with the submitted examination modules. Examiners use these five matrices pieces to determine occlusal/buccal/incisal/lingual/facial reductions during evaluation.

a. Fabrication of the matrices are done with typodonts mounted and are fabricated during the allotted four hours of preparation time.

b. When the five matrices pieces are completed, they must be checked and approved by the CFE prior to beginning the crown preparations.

NOTE: Please review fabrication options online at www.crdts.org > Dental tab > Candidate Orientations > Fabrication of Putty Matrices for CRDTS Prosthodontic Exam

4. Patient Simulation: The correct patient/operator position must be maintained while operating. Throughout the manikin procedures, the treatment process will be observed by Clinic Floor Examiners and evaluated as if the manikin were a live patient. With the exception of having the manikin wear protective eyewear, the manikin is subject to the same treatment standards as any patient. The facial shroud may not be displaced other than with those retraction methods which would be reasonable for a patient’s facial tissue. Some modifications in the treatment procedure are imposed due to the mechanical simulation conditions. For example, since the tooth length on #8 is directly measured prior to the procedure, no radiographs are utilized before or after treatment.

The Candidate should use only air but may use both air and water spray when preparing teeth #9, #14, #3 and #5. For tooth #8, when performing the complete endodontic procedure, the use of water irrigation is preferred when cleaning and filing the canal. If water spray is utilized, a mechanism to collect and remove the water must be in place during the use of the water spray. Models or pre-preparations are not permitted to be brought to the examination site.

5. Security Requirements: No written materials may be in the operating area other than this Candidate Manual and CRDTS forms.

6. Infection Control: The candidate must follow the most current recommended infection control procedures as published by the CDC during all manikin clinical procedures. The only exception to standard infection control precautions is that the candidate is not required to maintain protective eyewear on the manikin during manikin procedures. Infection control will be monitored by Clinic Floor Examiners. .(www.cdc.gov/oralhealth/infectioncontrol/guidelines)

7. Assigned Teeth: Once a procedure has been started, the procedure must be carried to completion on the assigned tooth/teeth with no substitutions permitted. Substitution of teeth or preparation of the wrong tooth/teeth during the Endodontic Examination or the Fixed Prosthodontic Examination will result in failure of the specific examination.

8. Assistants: Auxiliary personnel are not permitted to assist at chairside or in a laboratory during the manikin examination. Candidates may not assist each other, critique or discuss one another’s work.

9. Adjacent Damage: The candidate's score will be penalized for any unwarranted damage to adjacent teeth or to the simulated gingival area during manikin-based procedures.

a. The modules candidates provide must have undamaged teeth in place for the manikin procedures. Should CFE’s confirm adjacent damage is present, on A(13-15) module for the Prosthodontic Procedures or A(2-6) module for the Endodontic Procedures, the module in question will be confiscated and CRDTS will provide the candidate with another module.

10. Examination Sequence: The candidate must set up the manikin for the prosthodontic procedures and obtain the approval of a Clinic Floor Examiner between 8:00 and 8:30 A.M. The prosthodontic procedures must be completed between 8:30 and 12:30 P.M. No later than 12:30 P.M., the typodonts must be dismantled and the prosthodontic modules turned in to the examiner; candidates who utilize the maximum time allowed must then leave the clinic area for a brief period of time. At 1:00 P.M. candidates must mount their endodontic modules and the Clinic Floor Examiner must check the mounting of the endodontic typodont and authorize the candidate to proceed. The endodontic procedures must be completed between 1:00 and 4:00 P.M. During all manikin procedures, the typodont may not be disassembled without the permission of a Clinic Floor Examiner. Between 4:00 and 4:15, the candidate will dismantle the typodont and submit the endodontic modules to the examiners.

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Requirements Specific to the Endodontic Examination 1. Endodontic Typodont Modules: Endodontic treatment must be completed on two artificial

endodontic teeth, one multi-rooted endodontic first maxillary molar (#14) and one single-canal endodontic incisor (#8). Both #8 and #14 will be mounted in ModuPRO™ endodontic modules. The endodontic modules need to be inserted in Carrier Trays and must be attached to a typodont. The typodont may be mounted on a post and strapped to an operatory chair or mounted in a simulation laboratory. Post-mounted typodonts will require an articulating hinge. CRDTS will provide the following:

a. Module AE13-15 WP for the #14 posterior endodontic insert b. #14 endodontic insert AE401 14 WI which includes tooth #14 already mounted c. Module AE 7-12 for the anterior endodontic procedure d. The #8 artificial tooth which will be mounted in the AE7-12 module at the exam.

The candidate must provide the following modules with undamaged teeth: a. A2-6 or N2-6 b. A18-20 or N18-20 c. A21-27 or N21-27 d. A28-31 or N28-31

2. Required Materials: Accessories:

1. Articulating Hinge for chair mounted typodonts 2. Carrier Trays

Note: Carrier Trays and articulators are interchangeable between the endodontic modules and the prosthodontic modules.

3. Preparation of Teeth: Tooth #8 must be used to complete the access opening, canal instrumentation

and obturation. Tooth #8 is considered to have a normal size pulp chamber for a 21 year old. The size, shape and extent of the prepared access opening should reflect such anatomy and will be graded accordingly. The #14 artificial endodontic tooth must be used to complete access opening to the canals.

a. Use a bur to inscribe your 3-digit candidate number on the lingual surface of each modular section so it is visible when the modules are inserted in the carrier tray.

b. Your manikin modules will be delivered to your cubicle in a module storage box prior to your scheduled time block. A CFE must be notified prior to disassembly of the typodont. The modules will be returned to the module storage box until they are graded and all grade forms/Progress Forms will be collected by the Clinic Floor Examiners.

4. Endodontic Module: The endodontic modules (module AE7-12 to accommodate the #8 endodontic tooth and the module AE13-15 WP for #14) will be inserted in an Acadental ModuPRO™ and mounted in a manikin with a shroud to be provided by the testing site. The typodont may be mounted on a post and strapped to an operatory chair or mounted in a simulation laboratory. Post-mounted typodonts will require an articulating hinge. Once the typodont is mounted in the manikin, request a Start Check from a Clinic Floor Examiner.

5. Dismantling Manikin: During both the endodontic and the prosthodontic procedures, the candidate

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may not disassemble the manikin without permission of the Clinic Floor Examiner. Removal of the manikin, typodont or teeth during the examination without permission of the Clinic Floor Examiner will result in failure.

6. Isolation dam: Both the endodontic procedures must be performed under two separate isolation dams. In order to avoid evulsion, no clamps should be placed on the teeth to be treated; clamps should be placed on nearby artificial teeth. All work must be done with the isolation dam in place. The dams must be removed at the completion of the procedures.

7. Instruments: Other than the instruments and materials provided by the testing site, the candidates are responsible for providing the instruments, files and materials of their choice. Rotary instruments are permissible during the endodontic procedure.

8. Treatment: On the anterior tooth, any form of gutta-percha filling technique may be used, including any warm gutta-percha or carrier-based, thermoplasticized gutta-percha techniques. Instrumentation technique, either mechanical or manual is at the candidate’s discretion.

a. On the posterior tooth, access opening to all canals must be completed. b. If either of the teeth fractures during treatment, the procedure should be completed. If a

crown fractures during treatment, place the fractured pieces in a sealable plastic bag and turn them in with the treated tooth.

c. No occlusal reduction of clinical crowns may be done, other than the normal access prepara-tion. Any other alteration will result in a deduction of points.

9. Reference Point: The cemento-enamel junction (CEJ) on the facial surface should be used as the reference point to determine the fill depth.

10. No Temporaries: No temporary material may be placed over the obturation material. 11. Evaluation: As soon as the endodontic procedure is complete, a Clinic Floor Examiner must authorize

dismantling the typodont. If candidates have completed the endodontic portion of the examination before time is called, they may contact a Clinic Floor Examiner and request permission to dismantle the typodont, submit their procedures and leave the clinic area.

a. The endodontic modules must be removed from the carrier trays and must be inserted into the module storage box. The candidate’s Progress Form must accompany the module box when turned in to the examiners.

b. The treated endodontic modular sections will be maintained by CRDTS as part of the candidate’s examination record.

Requirements Specific to the Fixed Prosthodontics Examination

1. Fixed Prosthodontic Typodont Modules: The typodont must be articulated by being attached to either an articulator in a simulation laboratory, or fitted with an articulating hinge and post-mounted to an operatory chair. No endodontic modules are allowed in the Fixed Prosthodontic examination. CRDTS will provide the following prosthodontic modules:

a. Module A7-12 b. Module A2-6 These modules will be distributed to the candidate in a box before the Fixed Prosthodontic Examination begins. Inside the box, there will also be an extra label with the candidate’s number on it; this label will be attached to the typodont when it is submitted for evaluation. Use a bur to inscribe your candidate number in the lingual area of each modular section so that when the ModuPRO™ is disassembled, your modules can be readily identified.

The candidate must provide the following prosthodontic modules with undamaged teeth: a. A28-31 b. A13-15 c. A18-20 d. A21-27 2. Required Materials:

Accessories: a. Articulating Hinge for chaired mounted typodonts

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b. Carrier Trays Note: Carrier Trays and articulators are interchangeable between the endodontic modules and the prosthodontic modules.

3. Mounting Check-In: When the six prosthodontic modules are mounted in the typodont carrier trays and the typodont is mounted in the manikin, a Clinic Floor Examiner must check the mounting, and identification numbers and authorize the candidate to begin. The tooth preparations will require all six prosthodontic modules mounted on the Carrier Trays. Each module is number coded to indicate correct placement in the Carrier Trays.

4. Crown Preparations: The preparation for a full-cast (CGC) crown is completed on tooth #3; the preparation for a porcelain-fused-to-metal (PFM) crown is completed on tooth #5; and the preparation for a full-ceramic crown is completed on tooth #9. The crown preparations on teeth #3 and #5 must be prepared as abutments for a 3-unit bridge. The teeth must be prepared for full crowns with supragingival margins. The assigned teeth will be single layer teeth. The teeth should be prepared in the appropriate proportions, taper and depths as defined in the criteria. No isolation dam is required for the crown preparations.

5. Margins: Cut the margins to within 0.5 mm of the gingival shroud. For the ceramic crown preparation, due to the fact that margins are placed .5 mm above the simulated gingival, the criteria have been adjusted accordingly. The lingual margin for the porcelain-fused-to-metal crown should be prepared for a metal margin, 0.5 mm. The transition from the facial 1.0 mm width to the lingual 0.5mm with should be placed mid-proximal.

6. Occlusal Reduction: The tooth for the porcelain-fused-to-metal (PFM) crown should be prepared for a porcelain occlusal surface with an optimal occlusal reduction of 2 mm. For the full-cast gold crown preparation, the occlusal reduction is optimally 1.5 mm. Only the matrix will be used to evaluate occlusal reduction so it is recommended that candidates utilize a periodontal probe at the locations illustrated by these arrows to accurately determine the correct occlusal reduction, including two plane reduction.

7. Equilibration Prohibited: No equilibration will be permitted on the typodont prior to or subsequent

to either crown preparation. 8. Dismantling the Manikin: During the prosthodontic procedures, the candidate may not disassemble

the manikin without permission of the Clinic Floor Examiner. Removal of the manikin, typodont or teeth during the prosthodontic examination without permission of the Clinic Floor Examiner will result in failure.

9. Evaluation: When the crown preparations are complete, the candidate must request permission from the Clinic Floor Examiner to dismantle the manikin and remove the prosthodontic modules from the carrier trays. Put the two modules with the crown preparations and occlusal index in the labeled box provided by CRDTS and be sure the Prosthodontic Progress Form for the crown preparations are collected by the Clinic Floor Examiner. The Prosthodontic Progress Form and must be submitted with the modules.

10. Returning the Typodont: The prosthodontic modules (A7-12 and A2-6) containing the crown preparations will be maintained by CRDTS as part of the candidate’s examination record. The other four modules, along with the articulator and carrier trays, may be retained by the candidate or returned to the school, depending upon to whom they belong.

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ANTERIOR ENDONDONTIC PROCEDURE

Access Opening – Artificial Anterior #8

PLACEMENT

SAT The placement of the access opening reflects the position of the pulp chamber and straight-line access to the root canal system.

ACC The placement of the access opening is not directly over the pulp chamber but would allow for straight-line access to the root canal system.

SUB The placement of the access opening is not over the pulp chamber and would not allow straight-line access to the root canal system.

DEF The placement of the access opening is not over the pulp chamber and would not allow access to the root canal system.

SIZE

SAT The access opening incorporates the middle one-third of the lingual surface mesiodistally and inciso-gingivally and allows for complete debridement of the pulp chamber.

ACC The access opening is not less than ¼ or greater than ½ of the lingual surface, and does not weaken the marginal ridges or incisal edge.

SUB The access opening is [_] less than ¼ and allows for partial debridement of the pulp chamber or [_] greater than ½ the width of the lingual surface, or [_] the access opening weakens the marginal ridge(s). [_] The access encroaches on, but does not include, the incisal edge.

DEF The access opening includes the marginal ridge(s) and/or the incisal edge. The access opening is so small that debridement of the pulp chamber is impossible. The canal orifice is not accessed. The anterior crown is fractured due to excessive access preparation.

INTERNAL FORM

SAT From the lingual surface to the cervical portion, the internal form tapers to the canal opening with no ledges.

ACC From the lingual surface to the cervical portion, the internal form tapers to the canal opening with slight ledges.

SUB The internal form lacks taper to the canal orifice(s), gouges are present that do not affect access to the canal orifice.

DEF The internal form exhibits excessive ledging or gouges that do not allow access to the canal orifices and/or perforation.

PULP HORN REMOVAL

SAT All pulp horns are removed through the access opening.

ACC Pulp horns are not fully removed through the access opening.

SUB Pulp horns are not entered.

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ANTERIOR ENDODONTIC PROCEDURE

Canal Instrumentation – Artificial Anterior #8

CERVICAL PORTION

SAT The cervical portion of the canal is enlarged facial-lingually and mesio-distally to allow access to the apical portion of the canal.

ACC The cervical portion of the canal is too small and makes access to the apical portion of the canal difficult.

SUB In the cervical portion, the canal is over or under prepared.

DEF The cervical portion of the canal is grossly over prepared and/or perforated.

MID-ROOT PORTION

SAT The mid-root portion of the canal blends with the cervical portion and no ledges or shoulders are present.

ACC The mid-root portion of the canal does not blend smoothly with the cervical portion, but no ledges or shoulders exist.

SUB The mid-root portion of the canal does not blend with the cervical region of the canal and/or ledging or shoulders are present that will inhibit canal obturation. The mid-root portion of the canal is transported.

DEF The mid-root portion of the canal is perforated and/or has gross shoulders or ledges that will prevent canal obturation.

APICAL PORTION SAT The apical portion is instrumented to within 0.5 to 1.0 mm of the anatomical apex.

SUB The apical portion of the canal is prepared more than 1.0 mm but less than 2.0 mm short of the anatomical apex. The apical portion is transported, but the apical portion still blends with the anatomical apex.

DEF The apical portion of the canal is over prepared and instrumented beyond the anatomical apex, or is under prepared more than 2.0 mm from the anatomical apex. The apical portion of the canal is transported and does not blend with the anatomical apex and/or there is a perforation of the root.

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ANTERIOR ENDODONTIC PROCEDURE

Root Canal Obturation – Artificial Anterior #8

OVERFILL/UNDERFILL

SAT The root canal is obturated with gutta percha to the apex or up to 1.0 mm or less from the apical foramen.

ACC The root canal is obturated with gutta percha or extruded file up to 0.5 mm beyond the apical foramen.

SUB The root canal is obturated with gutta percha more than 1.0 mm up to 2.0 mm short of the apical foramen. The root canal is obturated with gutta percha or extruded file greater than 0.5 mm to 1.0 mm beyond the apical foramen.

DEF The root canal is obturated with gutta percha more than 2.0 mm short of the apical foramen. The root canal is obturated with gutta percha or a file extruded greater than 1.0 mm beyond the apical foramen.

EXTRUDED SEALER SAT There is 1.0 mm or less of sealer extruded beyond the apical foramen, measured in any direction.

SUB There is more than 1.0 mm of sealer extruded, beyond the apical foramen, measured in any direction.

VOIDS IN GUTTA PERCHA SAT There are no voids in the gutta percha from the CEJ to the apical foramen.

ACC The apical 1/3 of the gutta percha in the root canal is dense and without voids.

SUB There are voids present throughout the obturation of the root canal.

DEF There are large voids throughout the obturation of the root canal, there is no gutta percha present in the root canal, or a material other than gutta percha was used to obturate the canal.

FILLED CORONAL/APICAL TO CEJ SAT There is no gutta percha, restorative material, or sealer in the pulp chamber.

ACC The gutta percha in the root canal is 1.0 mm to 2.0 mm short of the CEJ..Gutta percha and/or sealer is evident in the pulp chamber extending up to 1 mm coronal to the CEJ.

SUB The gutta percha in the root canal is more than 2.0 mm but less than 3.0 mm short of the CEJ. Gutta percha and/or sealer is evident in the pulp chamber extending greater than 1.0 mm, but no more than 2.0 mm coronal to the CEJ.

DEF The gutta percha in the root canal is more than 3.0 mm short of the CEJ. Gutta percha and/or sealer is evident in the pulp chamber extending more than 2.0 mm coronal to the CEJ. There is restorative material in the pulp chamber.

SEPARATED FILE SAT There is no evidence of a separated file.

ACC A file is separated in the root canal, but does not prevent the obturation of the root canal.

DEF A file is separated in the root canal, and prevents the obturation of the root canal.

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POSTERIOR ENDONDONTIC PROCEDURE Access Opening ONLY – Artificial Posterior #14

PLACEMENT

SAT The placement of the access opening is the mesial triangular pit and central fossa of the tooth and would allow for straight-line access to the root canal system.

ACC The placement of the access opening is not directly over the pulp chamber, but would allow for straight-line access to the root canal system.

SUB The placement of the access opening is not over the pulp chamber and would not allow straight-line access to the root canal system.

DEF The placement of the access opening is not over the pulp chamber, and would not allow access to the root canal system.

SIZE

SAT The access opening is of optimal size and allows for complete debridement of the pulp chamber.

SUB The access opening is underextended allowing for partial debridement of the pulp chamber.

DEF The access opening is underextended so that debridement of the pulp chamber or access to one or more canal orifices is impossible.

INTEGRITY OF OCCLUSAL ANATOMY

SAT The access opening preserves 2mm or more of the mesial marginal ridge, oblique ridge, and all cusp tips.

SUB The access opening is overextended but preserves at least 1mm but less than 2mm of the mesial marginal ridge, oblique ridge, and/or any cusp tip.

DEF The access opening is overextended but preserves less than 1mm of the mesial marginal ridge, oblique ridge, and/or any cusp tip or extends over the occlusal table.

INTERNAL FORM SAT The internal form tapers to the canal opening with no ledges.

SUB The internal form lacks taper to the canal orfice(s), gouges are present that do not affect access to the canal orifice and/or there is incomplete removal of the pulp chamber roof.

DEF The internal form exhibits excessive ledging or gouges that do not allow access to the canal orifices and/or the pulp chamber is not entered and/or there is a perforation of the crown or the floor of the pulp chamber.

PULP HORN REMOVAL

SAT All pulp horns are removed through the access opening.

SUB Pulp horns are not fully removed through the access opening.

DEF Pulp horns are not entered.

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ENDODONTIC PROCEDURES Treatment Management

Critical Errors

Penalty Points ONLY

CONDITION OF ADJACENT TEETH SAT The adjacent teeth and/or restorations are free from damage.

ACC Damage to adjacent tooth/teeth can be removed with polishing without adversely altering the shape of the contour and/or contact.

SUB Damage to adjacent tooth/teeth requires recontouring which changes the shape and/or position of the contact.

DEF There is gross damage to adjacent tooth/teeth which requires a restoration.

CONDITION OF SOFT TISSUE

SAT The simulated gingiva and/or typodont is/are free from damage.

ACC There is slight damage to simulated gingiva and/or typodont consistent with the procedure.

SUB There is iatrogenic damage to the simulated gingiva and/or typodont inconsistent with the procedure.

DEF There is gross iatrogenic damage to the simulated gingiva and/or tyhpodont inconsistent with the procedure.

CRITICAL ERRORS

1. Wrong Tooth/Surface Treated

2. ANTERIOR ENDODONTIC PROCEDURE - Root is fractured

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PORCELAIN-FUSED-TO-METAL CROWN PREPARATION Tooth #5 - Cervical Margin and Draw

MARGIN/EXTENSION

SAT The margins should be 0.5 mm occlusal to the simulated free gingival margin.

ACC The cervical margin is at the level of or no more than 1.0 mm occlusal to the simulated free gingival margin.

SUB The cervical margin is overextended 0.5 mm apical to the CEJ or the crest of the simulated free gingival margin, whichever is most occlusal. The cervical margin is underextended, more than 1.0 mm but no more than 1.5 mm occlusal to the crest of the simulated free gingival margin.

DEF

The cervical margin is overextended more than 0.5 mm apical to the simulated free gingival margin causing visual damage to the typodont. The cervical margin is underextended more than 1.5 mm occlusal to the simulated free gingival margin, thereby compromising esthetics, resistance and retention form.

MARGIN/DEFINITION

SAT The cervical margin is smooth, continuous, well defined.

ACC The cervical margin is continuous but slightly rough and lacks some definition. The cervical bevel, when used, is greater than 1.0 mm but does not exceed 1.5 mm, and lacks some definition.

SUB The cervical margin has some continuity, is significantly rough and is poorly defined.

DEF The cervical margin has no continuity and/or definition or exhibits an indication of a lip or “J” design.

LINE OF DRAW

SAT The appropriate path of insertion varies less than 10° from parallel to the long axis of the tooth on all axial surfaces and a line of draw is established.

ACC The path of insertion / line of draw deviates 10° to less than 20° from the long axis of the tooth.

SUB The path of insertion / line of draw deviates 20° to less than 30o from the long axis of the tooth.

DEF The path of insertion / line of draw is grossly unacceptable, deviating 30° or more from the long axis of the tooth.

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PORCELAIN-FUSED-TO-METAL CROWN PREPARATION Tooth #5 - Walls, Taper and Finish Line

AXIAL WALLS – SMOOTHNESS/UNDERCUT

SAT Walls are smooth and well-defined, no undercuts.

ACC The walls are slightly rough and lack some definition.

SUB The axial walls are rough.

DEF There is an undercut.

TAPER

SAT There is full visual taper (6° - 16°).

ACC Taper is present, but nearly parallel (less than 6°) or slightly excessive (> 16°, but < 24°).

SUB There is no taper or excessive taper (greater than 24°).

DEF The taper is grossly over-reduced (greater than 30°).

FACIAL SHOULDER WIDTH

SAT The facial shoulder is optimally 1.0 mm wide.

ACC The facial shoulder varies slightly in width, but deviates no more than +/-0.5 mm from optimal.

DEF The facial shoulder is wider than 1.5 mm or less than 0.5 mm.

FACIAL AXIAL REDUCTION

SAT The facial reduction follows the facial planes of contour and is optimally 1.5 mm when measured at any point between the original height of contour and the facial-occlusal line angle.

ACC The facial reduction follows the facial planes of contour and is no < 1.0 mm and no > 2 mm.

SUB The facial reduction no longer follows the facial/ planes of contour and is no < 0.5 mm and no > 3.0 mm.

DEF The facial axial reduction is less than .5mm or greater than 3 mm.

OCCLUSAL/AXIAL REDUCTION SAT Reduction of the occlusal wall, which includes secondary planes, is optimally 2.0 mm.

ACC Reduction of the occlusal wall, which includes secondary planes, deviates no more than ± 0.5 mm from optimal.

SUB Reduction of the occlusal wall, which includes secondary planes, deviates no more than ± 1.0 mm from optimal.

DEF Reduction of the occlusal wall, which includes secondary planes, is grossly over-reduced, > 3.0 mm, encroaching on the pulp and impacting resistance and retention form; or grossly under-reduced, < 1.0 mm, resulting in insufficient occlusal clearance for adequate porcelain restorative material.

INTERNAL LINE ANGLES SAT Internal line angles and cusp tips are rounded.

ACC Internal line angles and cusp tip areas not completely rounded and show a slight tendency of being sharp.

SUB The internal line angles and cusp tip areas show only minimal evidence of rounding with a greater tendency of being sharp.

DEF The internal line angles or cusp tip areas are excessively sharp with no evidence of rounding.

OCCLUSAL ANATOMY SAT Internal line angles and cusp tips are rounded.

SUB The internal line angles and cusp tip areas show only minimal evidence of rounding with a greater tendency of being sharp.

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CAST GOLD CROWN PREPARATION Tooth #3 - Cervical Margin and Draw

MARGIN/EXTENSION

SAT The margins should be 0.5 mm occlusal to the simulated free gingival margin.

ACC The cervical margin is at the level of or no more than 1.0 mm occlusal to the simulated free gingival margin.

SUB The cervical margin is overextended 0.5 mm apical to the crest of the simulated free gingival margin. The cervical margin is under-extended, more than 1.0 mm but no more than 1.5 mm occlusal to the crest of the simulated free gingival margin.

DEF

The cervical margin is overextended more than 0.5 mm apical to the simulated free gingival margin causing visual damage to the typodont. The cervical margin is under-extended more than 1.5 mm occlusal to the simulated free gingival margin, thereby compromising esthetics, resistance and retention form.

MARGIN DEFINITION

SAT The cervical margin is smooth, continuous, well defined. ACC The cervical margin is continuous but slightly rough and lacks some definition. SUB The cervical margin has some continuity, is significantly rough and is poorly defined. DEF The cervical margin has no continuity and/or definition or exhibits an indication of a lip or “J” design.

LINE OF DRAW

SAT The appropriate path of insertion varies less than 10° from parallel to the long axis of the tooth on all axial surfaces and a line of draw is established.

ACC The path of insertion/line of draw deviates 10° to less than 20° from the long axis of the tooth. SUB The path of insertion/line of draw deviates 20° to less than 30° from the long axis of the tooth. DEF The path of insertion/line of draw deviates 30° or more from the long axis of the tooth.

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CAST GOLD CROWN PREPARATION Tooth #3 - Walls, Taper and Finish Line

AXIAL WALL-SMOOTHNESS/UNDERCUT SAT Walls are smooth and well-defined, no undercuts. ACC The walls are slightly rough and lack some definition. SUB The axial walls are rough. DEF There is an undercut.

TAPER SAT There is full visual taper (6°- 16°).

ACC Taper is present, but nearly parallel (less than 6°) or slightly excessive (greater than 16°, but less than 24°).

SUB There is no taper or excessive taper (greater than 24°). DEF The taper is grossly over-reduced (greater than 30°).

CERVICAL FINISH LINE SAT The margin (includes knife-edge, chamfer, and bevel) is optimally 0.5 mm or less. ACC The margin varies slightly in width, but is no greater than 1.0 mm.

SUB The margin varies significantly in width and deviates no more than 1.5 mm or exhibits inappropriate design.

DEF The margin is greater than 1.5 mm.

OCCLUSAL/AXIAL REDUCTION SAT Reduction of the occlusal wall, which includes secondary planes, is optimally 1.5 mm.

ACC Reduction of the occlusal wall, which includes secondary planes, deviates no more than ± 0.5 mm from optimal.

SUB Reduction of the occlusal wall, which includes secondary planes, deviates no more than ± 1.0 mm from optimal.

DEF Reduction of the occlusal wall, which includes secondary planes, is grossly over-reduced, greater than 2.5 mm; or grossly under-reduced, less than 0.5 mm, resulting in insufficient occlusal clearance for adequate restorative material and/or any axial surface on the preparation is in contact with the matrix.

INTERNAL LINE ANGLES SAT Internal line angles and cusp tips are rounded.

ACC Internal line angles and cusp tip areas are not completely rounded and show a slight tendency of being sharp.

SUB The internal line angles and cusp tip areas show only minimal evidence of rounding with a greater tendency of being sharp.

DEF The internal line angles or cusp tip areas are excessively sharp with no evidence of rounding.

OCCLUSAL ANATOMY SAT The general occlusal anatomy is maintained. SUB The occlusal anatomy is flat.

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BRIDGE FACTOR PATH OF INSERTION/LINE OF DRAW

SAT A line of draw or path of insertion that would allow for the full seating of a fixed prosthesis in a direct vertical plane without rotation either mesio-distally or bucco-lingually.

ACC A line of draw or path of insertion that, due to angulations of the surface of the preparations, would require altering the path of insertion both mesio-distally and/or bucco-lingually from a direct vertical axis to allow full seating.

DEF No line of draw or path of insertion exists through any plane of rotation without the removal of additional tooth structure of either/both of the preparations.

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CERAMIC CROWN PREPARATION Tooth #9 - Cervical Margin and Draw

MARGIN/EXTENSION

SAT The cervical margin is placed 0.5 mm incisal to the simulated free gingival margin.

ACC The cervical margin is at the level of or no more than 1.0 mm incisal to the simulated free gingival margin.

SUB The cervical margin is overextended 0.5 mm apical to the crest of the simulated free gingival margin. The cervical margin is under-extended, more than 1.0 mm but no more than 1.5 mm incisal to the crest of the simulated free gingival margin.

DEF

The cervical margin is overextended more than 0.5 mm apical to the simulated free gingival margin causing visual damage to the typodont. The cervical margin is under-extended more than 1.5 mm incisal to the simulated free gingival margin, thereby compromising esthetics, resistance and retention form.

MARGIN/DEFINITION

SAT The cervical margin is smooth, continuous, well-defined on all axial surfaces, and meets the external axial surface at approximately a right angle. The cervical margin exhibits no bevel.

ACC The cervical margin is continuous but slightly rough and lacks some definition.

SUB The cervical margin has some continuity, is significantly rough and is poorly defined.

DEF The cervical margin is beveled, or exhibits an indication of a lip or “J” design or exhibits an external axial surface of 135º or greater (sloping shoulder).

LINE OF DRAW

SAT The appropriate path of insertion varies less than 10° from parallel to the long axis of the tooth on all axial surfaces and a line of draw is established.

ACC The path of insertion / line of draw deviates 10° to less than 20° from the long axis of the tooth.

SUB The path of insertion / line of draw deviates 20° to less than 30o from the long axis of the tooth.

DEF The path of insertion / line of draw is grossly unacceptable, deviating 30° or more from the long axis of the tooth.

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CERAMIC CROWN PREPARATION

Tooth #9 - Walls, Taper and Finish Line AXIAL WALLS – SMOOTHNESS/UNDERCUT

SAT Walls are smooth and well-defined, no undercuts.

ACC The walls are slightly rough and lack some definition.

SUB The axial walls are rough.

DEF There is an undercut.

TAPER SAT There is full visual taper (6° - 16°).

ACC Taper is present, but nearly parallel (less than 6°) or slightly excessive (greater than 16°, but less than 24°).

SUB There is no taper or excessive taper (greater than 24°).

DEF The taper is grossly over-reduced (greater than 30°).

CERVICAL MARGIN WIDTH SAT The cervical margin is optimally 1.0 mm in width.

ACC The cervical margin is greater than 1.0 mm, but not more than 1.5 mm in width.

SUB The cervical margin is 0.5 mm to less than 1.0 mm or overextended to > 1.5 mm not to exceed 2.0mm in width.

DEF The cervical margin is less than 0.5 mm or more than 2.0 mm in width.

INCISAL REDUCTION SAT The optimal incisal reduction is 2.0 mm.

ACC The incisal reduction is not less than 1.5 mm or not more than 2.5 mm.

SUB The incisal reduction is less than 1.5 mm or or up to 3.0 mm.

DEF The incisal reduction is less than 1.0 mm or more than 3.0 mm.

LINGUAL FOSSA REDUCTION SAT The lingual reduction is ideally 1.0 mm. ACC The lingual reduction is 0.5 mm to 1.0 SUB The lingual reduction is greater than 1.0 mm but less than 2.0 mm. DEF The lingual reduction is less than .5mm or 2.0 mm or greater.

LINGUAL WALL HEIGHT SAT The lingual wall height is optimally 1.5 mm or more. ACC The lingual wall height is 1.0 to less than 1.5 mm. SUB The lingual wall height is 0.5 to less than 1.0 mm. DEF The lingual wall height is less than 0.5 mm.

FACIAL AXIAL REDUCTION SAT The facial reduction follows the facial planes of contour and is optimally 1.5 mm when measured at any point

between the original height of contour and the incisal edge. ACC The facial reduction follows the facial planes of contour and is no less than 1.0 mm and no greater than 2 mm. SUB The facial reduction no longer follows the facial planes of contour and is no < 0.5 mm and no > 3.0 mm. DEF The facial axial reduction is less than 0.5mm or greater than 3 mm.

EXTERNAL/INTERNAL LINE ANGLES SAT Internal line angles and external line angles are rounded and smooth. ACC External and/or internal line angles are rounded, but irregular. SUB External and internal line angles are sharp. DEF The external and/or internal line angles are excessively sharp with no evidence of rounding.

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PROSTHODONTIC MANIKIN PROCEDURES Treatment Management

Penalty Points ONLY

CONDITION OF ADJACENT TEETH SAT The adjacent teeth and/or restorations are free from damage.

ACC Damage to adjacent tooth/teeth can be removed with polishing without adversely altering the shape of the contour and/or contact.

SUB Damage to adjacent tooth/teeth requires recontouring which changes the shape and/or position of the contact.

DEF There is gross damage to adjacent tooth/teeth which requires a restoration.

CONDITION OF SOFT TISSUE

SAT The simulated gingiva and/or typodont is/are free from damage.

ACC There is slight damage to simulated gingiva and/or typodont consistent with the procedure.

SUB There is iatrogenic damage to the simulated gingiva and/or typodont inconsistent with the procedure.

DEF There is gross iatrogenic damage to the simulated gingiva and/or typodont inconsistent with the procedure.

CRITICAL ERRORS

1. Wrong Tooth/Surface Treated

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PART IV: PERIODONTAL EXAMINATION – 100 Points PART V: RESTORATIVE EXAMINATION – 100 Points

CONTENT The Periodontal Examination and Restorative Examination are each stand alone examinations that will be administered on the same day. The Periodontal Examination consists of six sections and the Restorative Examination consists of four sections, as follows:

PART IV: PERIODONTAL EXAMINATION Patient Selection & Calculus Detection Oral Assessment Subgingival Calculus Detection/Removal Supragingival Deposit Removal Probing Depth Measurements/Gingival Recession Tissue and Treatment Management

PART V: RESTORATIVE EXAMINATION Class II Amalgam –Preparation Class II Amalgam – Restoration OR Class II Composite –Preparation Class II Composite – Restoration

OR Class II Slot Composite- Preparation Class II Slot Composite - Restoration

AND Class III Composite –Preparation Class III Composite - Restoration

GENERAL REQUIREMENTS

1. Patient Selection: For patient-based procedures, candidates must furnish their own patients. Patient selection and management is an important part of the examination and should be completed independently, without the help or assistance of faculty or colleagues.

It is imperative that all assigned procedures be completed; incomplete procedures cannot be evaluated. Therefore, another consideration in patient selection is the cooperative attitude of the patient. Avoid selecting patients who are apprehensive, hypersensitive, have physical limitations or cannot remain until the examination is completed. Candidates must advise their patients of the time required to participate in this examination and ascertain that their patient is available for the entire day.

2. Patient Management: Significant Medical History and Pathosis: The candidate and assisting auxiliary must behave in an ethical and proper manner towards all patients. Patients shall be treated with proper concern for their safety and comfort. The candidate shall accurately complete the appropriate medical history form and establish a diagnosis and treatment plan as required for each selected patient. The patient’s health status must be acceptable for clinical treatment and the lengthy examination process. Misinformation or missing information that would endanger the patient, candidate, auxiliary personnel, or examiners is considered cause for appropriate action including dismissal from the examination.

3. Patient Acceptability Requirements - General & Medical History: A medical history form must be completed for all clinical patients who are present for the examination. This form may be completed prior to the examination date; however, a medical history that reflects the patient’s current health must be

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presented to the examiners at the time of patient check-in. All positive responses must be explored by the candidate with the patient and adequately explained on the Medical History.

A screening blood pressure reading should be taken when the patient is selected and must be retaken the day of the examination. In addition, on the day of the examination the candidate must also update all medications, pills or drugs both prescription and non-prescription consumed within the last 24 hours.

If a patient requires antibiotic premedication, it must be documented on the Progress Folder before patient check-in. If conditions indicate an alteration in treatment procedures or a need to consult the patient’s physician, the candidate must obtain the necessary written clearance before the patient is accepted. In order to be accepted for treatment, patients must meet all of the following criteria:

a. Minimum patient age is 16 years. b. No patient may be a dentist, dental hygienist, dental student or dental hygiene student. c. Have a blood pressure reading of 159/94 or below to proceed without medical clearance.

Patients with a blood pressure reading between 160/95 and 179/109 will be accepted only with written clearance from the patient’s physician. Patients with a blood pressure reading greater than 180/110 will not be accepted for this examination even if a consult from a physician authorizes treatment.

d. Candidates who are sharing a patient with a need for antibiotic prophylaxis must treat the patient the same clinical day. Treatment of the same patient on subsequent clinical days will not be permitted.

e. No heart attack, stroke or cardiac surgery within the past six months. f. Any cardiac or organ transplant requires a physician’s consultation. g. No active tuberculosis. A patient who has tested positive for TB, or is being treated for TB, but

does not have the clinical symptoms is acceptable. h. No chemotherapy treatment within the last 6 months. i. No history of taking IV bisphosphonate medications for the Periodontal Examination. Generally

no history of taking IV administered bisphosphonate medications for the Restorative Examination (with the exception that taking the approved annual IV dosage for osteoporosis is acceptable). Patients currently taking or who have a history of taking orally administered bisphosphonates may sit for both Restorative and Periodontal procedures, however, it is recommended that the diagnosing physician be consulted concerning any risk factors associated with the patient’s condition.

j. No active incidence of bisphosphonate osteonecrosis of the jaw (BON), also known as osteochemonecrosis or, osteonecrosis of the jaw – ONJ

k. No condition or medication/drug history that might be adversely affected by the length or nature of the examination procedures.

l. Patients with latex sensitivity must have a sticker placed on the top left-hand corner of the Progress Form for that procedure. Contact a CFE for the appropriate sticker.

m. Any item on the Medical History with a “YES” response could require a Medical Clearance from a licensed physician if the explanation section indicates the possibility of a significant systemic condition that could affect the patients suitability for elective dental treatment during the examination.

Candidates must follow the 2014 American Heart Association antibiotic premedication recommendations when treating patients at potential risk of infective endocarditis following dental treatment. A Medical Consult may be indicated to determine the patient’s potential risk of infective endocarditis.

Additionally, candidates must follow 2015 AAOS (American Association of Orthopedic Surgeons) recommendations when treating patients with joint replacements/concerns unless the physician provides a consultation note indicating premedication is not needed.

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Medical clearance, if necessary, must include: • A legible statement from a physician written within 30 days of the examination clearly

stating the medical concern. • A positive statement of how the patient should be managed. • The practitioner’s name, address and phone number

The Medical History and any physician’s statement will be reviewed by a Clinic Floor Examiner for the Restorative Clinical Examination and Periodontal Clinical Examination, and must accompany the patient when the treatment procedure is submitted for evaluation. If the patient sits for more than one candidate, a copy of the Medical History and Consent Form must be available for each procedure and records.

4. Treatment Consent: A Consent Form (Consent for Performance of Dental Procedures) is provided by CRDTS and must be completed for each clinical patient. Patients under the age of legal consent for the state in which the examination is being given must have the Consent Form signed by the parent or guardian. Only the candidate number should be recorded on the Consent Form; the candidate’s name may be added after the examination is completed and before the packet is turned in.

5. Anesthetic Record: An anesthetic record is included in the candidate's Progress Form. Candidates are not allowed to administer anesthesia until authorization has been received and a Clinic Floor examiner has reviewed the medical history and approved anesthesia. At the time of the starting check for each clinical procedure requiring anesthesia, either restorative or periodontal, the anesthetic information -must be indicated on the record. The record requires information as follows: The Type(s) of Injection pertains to the specific block and/or infiltration administered, including non-injectable subgingival anesthetics. The Anesthetic(s) relates to the brand name used. The Vasoconstrictor, if present, must specify the type and concentration. The Quantity is specific to volume. If more than two carpules (approximately 3.4 cc.) of local anesthetic are needed during any clinical procedure, the candidate must request approval from the Clinic Floor Examiner who will document and initial the request. This protocol must be followed for each subsequent carpule. An aspirating syringe and proper aspirating technique must be used for the administration of local anesthesia. Please be sure to complete the quantity actually administered prior to submitting patient to the evaluation area.

6. Premedication Record: A record must be noted for every patient who requires premedication prior to or during the course of the examination. For each patient treatment procedure, there is a place on the Health History Form to record the type of medication administered and the dosage. In addition to premedication, all medications taken within the last 24 hours—both prescribed and over-the-counter—must be recorded.

7. Analgesia: The administration of inhalation analgesia or parenteral sedation is not permitted for any clinical procedures.

8. Radiographs: The radiographs, which are appropriate for each part of the examination, must

demonstrate sufficient contrast to clearly reveal the extent of caries and other pathoses. Initial submission of radiographs (film or digital prints) of poor quality will result in a request for a new radiograph. If a subsequent required retake radiograph is not of diagnostic quality there will be a point deduction. If a third radiograph is not of diagnostic quality, the examination is stopped. Additional radiographs may be required by the examiner during the course of the examination. The radiographic films or digital views used in the examination may be collected at the end of the examination (either separately or on a disk) and become the property of the testing agency. Lack of, or alteration of radiographs or digital prints will result in failure of the examination. Post-operative radiographs or digital prints are not routinely required. However, a post-operative radiograph may be requested at any time at the discretion of the examiners in the Evaluation Station or a Clinic Floor Examiner. Any radiographs requested by a candidate after the start of a procedure must be approved and documented by the Chief Examiner.

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9. Digital Radiography: Candidates may present these images on paper or a monitor view, if available. Candidates are required to check with the site to determine availability, upload and presentation requirements for monitor views. The school will provide a disk of all exam images at the completion of the exam.

As a back-up, it is suggested that candidates have printed copies of the digital images available. If images are printed, the following requirements apply:

The films/images must be of diagnostic quality and unaltered. ♦ Enhancements that do not alter the data in the file of the original radiographic exposure are

acceptable. Any alterations to the original file data would be considered fraudulent.

For restorative procedures, periapicals and bite-wings must be non-distorted images printed on premium quality photo paper. If possible, more than one image may be placed on the sheet of photo paper.

A complete mouth series of digital radiographs must be printed on 8½” x 11” premium quality photo paper.

A regional school must verify the unaltered authenticity of the image(s) with an embossed seal on the photo paper of the radiographs. Incoming practitioners who are not associated with a dental school must submit a signed, dated statement on the back of or with their radiographs attesting that the images are unaltered. Example: "I hereby attest that this reproduction of digital radiographs is a copy of the original, unaltered exposure, and I agree that any subsequent evidence to the contrary will constitute a violation of CRDTS’ examination guidelines".

The patient’s name, the date of exposure and the candidate’s ID number must be written on the page.

10. Communications from Examiners: Clinic Floor Examiners are available for your benefit and to help facilitate the examination process. If you have any questions about any part of exam, please do not hesitate to confer with a Clinic Floor Examiner. Candidates may receive written instructions (“Instructions to the Candidate” form) from the Restorative Examiners to modify their treatment. If so, the candidate must immediately summon a Clinic Floor Examiner prior to carrying out any of the instructions. Candidates should not make the assumption that they have failed. The procedure may be acceptable even though modification is indicated. Conversely, candidates who receive no instructions to modify procedures may not necessarily assume their performance is totally satisfactory or will result in a passing grade. It is possible to have a deficient preparation which cannot be modified for the purposes of the examination. Such a preparation, while deficient in terms of CRDTS evaluation criteria, may still support a finished restoration without seriously jeopardizing the immediate prognosis of the treatment. In every instance, each procedure is evaluated as it is presented rather than as it may be modified. The examiner ratings are not converted to scores until after the examination is completed and all records are processed by computer. Examiners at the examination site do not know and cannot provide information on whether a candidate has passed or failed a specific Examination.

11. Infection Control: Candidates must follow all infection control guidelines required by the state where the

examination is taking place and must follow the CDC’s Guidelines for Infection Control in Dental Health-Care Settings – 2003 (CDC MMWR: December 19, 2003, Vol. 52, No. RR-17.) .(www.cdc.gov/oralhealth/infectioncontrol/guidelines)

The current recommended infection control procedures as published by the CDC must be followed for the Endodontics, Fixed Prosthodontics, Periodontal and Restorative Examinations. These procedures must begin with the initial setting up of the unit, continue throughout the examinations and include the final cleanup of the operatory. It is the candidate’s responsibility to assure that both the candidate and his/her auxiliary fully comply with these procedures. Failure to comply will result in loss of points and any violation that could lead to direct patient harm will result in termination of the examination and loss of all points.

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PART IV: PERIODONTAL PROCEDURES Periodontal Examination Procedural and Patient Management Guidelines:

1. Patient Selection - Patients must meet the eligibility requirements listed above. It is imperative that all assigned procedures be completed as incomplete procedures cannot be evaluated. Therefore, another consideration in patient selection is the cooperative attitude of the patient. Avoid selecting patients who are apprehensive, hypersensitive, or cannot remain until the examination is completed. Candidates must ascertain that their patient is available for the entire day. Waiting times to enter the evaluation station for Patient Check-in and time for examiners to complete their Final Evaluations must be taken in account. Candidates must inform their patients appropriately and confirm they understand that they must stay until their evaluation is complete. Patients must also be advised that they will not receive a complete oral prophylaxis during the exam.

2. Disclosing Solution: The use of disclosing solution by candidates and examiners is prohibited. 3. Periodontal Instruments: Instruments required for the periodontal examination are a new

unscratched, untinted front-surface, non-disposable, #4 or #5 mouth mirror (mouth mirrors that are clouded, tinted, or unclear will be rejected), a periodontal probe with 1 mm increments, 2x2 gauze and a #11/12 explorer. These instruments must be provided by the candidate and the candidate’s performance will not be evaluated without the proper instruments. Sonic/ultrasonic instruments are permissible for scaling, but they must be furnished by the candidate along with appropriate connection mechanisms. Air-abrasive polishers are NOT permissible.

4. Pre-Op Radiographs: Patients for the Periodontal Examination must have complete mouth radiographs with four bitewings, horizontal or vertical; the series must reflect the current clinical condition of the mouth. The bitewings are acceptable if they have been exposed within six months and the complete mouth series within 3 years—provided they still reflect current clinical conditions. Whether horizontal or vertical, bitewing images must extend 2 mm beyond the distal of the second molar and record at least 2 mm of the crest of the alveolar bone for the posterior teeth, excluding third molars, unless they are erupted and included in the treatment selection. If an erupted 3rd molar is in the treatment selection, it must meet the molar requirements outlined above. If a 3rd molar cannot be displayed on a standard radiograph, a panographic radiograph may be submitted to supplement the full mouth series. The radiographs must be of diagnostic quality and should be mounted/presented according to ADA procedures whether conventional or digital and the mounts marked "R" and "L" to represent patient's right and left side. They must be properly identified with the candidate's number, the patient's first name, and the date of exposure. The candidate may keep the radiographs at the end of the examination.

5. Treatment Selections: The treatment selection process is a global approach that incorporates various patient assessment skills such as medical history management, oral assessment and calculus detection. Penalty points are deducted from the final score if the criteria are not met in one or more of these areas. In order to be accepted, the Treatment Selection must fulfill all of the criteria. If the selection is acceptable, the examiners will record on the Progress Folder the approved Treatment Selection for the Periodontal Procedures, and they will make an assignment for Periodontal Measurements.

a. Documents - Treatment Selection Screening Worksheet - This worksheet should be copied and used PRIOR to the exam to screen patients to determine if the patient selected meets the CRDTS criteria for patient acceptability. It is provided in the Application Packet, Manual or online. Candidates are responsible for independently (without the help of faculty and/or colleagues) selecting their treatment selection. The candidate’s copy of their completed Treatment Selection Screening Worksheet should be kept for use during the examination, as the Treatment Selection Submission form will not be returned to the candidate. Periodontal Treatment Selection Submission Form – On the day of the examination the information on the Treatment Selection Screening Worksheet must be accurately transferred to the Periodontal Treatment Selection Submission Form. This form will be distributed in the candidate’s Examination Packet upon check-in. The tooth numbers ONLY and qualifying pocket depths for the candidate’s Treatment Selection can then be transferred from their Worksheet

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onto the Submission form and submitted at Patient Check-in. The candidate should be sure that their Treatment Selection paperwork is congruent with the patient's condition on the day of the exam. All tooth numbers in the primary quadrant/selection must be listed in ascending order with any appropriate notations regarding partially erupted 3rd molars, implants or deciduous teeth present.

b. CFE’s will determine the acceptability of the Medical history, Treatment Consent and date of radiographs. Periodontal Examiners will determine the acceptability of the teeth, calculus and qualifying probing depths. The candidate has the option to submit an alternate Treatment Selection the same patient at the time the initial Treatment Selection is submitted. Candidates wishing to submit an alternate Treatment Selection will complete the lower section of the Treatment Selection Submission Form according to the instructions.

c. Unacceptable Treatment Selections - If the Treatment Selection/Alternate Treatment Selection is not acceptable, the examiners will make no attempt to alter the selection; the patient will be rejected and the appropriate penalties will be assessed (-7 for 1st rejection & -7 for 2nd rejection). The candidate has the option to resubmit the same patient, or to submit a new patient. In either case, a new Treatment Selection Submission Form will need to be submitted, along with appropriate pre-op radiographs if a new patient is presented. After the second rejection, no further penalty points will be deducted and the candidate may continue to submit additional Treatment Selections; the appropriate deadlines previously outlined will apply.

6. The procedures, instruments and materials used are the choice of the candidate, as long as they are currently accepted and taught by accredited dental schools and the candidate has been trained in their use. It is the responsibility of the candidate to provide the instruments used in this examination and listed in this Manual unless such instruments are furnished by the school.

7. During the Periodontal Examination, a Clinic Floor Examiner (CFE) is responsible for checking the candidate's identification badge and to proctor the adherence to infection control protocols and proper patient management. If any problems arise during the examination, the candidate should immediately notify a CFE. The CFE is also present to aid in any emergencies which may occur.

8. Once the Periodontal Examination has begun, the patient may be seated and the blood pressure taken, the records reviewed for accuracy and completeness.

9. The CFE will review the Medical History, Treatment Consent, and date of the radiographs. If approved, anesthesia may be administered if necessary for patient comfort during check-in. Anesthesia cannot be administered prior to the 8:00 start time.

10. Once the CFE has reviewed the Medical History, Treatment Consent and date of the radiographs, the patient should be signed up for assignment evaluation. (A sign-up sheet will be placed near the evaluation station and the candidate assistant will place the 3-digit ID number on the sign-up sheet.) Patients will be evaluated for assignment in the order in which they are checked in. Patients must take the required forms and instruments with them to the Evaluation Station. Only the patient or an examiner assistant may carry the tray to the Evaluation Station. The following items must be presented on the instrument tray for assignment & final evaluation:

a. Completed Medical History b. Completed Periodontal Progress Form c. Completed Periodontal Treatment Submission Form d. Radiographs (conventional or printed digital, if utilized) e. Instruments (no scalers or curets):

(1) clear mirror (2) #11/12 explorer (must be sharp) (3) periodontal probe with 1mm markings (4) air/water tip for the syringe (5) 2 x 2 gauzes

Note: The instruments must be placed on the tray and covered with the napkin, fluid resistant side down. The Progress Form, Medical History Form, and any radiographs must be placed on top or underneath so forms are not contaminated.

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11. Patient Check-in

The periodontal examiners will evaluate patient acceptability to determine:

♦ Oral and systemic condition acceptable for treatment

♦ Intra/Extraoral findings are correctly noted on Progress Form ♦ Qualifying deposits in submitted Treatment Selection ♦ Treatment assignment for periodontal measurements ♦ Confirmation that Treatment Selection meets criteria ♦ Diagnostic Pre-Op Radiographs meet criteria

If the candidate’s first Treatment Selection is not acceptable a seven-point penalty will be assessed. If Intra/Extraoral findings are not correctly noted, a two-point penalty will be assessed. The candidate may present another patient or resubmit the same patient with a revised Treatment Selection. If a second Treatment Selection is unacceptable, another seven-point penalty will be assessed and the candidate may continue to submit additional Treatment Selections without further penalties. If an acceptable Treatment Selection is not presented according to the established deadlines at the end of the day, the candidate may not continue the examination, resulting in an automatic failure.

12. Evaluation: Patient Assessment & Prophylaxis

The candidate’s assistant will escort the patient, wearing a clean napkin, to the evaluation station waiting area for the Final Evaluation as soon as the treatment is completed. A sign-up form will be posted near the evaluation station and patients will be seen in order of their arrival. The patient must bring the Progress Folder with the anesthetic dosage documentation completed, the medical history/consent form, the required instruments, protective eyewear and any conventional/printed digital pre-op radiographs. Examiner assistants will escort patients into the examiner station in the order of sign-up. If all examiner stations are full, patients may be seated in a waiting area until they are called for evaluation. When the evaluation is complete, the patient will be returned to the reception area. Candidates should inform the patient that they have received incomplete treatment and advise them of the necessity and availability of services to obtain further treatment. Once the patient has been submitted to the Evaluation Station for Final Evaluation the candidate may clean the clinic area following accepted infection control procedures.

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PERIODONTAL EXAMINATION CRITERIA

TREATMENT SELECTION: The treatment selection fulfills or exceeds 100% of the examination criteria as follows:

Teeth:

UTILIZING ONE QUADRANT AND UP TO 4 ADDITIONAL TEETH, THE CANDIDATE MUST SUBMIT A TREATMENT SELECTION THAT MEETS THE FOLLOWING CRITERIA:

• The quadrant must have a minimum of 6 teeth including at least one molar. All teeth in the primary quadrant must be included in the treatment selection presented.

• The 1-4 additional teeth, if needed, must be contained within one quadrant • Partially erupted third molars, implants and retained deciduous teeth may be present in the

quadrant submitted for treatment, however, they cannot count as required teeth or qualifying calculus surfaces. These teeth must be listed on the Treatment Selection Submission form with a notation indicating their presence.

• Third molars in the occlusal plane must be presented and considered in the treatment selection assignment and listed on the Treatment Selection Submission form. Examiners are discouraged from selecting those surfaces unless necessary in order to approve the treatment selection.

Intra/Extraoral Assessment:

Any atypical finding requiring follow-up or monitoring are correctly noted on the Progress Form OR the box for Within Normal Limits (WNL) is checked.

The purpose of this part of the examination is to evaluate the level of a candidate's competency in performing an extra/intraoral assessment as part of gathering and documenting baseline data about the patient's oral health status. The candidate is expected to determine whether conditions are within normal limits or atypical. Atypical findings must be briefly described including the location and a presumptive diagnosis.

Probing Depths:

There must be two probing depths of 5 mm or more, each on a separate tooth among the teeth selected for treatment; it is recommended that probing depths greater than 6 mm not be included in the treatment selection. However, the patient will not be rejected if probing depths are greater than 6 mm. Although the two probing depths of 5 mm or more must be on teeth within the treatment selection, it is not required that the root surfaces of those teeth have subgingival calculus that is marked as one of the surfaces selected for treatment.

Calculus Detection - Subgingival Calculus:

Calculus must meet the definition of a qualifying deposit as described to be accepted. Calculus that does not meet the definition of a qualifying deposit will be denied. Consequently, candidates are encouraged to submit a Treatment Selection that exceeds the minimum requirements.

• At least 12 surfaces of qualifying subgingival calculus o At least 8 of the 12 qualifying surfaces must be on non-incisor teeth (posteriors and

canines) o At least 3 of the 8 posterior qualifying surfaces must be on molar(s). o There is no requirement for any of the 12 surfaces to be on anterior teeth (i.e.:

canines and/or incisors) but if chosen, no more than 4 of the 12 surfaces can be on incisors.

Qualifying Calculus: explorer-detectable subgingival calculus is defined as a distinct deposit of calculus which one can feel with a #11/12 explorer as it passes over the calculus. Qualified deposits must be

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apical to the gingival margin and may occur with or without associated supragingival deposits. Qualified deposits may exhibit such characteristics as:

• a definite “jump” or “bump” felt by the explorer, with the rough surface characteristic of calculus

• ledges or ring formations • spiny or nodular formations

The candidate is responsible for treating ALL surfaces of all teeth in the treatment selection.

Treatment Selection Prohibitions: Candidates must NOT present a Treatment Selection with: ♦ Class III furcations or mobility ♦ Orthodontic brackets, which includes patients with bonded retainers, in the areas selected for

treatment

The following may be present in the quadrant presented for treatment, however, they cannot count as required teeth or qualifying calculus surfaces. Implants Partially erupted 3rd molars Retained deciduous tooth

CRDTS strongly discourages the submission of a Treatment Selection which includes any of the following:

• gross caries • faulty restorations • more than 20 surfaces in the treatment selection • extensive full or partial veneer crowns • multiple probing depths in excess of 6 mm (if submitted they may be selected for

evaluation) Periodontal scaling can only be performed for the approved quadrants presented in the treatment selection. It is acceptable but not required, for candidates to treat the remainder of the secondary quadrant. Scaling in unassigned quadrants will be a critical error resulting in failure in the examination.

PERFORMANCE REQUIREMENTS: FINAL EVALUATION

The following criteria will be used by examiners to evaluate candidate performance.

CALCULUS DETECTION The candidate must correctly indicate the presence or absence of subgingival calculus on 4 assigned surfaces. The examiners will assign 4 surfaces within the submitted Treatment Selection. The candidate must record a Y or N (Yes or No) below each surface assigned.

PERIODONAL MEASUREMENTS/GINGIVAL RECESSION Periodontal Measurements The candidate must chart the depth of the gingival sulcus within one millimeter on six aspects of 2 assigned teeth. The examiners will assign two (2) teeth; one posterior tooth and one anterior tooth from the teeth submitted in the candidate’s Treatment Selection. The candidate must record the depth of each sulcus to the nearest millimeter on six aspects only (MF, F, DF, ML, L, DL) of each assigned tooth. Interproximally, the probe must be positioned with the shank against the contact point and the tip angled slightly into the col so it is directly beneath the contact area. If a tooth has no contact, the probe should be placed at the midpoint of the proximal surface and the same measurement recorded for both facial and lingual aspects. The facial and lingual measurements should be made at the midpoint of the tooth (See illustration below). Record every measurement for the assigned teeth to the nearest millimeter. The following illustrations depict the proper placement of the probe, from the occlusal and interproximal perspectives:

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Probe Positions Probing When Interproximal from Occlusal No Contact Angulation Gingival Recession Gingival recession is defined as the visible apical migration of the gingival margin, which exposes the cemento-enamel junction and root surface. On the same teeth assigned for probing, the candidate must measure the amount of gingival recession at the point of the greatest recession on the facial and lingual surfaces. The facial and lingual surfaces are defined as any point on those surfaces between the mesial and distal line angles of the tooth.

Measurements must be taken from the CEJ or the margin of a restoration, whichever is most apical, to the margin of the gingiva. The measurement should be rounded to the nearest millimeter and recorded in the boxes provided on the Progress Sheet. When erosion, abrasion or abfraction is present, it shall be measured from the point of greatest recession to the coronal edge of the lesion. The candidate’s findings must be accurate within 1 mm. If there is no recession present and you record a measurement of 1mm, an error will be recorded.

CALCULUS/SUPRAGINGIVAL DEPOSIT REMOVAL & TISSUE MANAGEMENT The candidate must complete a thorough scaling and calculus/plaque/stain removal on all teeth in the Treatment Selection. Scaling/Subgingival Calculus Removal The assigned subgingival surfaces must be smooth, with none of the selected deposits detectable with an 11/12 explorer. Air may be used to deflect the tissue to locate areas for tactile confirmation. All subgingival surfaces in the treatment selection must be scaled but only the selected surfaces will be evaluated. Supragingival Deposit Removal The candidate must effectively remove all supragingival deposits (hard and soft) and extrinsic stains from all the coronal surfaces of the treatment selection teeth submitted so that all non-decalcified surfaces are:

(a) Visually clean and smooth. (b) Tactilely smooth upon examination with an 11/12 explorer (c) Free of all supragingival accretions. Disclosing solution must not be utilized by candidates or by the examiners; and air- powered polishing is prohibited.

Tissue Management Soft tissue adjacent to all teeth in the selected Treatment Selection and surrounding areas will be evaluated. In addition, trauma to the lips or oral mucosa will be considered tissue trauma (see Glossary). The candidate must effectively utilize sonic/ultrasonic or hand instruments, polishing cups, and dental floss so that no unwarranted soft tissue trauma (abrasions, lacerations or ultrasonic burns) occurs as a result of the prophylaxis procedure. Acceptable performance will have been demonstrated if 100% of all tissue surfaces exhibit no unusual mechanical damage and tissues are well managed.

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Requirements Specific to the Restorative Examinations

General Required Procedures: Candidates may choose to place either a Class II Amalgam or Class II Composite in addition to the Class III Composite Preparation. The Class II Composite must be placed under a rubber dam. Restorative Instruments: A clear, unscratched, front-surface, non-disposable, #4 or #5 mouth mirror (mouth mirrors that are clouded, tinted, or unclear will be rejected), a sharp traditional Shepherd’s Hook-type explorer and a periodontal probe with 1mm markings are required for the restorative examination and must be provided by the candidate. Recontouring: No recontouring of adjacent teeth or restorations will be permitted without prior approval. Candidates may request to recontour restorations on adjacent teeth from the CFE. The CFE will initial the progress form if recontouring is approved. Candidates are not permitted to request to recontour until after the preparation has been evaluated. Once recontouring is completed, the candidate will request the same CFE evaluate the finished procedure. Post-op Radiographs: Post-operative radiographs are not required. However, a post-op radiograph may be requested at any time at the discretion of Restorative Examiners or Clinic Floor Examiners. The radiograph should be mounted, meet the same criteria as specified for pre-op radiographs, and returned to the requesting examiner for evaluation. Caries Detection Agents: Caries detector liquid may be used. If used it must be completely removed prior to the submission of the preparation for evaluation.

Standardized Floss: CRDTS will provide standardized, approved floss for evaluation of the interproximal contact on the Class III Composite Restoration: POH LiteWax Percept 630 Black Floss sachets Go to www.oralhealthproducts.com for more information.

Patient/Treatment Selection and Approval (Start Checks) Patient selection is very important. If the candidate is unable to complete a procedure due to patient management problems, the procedure cannot be evaluated and no credit will be assigned. Candidates may receive start checks for both procedures on the same patient. Candidates must complete their first procedure, submit it for evaluation and complete any instructions prior to beginning the second procedure. Candidate with 2 patients cannot receive start checks for both procedures at the same time. Five penalty points will be deducted from the overall Part V score for the first rejection on each procedure; no further points will be deducted for subsequent rejections, although deadlines and time constraints must be considered. Candidates may indicate an alternate treatment selection on the same patient on the back of the Progress Form for that particular procedure.

It is strongly suggested that substitute patients be available so that in the event the first patient is not accepted, the substitute patient may be called. When using a substitute patient, the candidate is required to complete the examination in the remaining scheduled time including completion of medical and dental charts and radiographs. The criteria for tooth selection outlined in this Manual are the guidelines utilized by examiners for the approval of treatment selection. However, it must be recognized that criteria cannot cover every possible condition that may exist in each situation. Examiners must also be guided by time factors, limitations of the examination setting, and reasonable

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consistency among candidates in the cases being treated. The examiners must make the final decision for approval of treatment selection.

All treatment selections must be approved by at least one (1) Examiner; two examiners are required for a treatment selection to be rejected. A Clinic Floor Examiner will be the first to evaluate each treatment selection. If the Clinic Floor Examiner should determine that the first treatment selection does not meet the criteria, the patient must be sent to the Evaluation Station for evaluation by a second examiner. If the first treatment selection is disapproved by two examiners, the alternate treatment selection, if indicated, will be evaluated while the patient is in the Express Chair. If the alternate treatment selection is rejected by two examiners, the patient will be returned to the candidate and additional treatment selections may be presented on the same patient or on a new patient; a new Progress Form must be completed. If the candidate has presented treatment selections for both procedures on the same patient and one of them is rejected, the candidate may proceed with the approved lesion, then present a treatment selection for the 2nd procedure later. Under no circum-stances can anesthetic solution be administered prior to assignment. The candidate should set up at least 15 minutes before the examination begins and have all materials prepared for examiners to begin starting checks promptly. The candidate may request only one starting check at a time, unless both lesions are on the same patient, then they may request both start checks. The candidate must carry the procedure through to the appropriate stage of completion before beginning the second procedure. Treatment Selection Exclusions:

A. Pulpal pathology or endodontic treatment B. Facial veneers C. Mobility of Class III or more D. Mandibular first premolars, including mesial surfaces

1. distal surface is acceptable for Class II amalgam and Class II composite E. Distal surface of cuspids allowed for Class III composite only, not Class II

For approval of tooth selection, the candidate will present: A. completed Medical History B. mirror, sharp explorer, cotton pliers, periodontal probe C. articulating paper and holder D. tooth # and type of restoration circled on the Progress Form, outline existing restoration(s)

1. A CFE will note the size of the lesion E. radiographs (bitewing and periapical no more than 6 months old) which depict the current

condition of the tooth and surrounding structures, properly presented and either attached to the Progress Form or viewed on a monitor

F. the anesthetic record filled out on the Progress Form (but no anesthetic administered)

Radiographs A periapical and a bitewing radiograph of the tooth selected for the Class II procedures must be presented at the time the treatment selection is presented for approval; only a periapical radiograph is required for the Class III composite procedure. These pre-op films must be of diagnostic quality: the periapical film must include the entire crown of the tooth and at least 2 mm beyond the apex; both the mesial and distal contacts must be open on the tooth selected for treatment on either the periapical or bitewing exposure for the Class II procedure, only the contact selected for treatment must be open for the Class III procedure. If necessary, more than one radiograph may be submitted to satisfy these requirements. The radiographs cannot be more than 6 months old, and must depict the current clinical condition of the tooth to be treated as well as surrounding teeth. That is, there must have been no treatment between the time of taking the radiograph and the CRDTS’ examination that would alter the situation depicted in the radiograph. Duplicate radiographs of diagnostic quality are acceptable.

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At the examination, the films must be mounted/presented according to ADA procedures. Conventional films should be attached to a Progress Form provided by CRDTS. Digital radiographs may either be printed and attached to the Progress Form or be presented on monitors within the clinic and must also be available in the evaluation area. These radiographs must be turned in at the end of the examination, either attached to the Progress Form or on a disk, labeled with candidate ID; these will become the property of CRDTS. The illustrations which appear below help define acceptable and unacceptable radiographic images of primary lesions. Radiographic appearance of caries must extend to the DEJ or beyond and/or there must be evidence of dentinal penetration.

Modification Requests If during the preparation the tooth indicates a need for a significant change from the criteria outlined for Satisfactory, the candidate should make modification request(s) prior to performing them. The preparation must be prepared to the Satisfactory criteria and all pre-existing restorative material must be removed before submitting the first Modification Request. If removal of the pre-existing restorative material might result in a direct or indirect pulp exposure, refer to Indirect Pulp Cap Request/Policy section of the Manual. Requests to extend the preparation to an MOD or to place different material than the approved Treatment Selection must be made utilizing the Modification Request process. Exceptions include: modification to extend the proximal box because of tooth rotation or position. These do not require a request for modification but are listed in the Notes to Examiners area at the bottom of the Progress Form and must be initialed by a CFE. Each modification needs to be numbered and listed separately with the time noted and a brief explanation of the proposed modifications. The request to modify should include:

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What: (Type of modification) Where: (gingival axial line angle, mesial box) See Illustration below Why: (due to caries, decalcification) How much: (reference back to either ideal or to the start)

The request should be shown to a Clinic Floor Examiner who will direct the candidate through the authorization process for modifications; all requests for modifications will be placed under a rubber dam and sent to the Express Chair in the Evaluation Station. If the candidate feels a finger extension is appropriate and/or necessary to eliminate marginal decalcification, such a modification should also be submitted for approval. If the candidate anticipates or actually experiences a pulpal exposure, the Clinic Floor Examiner should be notified at once.

Example Modification Request

Isolation dams are required and the Posterior Composite must be placed under an isolation dam. There will be one or more Express Chairs reserved in the Evaluation Station to process requests for modifications. When the patient is sent to the Evaluation Station, it must be made clear at the Exam Desk that the patient is there for the Express Chair. Instruct the assistant to notify the evaluation area that the patient is there for the Express Chair for a modification request and not for evaluation of the preparation. The examiners will record on the Modification Request Form whether the request is accepted or denied and forward notification to the candidate. Carefully review the criteria for modification requests. Inappropriate requests for modification(s) will result in a small penalty for each modification not granted. Requests for a modification for removal of caries when no stain, caries or decalcification exists will receive a larger penalty. Modifications that have been approved and appropriately accomplished will not result in any penalties. Regardless of whether the modification is granted or not granted, the candidate must complete the preparation and send the patient to the Evaluation Station for evaluation of the final completed preparation. The copy of the modification request form that is returned to you must be submitted with your Preparation Evaluation form. If more than one modification is anticipated at any time, it is to the candidate’s advantage to submit them on the same form as no additional time is provided for evaluation of modification requests and multiple submissions may significantly decrease treatment time. Candidates will submit their copy of the Modification Request Form with their Finished Restoration Forms.

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Terminology for Modification Requests Amalgam & Posterior Composite Preparations

Composite Preparation

Gingival cavosurface margin

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Instructions to Candidates When the patient returns from the Evaluation Station, if the candidate does not receive an “Instruction to the Candidate” form, the candidate should continue to the next step of the treatment. If the candi-date does receive an “Instruction to the Candidate” form, the candidate must inform the Clinic Floor Examiner before proceeding and follow the instructions that have been issued. The Clinic Floor Examiner must evaluate the performance of the candidate, per the instructions, and initial the “Instructions to the Candidate” form when the instructions have been satisfactorily completed.

Evaluation of Restorative Procedures Preparations With the isolation dam in place, the patient is sent to the Evaluation Station for evaluation of the preparation. On an instrument tray, the candidate should send:

1. Completed Medical History Form 2. Completed Restorative Progress Form – including anesthetic dose 3. Modification Request Forms, if any 4. a mirror 5. sharp explorer 6. a metal periodontal probe with 1mm markings, 7. cotton pliers 8. air/water syringe tip (if removable), 9. radiographs

There are deadlines for preparations and restorations to be presented for final evaluation, as specified in the discussion of the Restorative Examination under SCHEDULE/DATES. The preparation must be presented at least one hour prior to the end of the Restorative Examination. Isolation dam 1. A standard isolation dam should be used in all instances where an isolation dam is required. The

Posterior Composite must be placed under an isolation dam. Cavity preparations may be made with or without the isolation dam.

2. All cavity preparation checks by the examiners for the posterior procedures and anterior composite, including modifications, will be made with the dam intact, not torn or leaking.

3. Final evaluations for the finished restorations will be made with the isolation dam removed.

Finished Restoration 1. The finished restoration must be presented by the required time as specified in the examination

schedule or it will not be evaluated. Any wedges placed during treatment must be removed prior to evaluation. On a tray, the candidate should send to the Evaluation Station:

a. a mirror b. sharp explorer c. periodontal probe with 1 mm markings d. Floss (Class II only) e. articulating paper and holder f. air/water syringe tip (if removable) g. radiographs h. completed Medical History Form i. completed Restorative Progress Form – check for anesthetic dose

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2. If the candidate receives no communication from the Evaluation Station, the patient may be dis-missed. If the finished restoration is NOT acceptable as stated on the “Instruction to the Candidate” form, the candidate must contact a CFE. The restoration will either be requested to be removed and the tooth temporized by the candidate as directed by the Chief Examiner or be allowed to remain as a temporary restoration. The Chief Examiner will advise the candidate as to the decision and will also inform the patient. A follow-up form must be completed by the candidate and Chief Examiner to ensure that the responsibility for further treatment is understood and that the patient will receive the proper care. All post-treatment required as a result of treatment rendered as a part of the examination process is the responsibility of the candidate and done at the expense of the candidate.

Requirements Specific to the Restorative Examination

Class II Procedures- Amalgam and Composite

1. Must be a Class II restoration and the tooth selected for either restoration must be a permanent posterior tooth that meets these requirements:

• At least one proximal surface being restored must have a primary carious lesion OR a defective Class II restoration:

a. If a primary carious lesion is present: i. it must NOT have been previously excavated

ii. it must be in contact with a sound enamel surface or a permanently restored surface of an adjacent tooth

b. If a defective existing restoration is present:

i. defined as one which exhibits recurrent caries that is radiographically visible or detectable clinically with an explorer.

ii. it must be in contact with a sound enamel surface or a permanently restored surface of an adjacent tooth

iii. existing restoration may not include cuspal coverage or replacement iv. a digital or regular picture of the existing restoration must be submitted

with the radiographs for acceptance and grading.

v. existing defective restorations must be completely removed before submitting the patient to the Evaluation Station for a modification request or evaluation of the completed preparation.

• There may be a lesion on the proximal surface of the adjacent tooth provided that there is no breakdown of the contact before or during the preparation that would jeopardize proximal contour or contact of the finished restoration.

• When in maximum intercuspation, the selected tooth must be in occlusion with an opposing tooth or teeth. Those opposing tooth/teeth may be natural dentition, a fixed bridge, or any artificial replacement thereof with cusp to fossa relationship. Crossbite occlusion that exhibits cusp to fossa relationship is acceptable.

• An MOD Treatment selection that presents with only one qualifying proximal surface is acceptable:

a. Proximal contact that is visible radiographically is acceptable. b. If the non-qualifying proximal surface is adjacent to a temporary material, that

proximal surface should be restored to proper contour and/or contact c. If the non-qualifying proximal surface demonstrates an open contact, that

proximal surface should be restored to proper contour

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d. If caries dictates modifying a two surface preparation to a three surface preparation, the modified proximal surface, regardless of contact or contour, must be restored to proper contour and/or contact

2. Pre-existing restorations and any underlying liner must be entirely removed and the preparation must demonstrate acceptable principles of cavity preparation. A MOD treatment selection must have at least one proximal contact to be restored. In the event of a defect that would qualify as an acceptable lesion on the opposite proximal surface from the qualifying surface, the treatment plan must be a MOD unless there is an intact transverse or oblique ridge.

3. Proximal contact is a critical part of the evaluation and the candidate should be aware that the examiners will be checking the contact visually and with approved, standardized dental floss. Field trials have indicated that most amalgams can withstand floss being passed through the contact within 30 minutes after the matrix band has been removed. For either procedure, the candidate should be familiar with the properties of the material being used, and should be sure to allow suffi-cient time for any material requirements (i.e. amalgam set time) before sending the finished restoration to the Evaluation Station.

4. Slot Preparations are an acceptable treatment selection for the Class II Restorative Procedures if they meet the above and the following criteria:

a. The occlusal grooves cannot be carious. The occlusal surface cannot have a cavitation or exhibit shadowing under the enamel surface.

i. Grooves which are stained are not considered carious and can qualify for a slot preparation.

b. There cannot be an existing occlusal restoration or sealant. c. Any tooth may have an existing restoration or lesion on the opposite surface if the

oblique/transverse ridge remains intact. This includes mesial restorations on mandibular 1st premolars.

d. If, upon preparation, it becomes evident that the occlusal grooves are carious or exhibit uncoalesced enamel contiguous with the preparation, a modification request to extend to include the occlusal surface is required. Extension to include the occlusal grooves without a modification request will be considered preparation of the wrong surface and will result in the failure of the Restorative Procedures

e. **It is the candidates responsibility to check with the State Board for licensure regarding their statute/rules for this procedure as not all State Boards allow a slot preparation for licensure.**

f. Please obtain a sticker from a CFE at Treatment Selection approval to place on the Posterior Composite Progress Sheet if a slot preparation is planned.

i. Should the lesion require a Class II Posterior Composite be placed, the CFE will place another sticker over the “Slot” sticker for submission to the evaluation area.

5. A developed and mounted post-operative bitewing may be requested at any time at the discretion of a Restorative Examiner or Clinic Floor Examiner.

6. The candidate must decide if a treatment liner is indicated prior to sending the patient to the Evaluation Station for the preparation check. If a liner is to be placed, the candidate must indicate the placement of a liner in the Notes to Examiners section of the appropriate Progress Form & contact a CFE. In some instances, examiners may request that the candidate place a liner via an Instruction to Candidate form, but the candidate incurs no penalty for not requesting a liner. If the candidate has been directed to place a liner via an Instruction to Candidate form, the placement of the liner must be checked by the CFE.

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a. Definition of Bases and Liners i. Cavity Sealers: provide a protective coating for freshly cut tooth structure of the

prepared cavity. ii. Cavity Liners: Resin or cement coating of minimal thickness (usually less than 0.5

mm) to achieve a physical barrier and/or therapeutic effect (a chemical effect that in some way benefits the health of the tooth pulp). Examples include Dycal, Life, Cavitec, Hydroxyline, Vitrebond, and Fuji Lining LC.

iii. Cavity Bases: A replacement material for missing dentinal tooth structure, used

for bulk buildup and/or for blocking out undercuts.

b. PLACEMENT CRITERIA i. The liner must be placed only in those pulpal and/or axial wall areas that deviate

from established ideal depth. ii. The liner must not be placed on enamel or within 1.0 mm of any cavosurface

margin. iii. The liner must not compromise the internal retentive and resistant features of

the cavity preparation. iv. The liner must not be subject to dislodgment during placement of the

permanent restoration. v. Placement must reflect consideration of limitations of the materials used.

INDIRECT PULP CAP 1. At least one Modification Request to remove decay must be granted and completed prior to

requesting placement of an indirect pulp cap 2. All decay must be removed except the area of imminent pulp exposure 3. Ask for an indirect pulp cap by using Modification Request form:

a. What: Indirect pulp cap b. Where: indicate location c. Why: to prevent frank pulp exposure d. No other Modification Requests can be included with this request

4. Request is either approved or denied by the Express Chair a. If the Request is denied the penalties may be issued and the candidate will receive a notice

that the request has been denied. b. If the Request is approved, the candidate will receive an Instruction to Candidate form with

instructions to place an indirect pulp cap c. The completion of the procedure is managed by CFE’s on the floor, any unsatisfactory

results will be sent back to Express Chair 5. If a requested indirect pulp cap is approved, no further exploration or modification can occur to

any part of the preparation and once placed, checked/approved by a CFE, the preparation must be immediately sent to the evaluation area for final evaluation.

6. Placement of an indirect pulp cap without submission of a prior Modification Request to remove decay will result in failure of the examination.

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Requirements Specific to the Restorative Examination- Class III Composite Procedure

1. The composite must be a Class III restoration. The tooth selected for the composite restoration must be a permanent anterior tooth that meets the following requirements:

• at least one proximal primary carious lesion which shows no signs of previous excavation and radiographically or clinically appears to extend at least to the DEJ (see illustrations under the posterior procedure requirements).

• a defective existing restoration is present

o defined as one which exhibits recurrent caries that is radiographically visible or detectable clinically with an explorer.

o a picture printed on photo paper of the existing restoration must be submitted with the radiographs for acceptance and grading.

o existing defective restorations must be completely removed before submitting the patient to the Evaluation Station for a modification request or evaluation of the completed preparation.

• visually closed contact with the adjacent tooth on the proximal surface to be restored, although the area to be restored may or may not be in contact.

• The approximating contact of the adjacent tooth must be natural tooth structure or restored with a permanent restoration.

• There may be a lesion on the proximal surface of the adjacent tooth provided that there is no breakdown of the contact before or during the preparation that would jeopardize proximal contour or contact of the finished restoration. o Occlusion may or may not be present. o Single-sided (mesial/distal) restorations are acceptable.

2. Surface sealants will not be placed on the finished composite restoration.

3. Lesions which may initially be described as Class IV will not be accepted. However, Class III lesions that may require modifications resulting in Class IV restorations are acceptable.

4. Proximal contact is a critical part of the evaluation and the candidate should be aware that the examiners will be checking the contact with approved standardized dental floss provided by CRDTS. It is recommended that all wedges be removed well before the finished restoration is submitted to the Evaluation station. A developed and mounted post-operative bitewing may be requested at any time at the discretion of a Restorative Examiner or Clinic Floor Examiner.

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AMALGAM PREPARATION External Outline Form

PROXIMAL CLEARANCE SAT Contact is visibly open proximally.

ACC Proximal contact is visibly open, and proximal clearance at the height of contour extends beyond 0.5 mm but not more than 1.0 mm on either one or both proximal walls.

SUB Proximal contact is [_] not visually open; or proximal clearance at the height of contour [_] extends beyond 1.0 mm but not more than 2.0 mm on either one or both proximal walls.

DEF The proximal clearance at the height of contour extends beyond 2.0 mm on either one or both proximal walls.

GINGIVAL CLEARANCE SAT Contact is open gingivally up to 0.5 mm.

ACC The gingival clearance is greater than 0.5 mm but not greater than 2.0 mm.

SUB The gingival clearance is greater than 2.0 mm but not more than 3.0 mm, or is not open.

DEF The gingival clearance is greater than 3.0 mm.

OUTLINE SHAPE/CONTINUITY/EXTENSION SAT The outline form includes all carious and non-coalesced fissures.

SUB The outline form is inappropriately overextended so that it compromises the remaining marginal ridge and/or cusp(s). The outline form is underextended and non-coalesced fissure(s) remain which extend to the DEJ and are contiguous with the outline form.

DEF The outline form is overextended so that it compromises, undermines and leaves unsupported the remaining marginal ridge to the extent that the pulpal-occlusal wall is unsupported by dentin or the width of the marginal ridge is 1 mm or less.

ISTHMUS SAT The isthmus must be 1-2 mm wide, but not more than ¼ the intercuspal width of the tooth.

ACC The isthmus is more than ¼ and not more than 1/3 the intercuspal width.

SUB The isthmus is more than 1/3 and not more than ½ the intercuspal width.

DEF The isthmus is greater than ½ the intercuspal width or less than 1 mm.

CAVOSURFACE MARGIN

SAT The external cavosurface margin meets the enamel at 90°. There are no gingival bevels. The proximal gingival point angles may be rounded or sharp.

ACC The proximal cavosurface margin deviates from 90°, but is unlikely to jeopardize the longevity of the tooth or restoration; this would include small areas of unsupported enamel.

SUB The proximal cavosurface margin deviates from 90° and is likely to jeopardize the longevity of the tooth or restoration. This would include unsupported enamel and/or excessive bevel(s).

SOUND MARGINAL TOOTH STRUCTURE

SAT The cavosurface margin terminates in sound natural tooth structure. There is no previous restorative material , including sealants, at the cavosurface margin. There is no decalcification on the gingival margin.

SUB The cavosurface margin does not terminate in sound natural tooth structure; or, there is explorer penetrable decalcification remaining on any cavosurface margin, or the cavosurface margin terminates in a previously placed pit and fissure sealant.

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AMALGAM PREPARATION

Internal Form

AXIAL WALLS

SAT The axial wall follows the external contours of the tooth, and is entirely in dentin, .5 mm from the DEJ.

ACC The depth of the axial wall is .5 mm to 1.5 mm beyond the DEJ.

SUB The axial wall is more than 1.5 mm beyond the DEJ, but no more than 2.5 mm or the axial wall depth does not include the DEJ.

DEF The axial wall is [_] more than 2.5 mm beyond the DEJ or [_] there is no gingival floor.

PULPAL FLOOR SAT The pulpal floor is optimally 1.5 to 2.0 mm from the cavosurface margin at its shallowest point.

SUB The pulpal floor is less than 1.5 mm at its shallowest point or greater than 2.0 mm but not greater than 3.0 mm from the cavosurface margin.

DEF The pulpal floor is more than 3.0 mm from the cavosurface margin or is 0.5 mm or less at its shallowest point.

PULPAL-AXIAL LINE ANGLE SAT The pulpal-axial line angle is rounded.

SUB The pulpal-axial line angle is sharp.

CARIES/REMAINING MATERIAL SAT All caries and/or previous restorative material are removed.

DEF Caries or previous restorative material remains in the preparation or preparation is not extended to include caries.

PROXIMAL BOX WALLS

SAT The walls of the proximal box should be convergent occlusally and meet the external surface at a 90º angle.

ACC The walls of the proximal box are parallel, but appropriate internal retention is present.

DEF The walls of the proximal box diverge occlusally which offers no retention and will jeopardize the longevity of the tooth or restoration.

PREPARED SURFACES

SAT All prepared surfaces are smooth and well-defined, and the gingival floor is perpendicular to the long axis of the tooth.

SUB The prepared surfaces are irregular or ill-defined.

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AMALGAM PREPARATION

Critical Errors

Wrong Tooth/Surface Treated Retention, when used, grossly compromises the tooth or restoration Unrecognized Exposure Critical Lack of Clinical Judgment/Diagnostic Skills

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AMALGAM FINISHED RESTORATION Margin Integrity and Surface Finish

MARGIN DEFICIENCY SAT There is no marginal deficiency. There is no evidence of voids or open margins.

ACC There is a detectable marginal deficiency at the restoration-tooth interface either visually or with the tine of an explorer, but it is less than .5 mm.

SUB The restoration-tooth interface is detectable visually or with the tine of an explorer. There is evidence of marginal deficiency, 0.5 mm up to 1 mm, which can include pits and voids at the cavosurface margin

DEF There is evidence of marginal deficiency of more than 1 mm, to include pits and voids at the cavosurface margin, and/or there is an open margin.

MARGIN EXCESS

SAT There is no detectable excess at the cavosurface margin either visually or with the tine of an explorer.

ACC There is a detectable marginal excess at the cavosurface margin either visually or with the tine of an explorer, but it is no greater than 1.0 mm.

SUB The cavosurface margin is detectable visually or with the tine of an explorer. There is evidence of marginal excess of more than 1.0 mm and up to 2.0 mm.

DEF There is evidence of marginal excess at the cavosurface margin of more than 2.0 mm.

GINGIVAL OVERHANG SAT The restoration exhibits no gingival overhang.

ACC The restoration exhibits a slight gingival overhang but would not be expected to adversely affect the tissue health.

DEF The restoration exhibits a significant gingival overhang and would be expected to adversely affect the tissue health.

SURFACE FINISH SAT The surface of the restoration is uniformly smooth and free of pits and voids.

ACC The surface of the restoration is slightly grainy or rough, but it is free of significant pits and voids. SUB The surface of the restoration is rough and exhibits surface significant irregularities, pits or voids.

CONTIGUOUS TOOTH STRUCTURE

SAT There is no evidence of unwarranted or unnecessary removal, modification, or recontouring of tooth structure contiguous to the restoration.

ACC There is minimal evidence of unwarranted or unnecessary removal, modification, or recontouring of tooth structure contiguous to the restoration. (Enameloplasty)

SUB There is evidence of unwarranted or unnecessary removal, modification, or recontouring of tooth structure contiguous to the restoration. (Enameloplasty)

DEF There is gross enameloplasty resulting in the exposure of dentin.

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AMALGAM FINISHED RESTORATION Contour, Contact and Occlusion

INTERPROXIMAL CONTACT

SAT Interproximal contact is present, the contact is visually closed and is properly shaped and positioned; and there is definite, but not excessive, resistance to dental floss when passed through the interproximal contact area.

ACC Interproximal contact is visually closed, and the contact is adequate in size, shape, or position but demonstrates little resistance to dental floss.

SUB Interproximal contact is visually closed, but the contact is deficient in size, shape, or position and demonstrates little resistance to dental floss or shreds the floss.

DEF The interproximal contact is visually open or will not allow floss to pass through the contact area.

CENTRIC/EXCURSIVE CONTACTS

SAT When checked with articulating ribbon or paper, all centric and excursive contacts on the restoration are consistent in size, shape and intensity with such contacts on other teeth, in that quadrant.

SUB When checked with articulating ribbon or paper, the restoration is in hyper-occlusion inconsistent in size, shape and intensity with the occlusal contacts on surrounding teeth, and requires adjustment.

DEF There is gross hyperocclusion so that the restoration is the only point of occlusion in that quadrant.

ANATOMY/CONTOUR

SAT The restoration reproduces the normal physiological proximal contours of the tooth, occlusal and marginal ridge anatomy.

ACC The restoration does not reproduce the normal occlusal anatomy, proximal contours of the tooth or marginal ridge anatomy, but would not be expected to adversely affect the tissue health.

DEF The restoration does not reproduce the normal occlusal anatomy, proximal contours of the tooth or marginal ridge anatomy, and would be expected to adversely affect the tissue health.

AMALGAM FINISHED RESTORATION

Critical Errors

Fractured Restoration

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POSTERIOR COMPOSITE PREPARATION

External Outline Form PROXIMAL CLEARANCE

SAT Proximal contact is visibly open up to 0.5 mm.

ACC Proximal contact is visibly open, and proximal clearance at the height of contour extends beyond 0.5 mm but not more than 1.0 mm on either one or both proximal walls.

SUB Proximal contact is [_] not visually open; or proximal clearance at the height of contour [_] extends beyond 1.0 mm but not more than 2.0 mm on either one or both proximal walls.

DEF The proximal clearance at the height of contour extends beyond 2.0 mm on either one or both proximal walls.

GINGIVAL CLEARANCE SAT Contact is open gingivally up to 0.5 mm.

ACC The gingival clearance is greater than 0.5 mm but not greater than 2.0 mm.

SUB The gingival clearance is greater than 2.0 mm but not more than 3.0 mm, or is not open.

DEF The gingival clearance is greater than 3.0 mm.

OUTLINE SHAPE/CONTINUITY/EXTENSION

SAT The outline form includes all carious and non-coalesced fissures, and is smooth, rounded and flowing with no sharp curves or angles.

SUB The outline form is inappropriately overextended so that it compromises the remaining marginal ridge and/or cusp(s). The outline form is underextended and non-coalesced fissure(s) remain which extend to the DEJ and are contiguous with the outline form.

DEF The outline form is overextended so that it compromises, undermines and leaves unsupported the remaining marginal ridge to the extent that the cavosurface margin is unsupported by dentin or the width of the marginal ridge is 1.0 mm or less.

ISTHMUS SAT The isthmus may be up to 2 mm wide, but not more than ¼ the intercuspal width of the tooth.

ACC The isthmus is more than ¼ and not more than 1/3 the intercuspal width.

SUB The isthmus is more than 1/3 and not more than ½ the intercuspal width

DEF The isthmus is greater than ½ the intercuspal width.

CAVOSURFACE MARGIN SAT The external cavosurface margin meets the enamel at 90o.

SUB The proximal cavosurface margin deviates from 90o and is likely to jeopardize the longevity of the tooth or restoration. This would include unsupported enamel and/or excessive bevel(s).

SOUND MARGINAL TOOTH STRUCTURE

SAT The cavosurface margin terminates in sound natural tooth structure. There is no previous restorative material , including sealants, at the cavosurface margin. There is no decalcification on the gingival margin.

SUB The cavosurface margin does not terminate in sound natural tooth structure; or, there is explorer penetrable decalcification remaining on any cavosurface margin, or the cavosurface margin terminates in a previously placed pit and fissure sealant.

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POSTERIOR COMPOSITE PREPARATION

Internal Form

AXIAL WALLS

SAT The axial wall follows the external contours of the tooth, and is entirely in dentin, .5 mm from the DEJ.

ACC The depth of the axial wall is .5 mm to 1.5 mm beyond the DEJ.

SUB The axial wall is [_] more than 1.5 mm beyond the DEJ, but no more than 2.5 mm or the axial wall depth does not include the DEJ.

DEF The axial wall is more than 2.5 mm beyond the DEJ or [_] there is no gingival floor.

PULPAL FLOOR SAT The pulpal floor depth must be at 1.5—2.0 mm in all areas; there may be remaining enamel.

SUB The pulpal floor depth is greater than 0.5 mm but less than 1.5 mm or up to 3.0 mm.

DEF The pulpal floor is [_] less than 0.5 mm or [_] is more than 3.0 mm from the cavosurface margin.

CARIES/REMAINING MATERIAL SAT All caries and/or previous restorative material are removed.

DEF Caries or previous restorative material remains in the preparation or preparation is not extended to include caries.

PROXIMAL BOX WALLS SAT The walls of the proximal box should be parallel or converge occlusally.

SUB The walls of the proximal box are divergent.

DEF The walls of the proximal box are grossly [_] convergent so that the buccal-lingual gingival floor width is > than 2 times the buccal-lingual width of the occlusal access or [_] divergent so that the occlusal access is > two times the width of the buccal-lingual gingival floor.

PREPARED SURFACES

SAT All prepared surfaces are smooth and well-defined, and the gingival floor is perpendicular to the long axis of the tooth.

SUB The prepared surfaces are irregular or ill-defined.

POSTERIOR COMPOSITE PREPARATION

Critical Errors

Wrong Tooth/Surface Treated Unrecognized Exposure Critical Lack of Clinical Judgment/Diagnostic Skills

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POSTERIOR COMPOSITE FINISHED RESTORATION Margin Integrity and Surface Finish

MARGIN DEFICIENCY

SAT There is no marginal deficiency. There is no evidence of voids or open margins.

ACC There is a detectable marginal deficiency at the restoration-tooth interface either visually or with the tine of an explorer, but it is less than .5 mm.

SUB The restoration-tooth interface is detectable visually or with the tine of an explorer. There is evidence of marginal deficiency, 0.5 mm up to 1 mm, which can include pits and voids at the cavosurface margin

DEF There is evidence of marginal deficiency of more than 1 mm, to include pits and voids at the cavosurface margin, and/or there is an open margin.

MARGIN EXCESS

SAT There is no detectable marginal excess at the cavosurface margin either visually or with the tine of an explorer.

ACC There is a detectable marginal excess at the cavosurface margin either visually or with the tine of an explorer, but it is no greater than 1.0 mm.

SUB The cavosurface margin is detectable visually or with the tine of an explorer. There is evidence of marginal excess of more than 1.0 mm and up to 2.0 mm.

DEF There is evidence of marginal excess at the cavosurface margin of more than 2.0 mm.

GINGIVAL OVERHANG SAT The restoration exhibits no gingival overhang.

ACC The restoration exhibits a slight gingival overhang but would not be expected to adversely affect the tissue health.

DEF The restoration exhibits a significant gingival overhang and would be expected to adversely affect the tissue health.

SURFACE FINISH SAT The surface of the restoration is uniformly smooth and free of pits and voids.

ACC The surface of the restoration is slightly grainy or rough, but it is free of significant pits and voids. SUB The surface of the restoration is rough and exhibits surface significant irregularities, pits or voids.

CONTIGUOUS TOOTH STRUCTURE

SAT There is no evidence of unwarranted or unnecessary removal or recontouring of tooth structure contiguous to the restoration. There is no excess restorative material present that is not contiguous with the restoration.

ACC There is minimal evidence of unwarranted or unnecessary removal, or recontouring of tooth structure contiguous to the restoration. (Enameloplasty) Excess present that is not contiguous with the restoration no greater than 0.5mm.

SUB There is evidence of unwarranted or unnecessary removal or recontouring of tooth structure contiguous to the restoration. (Enameloplasty) Excess present that is not contiguous with the restoration greater than 0.5mm.

DEF There is gross enameloplasty resulting in the exposure of dentin.

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POSTERIOR COMPOSITE FINISHED RESTORATION Contour, Contact and Occlusion

INTERPROXIMAL CONTACT

SAT Interproximal contact is present, the contact is visually closed and is properly shaped and positioned; and there is definite, but not excessive, resistance to dental floss when passed through the interproximal contact area.

ACC Interproximal contact is visually closed, and the contact is adequate in size, shape, or position but demonstrates little resistance to dental floss.

SUB Interproximal contact is visually closed, but the contact is deficient in size, shape, or position and demonstrates little resistance to dental floss or shreds the floss.

DEF The interproximal contact is visually open or will not allow floss to pass through the contact area.

CENTRIC/EXCURSIVE CONTACTS

SAT When checked with articulating ribbon or paper, all centric and excursive contacts on the restoration are consistent in size, shape and intensity with such contacts on other teeth, in that quadrant.

SUB When checked with articulating ribbon or paper, the restoration is in hyper-occlusion inconsistent in size, shape and intensity with the occlusal contacts on surrounding teeth, and requires adjustment.

DEF There is gross hyperocclusion so that the restoration is the only point of occlusion in that quadrant.

ANATOMY/CONTOUR

SAT The restoration reproduces the normal physiological proximal contours of the tooth, occlusal and marginal ridge anatomy.

ACC The restoration does not reproduce the normal occlusal anatomy, proximal contours of the tooth or marginal ridge anatomy, but would not be expected to adversely affect the tissue health.

DEF The restoration does not reproduce the normal occlusal anatomy, proximal contours of the tooth or marginal ridge anatomy, and would be expected to adversely affect the tissue health.

POSTERIOR COMPOSITE FINISHED RESTORATION Critical Errors

Fractured Restoration The restoration is debonded and/or movable in the preparation.

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POSTERIOR COMPOSITE SLOT PREPARATION

External Outline Form

PROXIMAL CLEARANCE SAT Proximal contact is visibly open up to 0.5 mm.

ACC Proximal contact is visibly open, and proximal clearance at the height of contour extends beyond 0.5 mm but not more than 1.0 mm on either one or both proximal walls.

SUB Proximal contact is [_] not visually open; or proximal clearance at the height of contour [_] extends beyond 1.0 mm but not more than 2.0 mm on either one or both proximal walls.

DEF The proximal clearance at the height of contour extends beyond 2.0 mm on either one or both proximal walls.

GINGIVAL CLEARANCE SAT Contact is open gingivally up to 0.5 mm.

ACC The gingival clearance is greater than 0.5 mm but not greater than 2.0 mm.

SUB The gingival clearance is greater than 2.0 mm but not more than 3.0 mm, or is not open.

DEF The gingival clearance is greater than 3.0 mm.

OUTLINE SHAPE/CONTINUITY/EXTENSION SAT The outline form is smooth, rounded and flowing with no sharp curves or angles.

DEF The outline form is [_] underextended and non-coalesced fissure(s) remain which extend to the DEJ and are contiguous with the outline form. [ ] The outline at the occlusal surface is overextended and extends past the triangular fossa

CAVOSURFACE MARGIN SAT The external cavosurface margin meets the enamel at 90o.

SUB The proximal cavosurface margin deviates from 90o and is likely to jeopardize the longevity of the tooth or restoration. This would include unsupported enamel and/or excessive bevel(s).

SOUND MARGINAL TOOTH STRUCTURE

SAT The cavosurface margin terminates in sound natural tooth structure. There is no decalcification on any cavosurface margin

SUB The [_]cavosurface margin does not terminate in sound natural tooth structure; or, there is [_] explorer penetrable decalcification remaining on any cavosurface margin

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POSTERIOR COMPOSITE SLOT PREPARATION

Internal Form

AXIAL WALLS

SAT The axial wall follows the external contours of the tooth, and is entirely in dentin, .5 mm from the DEJ.

ACC The depth of the axial wall is .5 mm to 1.5 mm beyond the DEJ.

SUB The axial wall is [_] more than 1.5 mm beyond the DEJ, but no more than 2.5 mm or the axial wall depth does not include the DEJ.

DEF The axial wall is more than 2.5 mm beyond the DEJ or [_] there is no gingival floor.

CARIES/REMAINING MATERIAL SAT All caries and/or previous restorative material are removed.

DEF Caries or previous restorative material remains in the preparation or preparation is not extended to include caries.

PROXIMAL BOX WALLS SAT The walls of the proximal box should be parallel or converge occlusally.

SUB The walls of the proximal box are divergent.

DEF The walls of the proximal box are grossly [_] convergent so that the buccal-lingual gingival floor width is > than 2 times the buccal-lingual width of the occlusal access or [_] divergent so that the occlusal access is > two times the width of the buccal-lingual gingival floor.

PREPARED SURFACES

SAT All prepared surfaces are smooth and well-defined, and the gingival floor is perpendicular to the long axis of the tooth.

SUB The prepared surfaces are irregular or ill-defined.

POSTERIOR COMPOSITE SLOT PREPARATION

Critical Errors

Wrong Tooth/Surface Treated Unrecognized Exposure Critical Lack of Clinical Judgment/Diagnostic Skills

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POSTERIOR COMPOSITE SLOT RESTORATION Margin Integrity and Surface Finish

MARGIN DEFICIENCY SAT There is no marginal deficiency. There is no evidence of voids or open margins.

ACC There is a detectable marginal deficiency at the restoration-tooth interface either visually or with the tine of an explorer, but it is less than .5 mm.

SUB The restoration-tooth interface is detectable visually or with the tine of an explorer. There is evidence of marginal deficiency, 0.5 mm up to 1 mm, which can include pits and voids at the cavosurface margin

DEF There is evidence of marginal deficiency of more than 1 mm, to include pits and voids at the cavosurface margin, and/or there is an open margin.

MARGIN EXCESS

SAT There is no detectable marginal excess at the cavosurface margin either visually or with the tine of an explorer.

ACC There is a detectable marginal excess at the cavosurface margin either visually or with the tine of an explorer, but it is no greater than 1.0 mm.

SUB The cavosurface margin is detectable visually or with the tine of an explorer. There is evidence of marginal excess of more than 1.0 mm and up to 2.0 mm.

DEF There is evidence of marginal excess at the cavosurface margin of more than 2.0 mm.

GINGIVAL OVERHANG SAT The restoration exhibits no gingival overhang.

ACC The restoration exhibits a slight gingival overhang but would not be expected to adversely affect the tissue health.

DEF The restoration exhibits a significant gingival overhang and would be expected to adversely affect the tissue health.

SURFACE FINISH SAT The surface of the restoration is uniformly smooth and free of pits and voids.

ACC The surface of the restoration is slightly grainy or rough, but it is free of significant pits and voids. SUB The surface of the restoration is rough and exhibits surface significant irregularities, pits or voids.

CONTIGUOUS TOOTH STRUCTURE

SAT There is no evidence of unwarranted or unnecessary removal or recontouring of tooth structure contiguous to the restoration. There is no excess restorative material present that is not contiguous with the restoration.

ACC There is minimal evidence of unwarranted or unnecessary removal, or recontouring of tooth structure contiguous to the restoration. (Enameloplasty) Excess present that is not contiguous with the restoration no greater than 0.5mm.

SUB There is evidence of unwarranted or unnecessary removal or recontouring of tooth structure contiguous to the restoration. (Enameloplasty) Excess present that is not contiguous with the restoration greater than 0.5mm.

DEF There is gross enameloplasty resulting in the exposure of dentin.

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POSTERIOR COMPOSITE SLOT RESTORATION Contour, Contact and Occlusion

INTERPROXIMAL CONTACT

SAT Interproximal contact is present, the contact is visually closed and is properly shaped and positioned; and there is definite, but not excessive, resistance to dental floss when passed through the interproximal contact area.

ACC Interproximal contact is visually closed, and the contact is adequate in size, shape, or position but demonstrates little resistance to dental floss.

SUB Interproximal contact is visually closed, but the contact is deficient in size, shape, or position and demonstrates little resistance to dental floss or shreds the floss.

DEF The interproximal contact is visually open or will not allow floss to pass through the contact area.

CENTRIC/EXCURSIVE CONTACTS

SAT When checked with articulating ribbon or paper, all centric and excursive contacts on the restoration are consistent in size, shape and intensity with such contacts on other teeth, in that quadrant.

SUB When checked with articulating ribbon or paper, the restoration is in hyper-occlusion inconsistent in size, shape and intensity with the occlusal contacts on surrounding teeth, and requires adjustment.

DEF There is gross hyperocclusion so that the restoration is the only point of occlusion in that quadrant.

ANATOMY/CONTOUR

SAT The restoration reproduces the normal physiological proximal contours of the tooth, occlusal and marginal ridge anatomy.

ACC The restoration does not reproduce the normal occlusal anatomy, proximal contours of the tooth or marginal ridge anatomy, but would not be expected to adversely affect the tissue health.

DEF The restoration does not reproduce the normal occlusal anatomy, proximal contours of the tooth or marginal ridge anatomy, and would be expected to adversely affect the tissue health.

POSTERIOR COMPOSITE SLOT RESTORATION Critical Errors

Fractured Restoration The restoration is debonded and/or movable in the preparation.

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ANTERIOR CLASS III COMPOSITE PREPARATION External Outline Form

OUTLINE EXTENSION

SAT

Outline form provides adequate access for complete removal of caries and/or previous restorative material and insertion of composite resin. Access entry is appropriate to the location of caries and tooth position. If a lingual approach is initiated, facial contact may or may not be broken as long as the margin terminates in sound tooth structure.

ACC The wall opposite the access, if broken, may extend no more than 1.0 mm beyond the contact area. The outline form is overextended mesiodistally 0.5-1 mm beyond what is necessary for complete removal of caries and/or previous restorative material.

SUB

The outline form is underextended making caries removal or insertion of restorative material questionable. The outline form is overextended mesiodistally more than 1mm, but no more than 2 mm beyond what is necessary for complete removal of caries and/or previous restorative material. The incisal cavosurface margin is overextended so that the integrity of the incisal angle is compromised. The wall opposite the access opening extends more than 1 mm beyond the contact area.

DEF

The outline form is underextended making it impossible to manipulate and finish the restorative material. The outline form is overextended mesiodistally more than 2.0 mm beyond what is necessary for complete removal of caries and/or previous restorative material. The incisal cavosurface margin is overextended so that the incisal angle is removed or fractured. A Class IV restoration is now necessary without justification. The wall opposite the access opening extends more than 2.5 mm beyond the contact area.

GINGIVAL CONTACT BROKEN

SAT The gingival contact must be broken. The incisal contact need not be broken, unless indicated by the location of the caries. If a lingual approach is initiated, facial contact may or may not be broken as long as the margin terminates in sound tooth structure.

ACC The gingival clearance does not exceed 1.5 mm.

SUB The gingival clearance is greater than 1.5 mm. The gingival contact is not visibly broken.

DEF The gingival clearance is greater than 2.0 mm.

MARGIN SMOOTHNESS/CONTINUITY/BEVELS

SAT Cavosurface margins form a smooth continuous curve with no sharp angles. Enamel cavosurface margins may be beveled.

ACC The cavosurface margins are slightly irregular. Enamel cavosurface margin bevels, if present, do not exceed 1.0 mm in width.

SUB The cavosurface margin is rough and severely irregular. Enamel cavosurface margin bevels, if present, exceed 1.0 mm in width, are not uniform or are inappropriate for the size of the restoration.

SOUND MARGINAL TOOTH STRUCTURE

SAT The cavosurface margin terminates in sound natural tooth structure. There is no previous restorative material, including sealants, at the cavosurface margin. All unsupported enamel is removed unless it compromises facial esthetics.

ACC There is a small area of unsupported enamel which is not necessary to preserve facial esthetics.

SUB There are large or multiple areas of unsupported enamel which are not necessary to preserve facial esthetics. The cavosurface margin does not terminate in sound natural tooth structure; or, the cavosurface margin terminates in previous restorative material.

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ANTERIOR CLASS III COMPOSITE PREPARATION

Internal Form

AXIAL WALLS

SAT The axial wall follows the external contours of the tooth and the depth does not exceed .5 mm beyond the DEJ.

ACC The depth of the axial wall is no more than 1.5 mm beyond the DEJ.

SUB The axial wall is more than 1.5 mm beyond the DEJ.

DEF The axial wall is more than 2.5 mm beyond the DEJ.

INTERNAL RETENTION

SAT If used, rounded internal retention is placed in the dentin of the gingival and incisal walls just axial to the DEJ as dictated by cavity form. Retention is tactilely and visually present.

SUB When used, retention is excessive and undermines enamel or jeopardizes the incisal angle or encroaches on the pulp.

CARIES/REMAINING MATERIAL SAT All caries and/or previous restorative material are removed.

DEF Caries or previous restorative material remains in the preparation or preparation is not extended to include caries.

ANTERIOR COMPOSITE PREPARATION

Critical Errors

Wrong Tooth/Surface Treated Unrecognized Exposure Critical Lack of Clinical Judgment/Diagnostic Skills

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ANTERIOR CLASS III COMPOSITE PREPARATION

Internal Form MARGIN DEFICIENCY

SAT There is no marginal deficiency. No marginal deficiency is detectable at the restoration-tooth interface either visually or with the tine of an explorer. There is no evidence of voids or open margins.

ACC There is a detectable marginal deficiency at the facial or lingual restoration-tooth interface either visually or with the tine of an explorer, but it is less than .5 mm.

SUB The restoration-tooth interface is detectable visually or with the tine of an explorer. There is evidence of marginal deficiency, 0.5 mm up to 1 mm, which can include pits and voids at the cavosurface margin

DEF There is evidence of marginal deficiency of more than 1 mm, to include pits and voids at the cavosurface margin, and/or there is an open margin.

MARGIN EXCESS SAT No marginal excess is detectable at the cavosurface margin either visually or with the tine of an explorer.

ACC There is a detectable marginal excess at the cavosurface margin either visually or with the tine of an explorer, but it is no greater than 1.0 mm..

SUB

The cavosurface margin is detectable visually or with the tine of an explorer. There is evidence of lingual marginal excess, more than 1.0 mm and up to 2 mm. There is facial and/or lingual flash with contamination underneath, but it is not internal to the cavosurface margin, and could be removed by polishing or finishing.

DEF There is evidence of marginal excess at the cavosurface margin of more than 2 mm, and/or there is internal contamination at the facial and/or lingual interface between the restoration and the tooth.

GINGIVAL OVERHANG SAT The restoration exhibits no gingival overhang.

ACC The restoration exhibits a slight gingival overhang but would not be expected to adversely affect the tissue health.

DEF The restoration exhibits a significant gingival overhang and would be expected to adversely affect the tissue health.

SURFACE FINISH SAT The surface of the restoration is uniformly smooth and free of pits and voids. ACC The surface of the restoration is slightly grainy or rough, but it is free of significant pits and voids. SUB The surface of the restoration is rough and exhibits surface significant irregularities, pits or voids.

CONTIGUOUS TOOTH STRUCTURE

SAT There is no evidence of unwarranted or unnecessary removal or recontouring of tooth structure contiguous to the restoration. There is no excess restorative material present that is not contiguous with the restoration.

ACC There is minimal evidence of unwarranted or unnecessary removal, modification, or recontouring of tooth structure contiguous to the restoration. (Enameloplasty) Excess present that is not contiguous with the restoration no greater than 0.5mm.

SUB There is evidence of unwarranted or unnecessary removal or recontouring of tooth structure contiguous to the restoration. (Enameloplasty) Excess present that is not contiguous with the restoration greater than 0.5mm.

DEF There is gross enameloplasty resulting in the exposure of dentin.

SHADE SELECTION SAT The shade of the restoration blends with the surrounding tooth structure.

SUB The shade of the restoration contrasts markedly with the surrounding tooth structure.

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ANTERIOR CLASS III COMPOSITE FINISHED RESTORATION Contour, Contact and Occlusion

INTERPROXIMAL CONTACT

SAT Interproximal contact is present, the contact is visually closed and is properly shaped and positioned; and there is definite, but not excessive, resistance to dental floss when passed through the interproximal contact area.

ACC Interproximal contact is visually closed, and the contact is adequate in size, shape, or position but demonstrates little resistance to dental floss.

SUB Interproximal contact is visually closed, but the contact is deficient in size, shape, or position and/or demonstrates little resistance to dental floss, shreds the floss or is visually open but deflects floss.

DEF The interproximal contact allows standardized dental floss to pass without deflection or resistance or will not allow dental floss to pass through the contact area.

CENTRIC/EXCURSIVE CONTACTS

SAT When checked with articulating ribbon or paper, all centric and excursive contacts on the restoration are consistent in size, shape and intensity with such contacts on other teeth, in that quadrant.

SUB When checked with articulating ribbon or paper, the restoration is in hyper-occlusion inconsistent in size, shape and intensity with the occlusal contacts on surrounding teeth, and requires adjustment.

DEF There is gross hyperocclusion so that the restoration is the only point of occlusion in that quadrant.

ANATOMY/CONTOUR

SAT The restoration reproduces the normal anatomical contours of the tooth, including facial, lingual, proximal and marginal ridge anatomy when compared to contiguous tooth structure.

ACC The restoration deviates slightly from the normal anatomical contours of the tooth, when compared to contiguous tooth structure but would not be expected to adversely affect the tissue health.

DEF The restoration deviates significantly from the normal anatomical contours of the tooth, including facial, lingual, proximal or marginal ridge anatomy, and/or would be expected to adversely affect the tissue health.

ANTERIOR COMPOSITE RESTORATION

Critical Errors

Restoration is debonded.

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RESTORATIVE PROCEDURES Treatment Management

Penalty Points Only

CONDITION OF ADJACENT TEETH SAT The adjacent teeth and/or restorations are free from damage.

ACC Damage to adjacent tooth/teeth can be removed with polishing without adversely altering the shape of the contour and/or contact.

SUB Damage to adjacent tooth/teeth requires recontouring which changes the shape and/or position of the contact.

DEF There is gross damage to adjacent tooth/teeth which requires a restoration.

CONDITION OF SOFT TISSUE

SAT The soft tissue is free from damage or there is tissue damage that is consistent with the procedure.

SUB There is iatrogenic soft tissue damage that is inconsistent with the procedure.

DEF There is gross iatrogenic damage to the soft tissue inconsistent with the procedure and pre-existing condition of the soft tissue.

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EXAMINATION CHECK-OUT Patient/Candidate Feedback Forms Candidates and their patients have an opportunity to provide input to CRDTS about the examination. CRDTS wishes to continually improve its examination program, and feedback from the perspective of both candidates and patients is one of the best ways for CRDTS to gather ideas on how to do this. The Feedback Forms for candidates and patients have been included in the candidate’s packets. They are not required, and will be collected separately from the candidate’s packet to ensure that the candidate’s examination results will in no way be affected by any feedback the candidate or the candidate’s patients might have. Therefore, CRDTS encourages candidates and patients to complete the forms honestly and thoughtfully before checking out.

Check-Out Procedure When the candidates are ready to check out, they must go to the examiners’ desk and get a clearance check that all procedures are completed or accounted for. The packets may be collected at the desk. The following items must be enclosed in the candidate's packet envelope: 1. Pre-operative and post-operative radiographs

a. (if any were requested and returned to the candidate) of teeth restored during the examination must be submitted, clearly marked for identification either separately or on a disk from the school; the complete mouth series for the periodontal patient need not be submitted. (If the testing site requires that radiographs be returned with board patient records, the candidates must submit duplicates of the required radiographs)

2. Completed Progress Forms (with any conventional or printed digital pre-op radiographs attached) 3. Identification badge 4. Consent Forms for each clinical patient 5. Medical History forms for each clinical patient 6. Testing Site Fee Receipt

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EXAMINATION APPLICATION POLICIES Qualified candidates may apply to take the examination by submitting an application online at www.crdts.org. Once an application is completed online, it is considered a contract with CRDTS. If a candidate fails to fulfill all requirements of the application, or is unable to take the exam, the policies below will apply. Additional portions of the application must be submitted by mail. Detailed information regarding required documents/fees, test sites and examination dates/deadlines are outlined on the CRDTS website and in this Manual. A fully executed application complete with the appropriate documentation and fee is required to take the examination.

Read the entire application form before submitting any information. Be accurate and complete. If directions are not followed, the application may not be accepted.

1. Application Deadline: The application deadline is approximately 40 days before the date of the examination. Applications and all documentation/fees must be received on or before the published application deadline date. (See www.crdts.org or inside cover of Manual for exam/deadline dates.)

2. Social Security Number: Candidates must enter their US government-issued social security number when applying online. Candidates without a social security number must contact CRDTS Central Office. The social security number will remain a part of the candidate’s secure record. A 10-digit CRDTS ID number will be assigned, appear on all the candidate’s examination forms and become the Username for login to CRDTS website. When logged-in, candidates will be able manage their information and view application documents, examination results. This 10-digit CRDTS ID number will connect the results back to the candidate’s permanent record.

3. Photographs: Candidates must submit a digital photograph. The photograph MUST BE RECENT, passport quality, it may be in black & white or color, JPG/JPEG, FIG, or PNG formats, square and have minimal resolution of 200x200 and max resolution of 500x500.

4. Signature of Candidate: The candidate will sign the online application electronically. The electronic signature is legally binding and has the full validity and meaning as the applicant’s handwritten signature. With the signature the applicant acknowledges that he/she has read and understood the application and the CRDTS Dental Candidate Manual and agrees to abide by all terms and conditions contained therein.

5. Initial Examination/Application Fee: The appropriate examination fee must be paid at the time of application. Payment submitted must be for the exact amount and can be paid online via VISA or Mastercard or by cashier’s check or money order with the applicant’s CRDTS ID number written in the lower left-hand corner. PERSONAL CHECKS WILL NOT BE ACCEPTED AND WILL BE RETURNED TOGETHER WITH THE APPLICATION TO THE APPLICANT.

The examination fee is $2350 and includes application for one attempt at Parts II through V of the examination. Specifically, the initial offering of the manikin-based examinations- Part II Endodontic & Part III Prosthodontics, and the initial offering of patient-based examinations Part IV – Periodontal & Part V - Restorative.

The examination fee for D3 dental students taking the Manikin procedures during their Junior year is $1175 and includes application for one attempt at the initial offering of the manikin-based examinations- Part II Endodontic & Part III Prosthodontics.

The D4 dental students taking the Patient-based procedures during their Senior year must have previously attempted the Manikin procedures (Parts II & III) and the examination fee is $1175. This fee includes application for one attempt at the initial offering of the patient-based examinations Part IV – Periodontal & Part V - Restorative.

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For candidates applying for only 1 Dental Examination Part or 1 Restorative Procedure, the fee is $1175.

6. Administrative Fee: An administration fee of $200 is included in all examination fees described herein. This administrative fee is non-refundable and deducted from all returned application fees. Under certain circumstances, an additional administrative fee may be imposed. In such cases the candidate will be notified accordingly.

7. Site Fee: The school may charge a site fee/rental fee for use of instruments, clinic facilities, manikin heads, supplies, and disposables. Some sites require that all instruments be supplied by the school. A rental charge or deposit imposed by the testing site must be remitted directly to the school.

Candidates taking the examination at a dental school other than their own are encouraged to visit the site prior to the time of the examination to become familiar with the school. It is the responsibility of the candidate to make arrangements with the school for the provision of instruments, radiographic equipment and to ascertain whether the Acadental ModuPRO™ Typodont will be mounted in a lab or at the operatory chair so that the appropriate equipment for mounting can be available.

8. Retest Examination Fee: A new application and the appropriate fee must be filed for any retest of a failed or incomplete part or procedure. Candidates are permitted to apply for only one examination at a time and may not submit another application until after the results of the prior examination have been distributed. The retake fees are outlined below:

Manikin-based Exams – 1 or both $1175 Part II – Endodontics Part III - Prosthodontics Patient-based Exam – 1 or both $1175 Part IV – Periodontics Part V - Restorative or 1 procedure

Maximum initial retest fee, regardless of the number of Parts/procedures candidate is retaking: $2,350. Subsequent failures will require appropriate retest fees as specified above.

REQUIRED DOCUMENTATION

After fully executing the online application, the following items must be received in CRDTS Central Office prior to the Application Deadline:

1. Proof of Graduation:

a. Accredited Graduates: If candidates are taking the examination for the first time, they must present proof of enrollment in or graduation from an accredited dental school. Candidates applying for the Curriculum Integrated Format must be currently enrolled in a participating program, as a rising junior or senior, in an educational program that leads to the successful completion of a DDS/DMD degree from an educational program accredited by the ADA Commission on Dental Accreditation, or have graduated from such a program and are currently enrolled in a post-graduate program or residency and must furnish proof of the above enrollment as a student of record. Candidates applying for the Traditional Format must furnish proof of graduation from an accredited dental school or provide a Letter of Certification (a form provided by CRDTS). The Letter of Certification must be completed by the Dean of the school to verify that the candidate has demonstrated sufficient clinical competence, is in good standing, and it is anticipated that all school requirements are current and up to date and the student will be recommended for graduation based on their current standing. Alterations to this letter or misrepresentation of any application requirements may result in elimination of the candidate’s application.

b. Non-accredited graduates: The results of the CRDTS examination for graduates of non-accredited dental schools are recognized only by states which allow licensure of such non-accredited

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graduates. Candidates with a degree from an educational program not accredited by the ADA Commission on Dental Accreditation applying for examination must be authorized to take the examination by at least one state which accepts the results of the CRDTS’ examination and are only eligible for the Traditional Examination Format.

i. Non-accredited graduates must furnish a letter indicating that they are eligible for licensure in that state upon successful completion of the CRDTS examination

ii. Equivalency/ECE certificates may not be substituted for this letter

iii. A copy of the candidate’s dental diploma with an English translation must be provided

iv. Non-accredited graduates are not eligible for CRDTS Status and Dental Examination results will only be reported to the State providing the letter

2. Professional Liability Insurance: Insurance in the amount of $1,000,000 / $3,000,000 is required. The

Medical Protective Company of Fort Wayne, IN, in cooperation with CRDTS, will provide complementary professional liability coverage, in the required amount, for all candidates and their dental assistants taking the patient based portions of this examination during the current academic school year. Candidates must submit the Student Dental Board Coverage Application with their initial application for patient-based portions of the examination. This application for coverage will apply to all CRDTS licensing exams a candidate may have to take for a period of 12 months.

ADMINISTRATIVE POLICIES Once an application has been received or accepted for examination, the policies described in this section become effective.

1. Candidates for Curriculum Integrated Format

a. Site Selection: The initial offering of the manikin-based examinations will be at the dental school at which the applicant is enrolled as a senior dental student. One of the objectives of the Curriculum Integrated Format is for candidates to take the initial offerings of the manikin-based examinations and the patient-based examinations at their own school.

b. Examination Completion: All parts of the examination must be successfully completed by June 30th of the graduation year. There are 3 attempts possible for the Manikin procedures and 2 attempts possible for the patient-based procedures. If the parts to this examination are not successfully completed accordingly, regardless of the reason, all parts to this examination must be taken following the Spring graduation from dental school, utilizing the Traditional Format or in a subsequent academic year in which the candidate is recertified by the Dean as a senior student of record. A new application must be filed together with appropriate documentation, including a diploma or updated letter of certification, and applicable fees. This constitutes a new examination series and the rules for the respective format of that series shall apply.

c. Clinical Exam Schedule/Sequence: The initial offering of the manikin-based examinations for endodontic and fixed prosthodontic procedures will take place at the candidate’s school of attendance on a specified date(s) in the Fall. A maximum of two retest opportunities for unsuccessful candidates will be available, the first on a specified date(s) December – April, and the second on a specified date(s) in May/June. The second and third retest opportunities will be administered at select dental schools that may or may not be the candidate’s school of attendance.

The initial offering of the patient-based examinations for restorative and periodontic procedures will take place at the candidate’s school of attendance on a specified date(s) in February – early April. One retest opportunity for unsuccessful candidates will be available on a specified date(s) in

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May/June. The retest opportunity will be administered at select dental schools that may or may not be the candidate’s school of attendance.

All candidates must take the initial offering of the manikin-based examinations in September-November and the initial offering of the patient-based examinations in February-April.

This requirement may be waived or accommodated due to extenuating circumstances not under the control of the candidate and subject to the full discretion of the testing agency. A request for waiver from this requirement will be considered on an individual basis when received by the testing agency no less than 30 days before the scheduled examination date for foreseeable circumstances and no later than 14 days after the scheduled examination date in instances of unforeseeable situations. Requests must be made in writing to the testing agency and must include original documentation in support of the request. Notification will be sent immediately after determination is made. Should the waiver or accommodation be granted, the terms and conditions for future examinations will be included.

Candidates who do not complete the initial offering of the manikin-based examinations or the initial offering of the patient-based examinations, or an accommodation recommended by the testing agency in lieu of a waiver, may be disqualified for the remainder of the Curriculum Integrated Format examination and will forfeit their fee.

2. Traditional Candidates

a. Site Selection: The initial offering of these examinations, Parts II, III, IV & V (Manikin and Patient-Based Examinations) is administered during the Spring testing period will be at select dental schools. Any exam having an insufficient number of candidates by the Application Deadline may be cancelled. If this happens, a candidate will receive a full refund of their examination fee(s).

Unsuccessful candidates are allowed a maximum of two retest opportunities. Thereafter, appropriate remediation requirements apply and the candidate must retake the entire examination in the Traditional Format.

b. Examination Completion: Candidates who are taking the Traditional Format must successfully complete all Parts of the Examination within 12 months of the date of their initial clinical examination. There are 3 attempts possible for all of the procedures outlined for the exam. Candidates who do not successfully complete the examination within these time/attempt limits must retake the entire examination in the Traditional Format.

3. Retests - Parts II, III, IV & V: A score is reported for each of the conjunctive Parts of the CRDTS dental examination. If one or more Parts are failed, all procedures in that Part must be retaken, not just the procedures with deficient performance with the exception of the Part V – Restorative Procedures. If the 2nd procedure is not completed successfully, candidates will only need to retake that particular procedure upon retest. Traditional candidates applying for re-examination must provide docu-mentation that all school requirements have been completed and the candidate has graduated.

Retest opportunities for the Manikin and Patient-Based Examinations will be administered at select dental schools that may or may not be the candidate’s school of attendance. Applicants from the school where the examination is administered receive priority for assignment to that site. Candidates retaking Parts IV and V will adhere to the open schedule previously outlined. Candidates retaking Part IV or Part V only will have 3 hours to complete Part IV-Periodontal Examination and 6 hours to complete both procedures within the Part V-Restorative Examination; candidates retaking only 1 Restorative Procedure will have 3 hours to complete that procedure; appropriate end-of-examination deadlines apply, regardless of start time for the examination: Initial Treatment Selection Approval 1.5 hours prior to End of Exam Periodontal Resubmissions/Restorative Preparations 1.0 hour prior to End of Exam

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Periodontal Final Eval/Restorative Restorations By End of Exam Deadline Example: Restorative only exam, 2 procedures, scheduled from 8 AM until 2 PM would require initial treatment selection approval on 2nd procedure no later than 12:30 PM; the 2nd preparation submitted for final evaluation by 1 PM and 2nd/final restoration submitted by 2 PM. Candidates who are retaking the examination must fulfill current examination requirements since the examination format is periodically redesigned. In every instance of re-examination, the candidate must complete a new application and remit the current examination fee.

4. Remediation requirements: It is the responsibility of each state or licensing jurisdiction to enforce its own remediation policy. There is no state which requires remediation after only one failure; some states may require remediation after two failures. Any candidate intending to seek licensure in one of the states that accepts the results of the CRDTS examination should check with the appropriate State Board regarding its remediation and re-examination requirements. It is the responsibility of the candidate to obtain and complete all requirements for remedial education in accordance with the requirements of the licensing jurisdictions in which they seek to obtain licensure. CRDTS does not assume any responsibility in providing this information or in monitoring the completion of such requirements prior to examination. After three or more failures, CRDTS requires that the candidate submit documentation from a state participating in the CRDTS examination verifying that the candidate has completed the remediation requirements of the state and that the state will consider the results of the re-examination for licensure.

5. Incomplete Applications: It is the candidate’s responsibility to ensure that all application requirements are met and that all required items are received in CRDTS Central Office prior to the Application Deadline. All applications with incorrect or missing information, documentation or fees will be assessed a $200 fee and held until the missing item(s) and/or fees are received in Central Office. Once an exam site has closed, no additional applications will be processed and forfeiture of fees may apply.

It should be noted that for applications, fees and required documentation, the testing agency uses the date of receipt and assumes no responsibility for insufficient postage or delays caused by the post office or other delivery agencies. Applications will be processed on a first-come, first serve basis for candidates who are not students at the testing site. It is suggested that the application process be completed well in advance of the deadline date to assure adequate time to submit a returned application or submit incomplete documentation by the deadline date. The following items must be mailed in to CRDTS in order to complete the application:

• Examination Fee payable to CRDTS (VISA/Mastercard online, Cashier’s Check or MoneyOrder) Retake Fee: See Retake Examination Fee

• Notarized copy of diploma or Certification letter for 1st time applicants • Non-accredited Graduates – Photocopy of diploma and letter from State board • Student Dental Board Coverage Application – required for patient-based examinations

6. Disqualification: A candidate may be disqualified by the Dean of the dental school that the candidate attends at any time after application is made in the event the candidate ceases to be a senior student of record or for any other reason within the discretion of the Dean after acceptance of application. Notification of disqualification by the Dean (or designated school official) must be received by the testing agency, in writing or by facsimile, IN ADVANCE OF THE START DATE OF A SCHEDULED EXAMINATION. Notification by any other source or in any other manner is not recognized or accepted. Facsimiles must be immediately followed by a letter to the testing agency with the required signature of the Dean (or designated school official). Acceptance of disqualification is considered final. Once disqualified, a candidate will not be reinstated for the Traditional Format examination during that academic year. Candidates who are disqualified shall receive a refund of the exam fee minus an administrative fee of $200. Candidates who are disqualified during the Curriculum Integrated Format

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examination schedule shall have access to the Traditional Format of the examination upon graduation and presentation of a diploma or in a subsequent academic year in which the candidate has been appropriately certified by the Dean (or designated school official) as a senior student of record. A new application must be submitted together with all required documentation and appropriate fee. All applicants will be notified by the testing agency when official notification of disqualification has been received and recorded.

7. Schedule Changes: The examination assignment schedule (Day 1 and Day 2 assignments) is considered final when issued and mailed to the candidate. Request for change will not be considered or made once the schedule has been distributed. School personnel do not have the authority to accept a candidate for examination at their site or to make assignment changes within an examination series. Such arrangements concluded between school personnel and candidate may preclude the candidate from being admitted to the examination as well as forfeiture of fee. The CRDTS Chief Examiner is the only authorized individual who may consider a request for schedule change. If unusual circumstances warrant such change and space is available, it is the decision of the CRDTS Chief Examiner to approve such a request. This decision is made on site, on the day of examination. Prior requests are not accepted or considered.

8. Fee Deferral: Under extenuating circumstances a request for the examination fee to be deferred to a later examination will be considered on an individual basis when RECEIVED BEFORE THE SCHEDULED EXAMINATION DATE. Requests must be made in writing to the testing agency and must include original documentation in support of the request. Should a fee deferral be granted, the candidate will be informed of the terms and conditions for future examinations. Requests for fee deferral on or after the date of the scheduled examination will not be honored and the fee will be forfeited. A non-refundable administrative processing fee of $200 is applicable at all times and under all circumstances.

9. Fee Refunds: Refunds will be made, minus a $200 administrative fee, if notification of cancellation is received in the CRDTS Central Office 30 days prior to the first day of the examination. A 50% refund will be made if notification is made at least 6 business days prior to the first day of the examination. After that time, any cancellations will result in forfeiture of the entire examination fee. Once a candidate has paid the entire examination fee and has taken any Part of the examination, there will be no refund of fees for the Parts that have not yet been taken, should the candidate decide to cancel or withdraw from other Parts of the examination. In addition, failure to appear for the exam will result in a forfeiture of the entire examination fee. This policy applies to all cancellations, regardless of reason.

10. Confirmation Notification: Candidates will receive a notice confirming their examination schedule; this notice may be distributed or posted by the school. Candidates will receive an email approximately 30 days prior to the examination. This email will contain:

1. A letter confirming the exam site to which you have been assigned, the date and the exam schedule.

2. A letter from the clinical facility serving as a testing site providing general information about the site, its facilities, policies and usage fees. This letter may also contain information related to nearby hotels. (Candidates that are current students at the exam site will not receive the site information letter)

3. Other information and/or forms which may be needed to take the examination. For candidates who are not attending the dental school where the examination is being administered, it will be necessary to make arrangements with the school for the provision of instruments, type of manikins, etc. Most schools charge a fee for the use of the clinic facilities, manikin heads, supplies and disposables. Any deposit or fee for the use of the testing site must be remitted to the school, NOT to the testing agency. No candidate should come to the examination unless confirmation containing the above information has been received.

11. Release of Scores: Scores are not released at any time other than to the candidate, the candidate’s dental school and all CRDTS’ member states. No scores will be released by telephone and calling the Administrative Office will only delay the release of scores. Any address changes since the time of original application should be provided to the CRDTS’ Administrative Office immediately.

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a. Candidates: Scores will be reported to candidates online; upon successful completion of all parts, a results letter will be sent via mail to the candidate’s permanent address. For online access to scores, candidates may Log-In at www.crdts.org using their assigned CRDTS ID and password. The ‘Candidates’ tab will allow access to scores. Scores will also be reported to the dental school of graduation if the candidate is a current graduate. For Parts II – V, candidates whose total score on any part is less than 75 can review their scores online, including an itemization of their deficiencies. The manikin-based examinations and the patient-based examinations are reported within 1-2 days after the date of the candidate’s examination. If the manikin procedures are evaluated off-site, results are reported 1-2 days after evaluation is completed. No actual examination papers or clinical evaluation forms will be released in order to maintain security of the examination. Current year graduates will receive a mailing containing a history of scores as well as a certified copy of the final results in a separate, sealed envelope to be mailed directly to the licensing state of their choice. DO NOT OPEN the 2nd sealed envelope. Member States: A Master Grade Sheet listing all scores will be automatically reported to all CRDTS member states AFTER candidates have attempted all parts in either format of the examination. Individual score reports are not automatically sent to member states/recognizing jurisdictions. It is the candidates’ responsibility to provide a copy of their examination score report to any state in which they are seeking licensure so that State Board can verify the candidates’ scores against their master grade sheet received from CRDTS. Candidates are responsible for checking with State Boards to determine all requirements for licensure.

b. Duplicate Scores/Score Report Request: For non-member states and for duplicate scores: Scores will be reported upon receipt of a request made online, www.crdts.org (Score Report Request). Such requests must include the following:

i. Candidate’s name, mailing address and telephone number ii. Candidate’s name at time of examination

iii. Year in which the CRDTS clinical examination was completed iv. Address to which the results are to be sent v. $50 per each address to where the scores are to be forwarded

If the candidate wishes to have the Candidate’s Manual sent along with the scores to provide an explanation of scores, the fee is an additional $25. An additional fee of $4 is charged to have the scores notarized. A credit card must be used when requesting a duplicate score report online. No personal checks will be accepted. Please access the CRDTS’ website (www.crdts.org) or contact the CRDTS Administrative Office for more information.

COMPLAINT REVIEW PROCESS CRDTS maintains a complaint review process whereby a candidate may submit a request for a review of documentation, concerns or protocols affecting his/her individual examination results. This is a formalized process conducted by a special committee whose charge is to review the facts to determine if the examiners' findings substantiate the results. Any request for such a review MUST BE FILED and received at CRDTS Central Office no later than 14 days following the official date on which the scores were provided to the candidate or the candidate’s dental school. The Committee is required to complete its review within 60 days from the time of receiving a formal request; during that time, the candidate may apply for re-examination. If the candidate files a formal complaint, then retests and passes the examination before the complaint has been fully processed, the complaint review will be terminated. Forms may be obtained from CRDTS’ Administrative Office or from the CRDTS website; documentation for the complaint must be typed or written on this form.

In determining whether to file a request to initiate the complaint review process, the candidate should be advised that all reviews are based on a reassessment of documentation of the candidate’s performance on the

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examination. The review does not include a regrading of that performance; it is limited to a determination of whether or not there exists substantial evidence to support the judgment of the three calibrated examiners conducting independent evaluations at the time of the examination. The review will not take into consideration other documentation that is not part of the examination process, such as; post-treatment photographs, radiographs, models, character references or testimonials, dental school grades, faculty recommendations or the opinions of other "experts" solicited by the candidate. In addition, the review will be limited to consideration of the results of only one examination at a specific test site. If a candidate has completed more than one CRDTS’ examination, the results of two or more examinations may not be selectively combined to achieve an acceptable final score.

Candidates who contact the Administrative Office regarding their examination results must clearly indicate whether they simply wish to express a concern relating to the examination or are interested in initiating a formal petition for review. A $250 filing fee will be charged by CRDTS to file and process a formal complaint review request.

POLICY FOR TESTING OF DISABLED CANDIDATES Any candidate with a documented physical and/or learning disability that impairs sensory, manual or speaking skills which require a reasonable deviation from the normal administration of the examination may be accommodated. All reasonable efforts will be used to administer the examination in a place and manner accessible to persons with disabilities or an attempt will be made to offer alternative accessible arrangements for such individuals. Efforts will be made to ensure that the examination results accurately reflect the individual’s impaired sensory, manual or speaking skills, except where those skills are factors the examination purports to measure. Also, attempts will be made to provide appropriate auxiliary aids for such persons with impaired sensory, manual or speaking skills unless providing such auxiliary aids would fundamentally alter the measurement of the skills or knowledge the examination is intended to test or would result in an undue burden. To ensure that an auxiliary aid or other requested modification exists and can be provided, it is a requirement that any candidate with a disability requesting such modification or auxiliary aid must:

1. Timing of request: Submit, in writing together with the application, a request and all documentation for the auxiliary aid or modification. Requests received after the application date or retroactive requests will not be considered.

2. Documentation verifying disability: Provide documentation of the need for the auxiliary aid or modification. If the candidate is a student in an accredited school, a letter from a school official fulfills this requirement. Otherwise, a letter from the appropriate health care professional is required.

3. Modification(s) needed: Request in writing the exact auxiliary aids or modifications needed and indicate the exact portion(s) of the examination for which such auxiliary aid or modification will be needed.

In providing such auxiliary aids or modifications, the testing agency reserves the ultimate discretion to choose between effective auxiliary aids or modifications and reserves the right to maintain the security of the examination. All information obtained regarding any physical and/or learning disability of a candidate will be kept confidential with the following exceptions:

1. Authorized individuals administering the examination may be informed regarding any auxiliary aid or modification; and

2. First aid and safety personnel at the test site may be informed if the disability might require emergency treatment.

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LOCATION OF TESTING SITES & LICENSURE INFORMATION

Contact information for the above can be found online at www.crdts.org >Contacts tab

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CHECKLIST OF REQUIRED MATERIALS AND INSTRUMENTS

ORIENTATION: Picture ID for admission to orientation

This Candidate Manual

CLINICAL EXAMINATION: This Candidate Manual

Sphygmomanometer

Pre-op Restorative Radiographs and Periodontal Radiographic Survey

Completed Medical Histories and Consent Forms

Progress forms with anesthesia record completed, if applicable

Completed Periodontal Treatment Selection Screening Worksheet

#11/12 explorer

Metal periodontal probe with 1 mm markings

Sonic/ultrasonic scaler (optional)

2 x 2 Gauze

Sharp traditional explorer for caries detection (such as a Shepherd’s Hook)

Dental mirror, clean unscratched

Cotton Pliers

Articulating paper and holder

Handpiece compatible with testing site attachments

Acadental ModuPRO™ Typodont — Endodontic and Prosthodontic Modules

Operating instruments

Instrument Tray

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GLOSSARY

Glossary of Words, Terms and Phrases

Abfraction The deep V-shaped groove usually noted at the CEJ which is caused by bruxism. This may be visible or apical to the gingival margin.

Abrasion Abnormal wearing of tooth substance or restoration by mechanical factors other than tooth contact.

Abutment A tooth used to provide support or anchorage for a fixed or removable prosthesis.

Acrylic Resin Synthetic resin derived from acrylic acid used to manufacture dentures/denture teeth and provisional restorations.

Adjustment Selective grinding of teeth or restorations to alter shape, contour, and establish stable occlusion.

Angle A corner; cavosurface angle: angle formed between the cavity wall and surface of the tooth; line angle: angle formed between two cavity walls or tooth surfaces.

Apical the tip, or apex, of a root of a tooth and its immediate surroundings.

Attached Gingiva The portion of the gingiva that extends apically from the base of the sulcus to the mucogingival junction.

Attrition loss of tooth substance or restoration caused by mastication or tooth contact.

Axial wall An internal cavity surface parallel to the long axis of the tooth.

Base A replacement material for missing dentinal tooth structure, used for bulk buildup and/or for blocking out undercuts. Examples include ZOIB&T, IRM and zinc-phosphate cement.

Bevel A plane sloping from the horizontal or vertical that creates a cavosurface angle which is greater than 90°.

Bonding Agent See Sealers.

Bridge Permanently fixed restoration that replaces one or more missing natural teeth.

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Build Up A restoration associated with a cast restoration, which replaces some, but not all, of the missing tooth structure coronal to the cementoenamel junction. The buildup provides resistance and retention form for the subsequent cast restoration. Also called Pin Amalgam Build Up (PABU) or Foundation.

Calculus A hard deposit attached to the teeth, usually consisting of mineralized bacterial plaque.

Caries An infectious microbiological disease that results in localized dissolution and destruction of the calcified tissues of the teeth. The diagnosis of dentinal caries is made by tactile sensation with light pressure on an explorer, described as (1) a defect with a soft, sticky base, or (2) a defect that can be penetrated or altered by the tine of the explorer.

Cavity Preparation

Removal and shaping of diseased or weakened tooth tissue to allow placement of a restoration.

Cavosurface Margin

The line angle formed by the prepared cavity wall with the unprepared tooth surface. The margin is a continuous entity enclosing the entire external outline of the prepared cavity. Also called the cavosurface line angle.

Cementoenamel Junction

Line formed by the junction of the enamel and cementum of a tooth.

Centric occlusion That vertical and horizontal position of the jaws in which the cusps of the maxillary and mandibular teeth intercuspate maximally.

Centric relation That operator guided position of the jaws in which the condyles are in a rearmost and uppermost position in the fossae of the temporomandibular joint.

Contact Area The area where two adjacent teeth approximate.

Convenience Form

The shape or form of a cavity preparation that allows adequate observation, accessibility, and ease of operation in preparing and restoring the cavity.

Convergence The angle of opposing cavity walls which, when projected in a gingival to occlusal direction, would meet at a point some distance occlusal to the occlusal or incisal surface.

Core A restoration associated with a cast restoration which replaces all coronal tooth structure and is usually associated with a post of one type or another. The core provides resistance and retention form for the subsequent cast restoration.

Crown Cast-metal restoration or porcelain restoration covering most of the surfaces of an anatomical crown.

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Cusp (functional) Those cusps of teeth which by their present occlusion, provide a centric stop which intercuspates with a fossa or marginal ridge of an opposing tooth/teeth.

Cusp (non-functional)

Those cusps of teeth which by their present occlusion, do not provide a centric stop which intercuspates with a fossa or marginal ridge of an opposing tooth/teeth.

Debris Scattered or fragmented remains of the cavity preparation procedure. All debris should be thoroughly removed from the preparation before the restoration is placed.

Decalcification Demineralized area of enamel that may appear white and chalky or may be discolored. It is considered unsound tooth structure if it can be penetrated by an explorer or is more than ½ the thickness of the enamel.

Defective Restoration

Any dental restoration which is judged to be causing or is likely to cause damage to the remaining tooth structure if not modified or replaced.

Dentin Calcified tissue surrounding the pulp and forming the bulk of the tooth.

Deposits - subgingival

Deposits which are apical to the gingival margin.

Deposits - supragingival

Deposits which are coronal to the gingival margin.

Divergence The angle of opposing cavity walls which, when projected in an occlusal to gingival direction, would meet at a point some distance gingival to the crown of the tooth.

Embrasure A “V” shaped space continuous with an interproximal space formed by the point of contact and the subsequent divergence of these contacting surfaces in an occlusal (incisal), gingival, facial or lingual direction.

Enameloplasty The selected reshaping of the convolutions of the enamel surface (fissures and ridges) to form a more rounded or “saucer” shape to make these area more clean able, finish able, and allow more conservative cavity preparation external outline forms.

Erosion Abnormal dissolution of tooth substance by chemical substances. Typically involves exposed cementum at the CEJ.

Exposure

Finish Line

See “Pulp Exposure”

The terminal portion of the prepared tooth

Fissure A developmental linear fault in the occlusal, buccal or lingual surface of a tooth, commonly the result of the imperfect fusion of adjoining enamel lobes.

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Flash Excess restorative material extruded from the cavity preparation extending onto the unprepared surface of the tooth.

Foundation See Build Up

Gingival Recession

The visible apical migration of the gingival margin, which exposes the CE junction and root surface.

Gingival wall An internal cavity surface perpendicular to the long axis of the tooth near the apical or cervical end of the crown of the tooth or cavity preparation.

Gingivitis Inflammation of the gingiva

Glass Ionomer Material containing polyacrylic acid and aluminosilicate glass that can be used as restorative, lining or luting material.

Grainy The rough, perhaps porous, poorly detailed surface of a material.

Ill-defined A cavity preparation which, while demonstrating the fundamentals of proper design, lacks detail and refinement in that design.

Infra-occlusion A tooth or restoration which lacks opposing tooth contact in centric when such contact should be present.

Interproximal contact

The area of contact between two adjacent teeth; also called proximal contact.

Isthmus A narrow connection between two areas or parts of a cavity preparation.

Keratinized Gingiva

In healthy mouths, this includes both the free marginal and attached gingiva which are covered with a protective layer of keratin. It is the masticatory oral mucosa which withstands the frictional stresses of mastication and toothbrushing; and provides a solid base for the movable alveolar mucosa for the action of the cheeks, lips and tongue.

Line angle The angle formed by the junction of two surfaces. In cavity preparations there can be internal and external line angles which are formed at the junction of two cavity walls.

Line of draw The path or direction of withdrawal or seating of a removable or cast restoration.

Liner Resin or cement coating of minimal thickness (usually less than 0.5 mm) to achieve a physical barrier and/or therapeutic effect (a chemical effect that in some way benefits the health of the tooth pulp). Examples include Dycal, Life, Cavitec, Hydroxyline, Vitrebond, and Fuji Lining LC.

Liner - treatment An appropriate dental material placed in deep portions of a cavity preparation to produce desired effects on the pulp such as insulation, sedation, stimulation of odontoblasts, bacterial reduction, etc. Also called therapeutic liner.

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Long axis An imaginary straight line passing through the center of the whole tooth occlusoapically.

Marginal deficiencies

Failure of the restorative material to properly and completely meet the cut surface of the cavity preparation; the marginal discrepancy does not exceed .5 mm, and the margin is sealed. May be either voids or under-contour.

Marginal excess Restorative material which extends beyond the cavosurface margin of the cavity walls. Marginal excess may or may not extend onto the unprepared surface(s) of the tooth. See also: over-contoured, flash, over-extension.

Mobility The degree of looseness of a tooth.

Occluso-axial line angle

In a casting preparation, the angle formed by the junction of the prepared occlusal and axial (lingual, facial, mesial, distal) surfaces.

Open margin A cavity margin or section of margin at which the restorative material is not tightly adapted to the cavity preparation wall(s). Margins are generally determined to be open when they can be penetrated by the tine of a sharp dental explorer.

Outline Form (external)

The external boundary or perimeter of the area of the tooth surface to be included within the outline or enamel margins of the finished cavity preparation

Outline Form (internal)

The internal details and dimensions of the finished cavity preparation.

Over-contoured Excessive shaping of the surface of a restoration so as to cause it to extend beyond the normal physiologic contours of the tooth when in health.

Over-extension (preparation)

The placement of final cavity preparation walls beyond the position required to properly restore the tooth as determined by the factors which necessitated the treatment.

Over-extension (restoration)

Restorative material which extends beyond the cavosurface margin of the cavity walls. Marginal excess may or may not extend onto the unprepared surface(s) of the tooth. See also; Over-contoured, Flash, Marginal excess.

Overhang (restoration)

The projection of restorative material beyond the cavosurface margin of the cavity preparation but which does not extend on to the unprepared surface of the tooth; also, the projection of a restoration outward from the nominal tooth surface. See also Flash.

Path of insertion The path or direction of withdrawal or seating of a removable or cast restoration. See Line of Draw.

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Periapical Area around the root end of a tooth.

Periodontitis Inflammation of the supporting tissues of the teeth. Usually a progressively destructive change leading to loss of bone and periodontal ligament. An extension of inflammation from gingiva into the adjacent bone and ligament.

Pits (surface) Small voids on the polished surface (but not at the margins) of a restoration.

Polishing (restoration)

The act or procedure of imparting a smooth, lustrous, and shiny character to the surface of the restoration

Pontic The suspended portion of a fixed bridge that replaces the lost tooth or teeth.

Porous (restoration)

To have minute orifices or openings in the surface of a restoration which allows fluids or light to pass through.

Provisional restoration

Any restoration, which by it’s intent, is placed for a reduced period of time or until some event occurs. Any restorative material can be placed as a provisional restoration. It is only the intent of the restoration and not the material which determines the provisional status.

Pulp cap (direct) The technique of placing a base over the exposed pulp to promote reparative dentin formation and the formation of a dentinal bridge across the exposure. The decision to perform a pulp cap or endodontics and the success of the procedure is determined by the conditions under which the pulp was exposed.

Pulp cap (indirect) The technique of deliberate incomplete caries removal in deep excavation to prevent frank pulp exposure followed by basing of the area with an appropriate pulpal protection material to promote reparative dentin formation. The tooth may or may not be re-entered in 6-8 weeks to remove the remaining dentinal caries.

Pulp exposure (carious)

The frank exposure of the pulp through clinically carious dentin.

Pulp exposure (general)

The exposure of the pulp chamber or former pulp chamber of a tooth with or without evidence of pulp hemorrhage.

Pulp exposure (irreparable)

Generally, a pulp exposure in which most or all of the following conditions apply: The exposure is greater than 0.5 mm; the tooth had been symptomatic; the hemorrhage is not easily controlled; the exposure occurred in a contaminated field; the exposure was relatively traumatic.

Pulp exposure (mechanical) (unwarranted)

The frank exposure of the pulp through non-carious dentin caused by operator error, misjudgment, pulp chamber aberration, etc.

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Pulp exposure (reparable)

Generally, a pulp exposure in which most or all of the following conditions apply: the exposure is less than 0.5 mm; the tooth had been asymptomatic; the pulp hemorrhage is easily controlled; the exposure occurred in a clean, uncontaminated field; the exposure was relatively atraumatic.

Pulpal wall An internal cavity surface perpendicular to the long axis of the tooth. Also pulpal floor.

Pulpoaxial line angle

The line angle formed by the junction of the pulpal wall and axial wall of a prepared cavity.

Pulpotomy The surgical amputation of the vital dental pulp coronal to the cementoenamel junction in an effort to retain the radicular pulp in a healthy, vital state.

Resistance Form The features of a tooth preparation that enhance the stability of a restoration and resist dislodgement along an axis other than the path of placement.

Retention Form The feature of a tooth preparation that resists dislodgment of a crown in a vertical direction or along the path of placement.

Root planing A definitive treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microoganisms.

Scaling Instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces.

Surface Sealant - composite resin restoration coating

After polishing, the application of the unfilled resin (bonding agent) of the composite resin system to the surface of the restoration to fill porosities or voids in the body of the restoration or at the margins or to provide a smooth surface to the restoration followed by curing.

Sealers

Cavity sealers provide a protective coating for freshly cut tooth structure of the prepared cavity. a. Varnish: A natural gum, such as copal rosin, or a synthetic resin

dissolved in an organic solvent, such as acetone, chloroform, or ether. Examples include Copalite, Plastodent, Varnish, and Barrier.

b. Resin Bonding Agents: Include the primers and adhesives of dentinal and all-purpose bonding agents. Examples include All-Bond 2, Scotchbond MP+, Optibond, ProBond, Amalgambond, etc.

Shade (restoration)

The color of a restoration as defined by hue, value, and chroma which is selected to match as closely as possible the natural color of the tooth being restored.

Shoulder Preparation

Finish line design for tooth preparation in which the gingival floor meets the external axial surfaces at approximately a right angle.

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Sonic scaler An instrument tip attached to a transducer through which high frequency current causes sonic vibrations (approximately 6,000 cps). These vibrations, usually accompanied by the use of a stream of water, produce a turbulence which in turn removes adherent deposits from the teeth.

Sound Tooth Structure

Enamel that has not been demineralized or eroded; it may include proxi-mal decalcification that does not exceed ½ the thickness of the enamel and cannot be penetrated by an explorer.

Stain - Extrinsic Stain which forms on and can become incorporated into the surface of a tooth after development and eruption. These stains can be caused by a number of developmental and environmental factors.

Stain - Intrinsic Stain which becomes incorporated into the internal surfaces of the developing tooth. These stains can be caused by a number of developmental and environmental factors.

Sterilization A heat or chemical process to destroy microorganisms.

Straight-line Access

Supra-occlusion

An access preparation that allows for an unimpeded path from the occlusal surface to the apex or to the first point of canal curvature.

A tooth or restoration which has excessive or singular opposing tooth contact in centric or excursions when such contact should not be present and should be balanced with the other contacts in the quadrant or arch.

Taper To gradually become more narrow in one direction

Temporary restoration

See Provisional Restoration.

Tissue Trauma Transported Canal

Unwarranted iatrogenic damage to extra/intraoral tissues resulting in significant injury to the patient, such as lacerations greater than 3mm, burns, amputated papilla, or large tissue tags.

The prepared root canal is over-instrumented, causing deviation from the natural pathway of the anatomical canal.

Ultrasonic scaler An instrument tip attached to a transducer through which high frequency current causes ultrasonic vibrations (approximately 30,000 cps). These vibrations, usually accompanied by the use of a stream of water, produce a turbulence which in turn removes adherent deposits from the teeth.

Uncoalesced The failure of surfaces to fuse or blend together such as the lobes of enamel resulting in a tooth fissure.

Under-contoured Excessive removal of the surface of a restoration so as to cause it to be reduced beyond the normal physiologic contours of the tooth when in health.

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Undercut a. Feature of tooth preparation that retains the intra-coronal restorative material.

b. An undesirable feature of tooth preparation for an extra-coronal restoration.

Under-extension (preparation)

Failure to place the final cavity preparation walls at the position required to properly restore the tooth as determined by the factors which necessitated the treatment.

Under-extension (restoration)

Restorative material which fails to extend to the cavosurface margin of the cavity walls thereby causing exposure of the prepared cavity wall.

Undermined enamel

During cavity preparation procedures; an enamel tooth surface (particularly enamel rods) which lacks dentinal support. Also called unsupported enamel.

Unsound Marginal Enamel

Loose or fragile cavosurface enamel that is usually discolored or demineralized, which can be easily removed with hand instruments when mild to moderate pressure is applied.

Varnish See Sealers

Void(s) An unfilled space within the body of a restoration or at the restoration margin which may or may not be present at the external surface and therefore may or may not be visible to the naked eye.

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Exam Site____________________________

Central Regional Dental Testing Service, Inc.

T R E A T M E N T C O N S E N T F O R M DENTAL EXAMINATION

Fill in the Candidate name below after the examination is over and before you turn in your packet.

I, __________________________________________________, authorize Candidate #________________, Candidate Name

(added later) __________________________________, a dental examinee and whomever the dental examinee may designate

as an assistant or assistants, to perform upon myself the following dental procedure(s):

Amalgam Preparation and Restoration Composite Preparation and Restoration Periodontal Treatment (Scaling, Supragingival Deposit Removal, Periodontal Measurements)

I understand that the dental examinee may not be a licensed dentist. I further understand that such procedure(s) will be performed by the examinee as part of an examination conducted to determine the qualification of the dental examinee for licensure. I recognize that medical information which could be pertinent to the oral health care I receive in the course of the examination may be communicated to examiners.

The nature and purpose of the dental procedure(s) as well as the risks and possible complications have been explained to me. My questions with regard to the dental procedure(s) have been answered. I acknowledge that no guarantee or warranty has been made as to the results to be obtained. I understand that the treatment provided during the examination does not necessarily fulfill all my oral health needs or represent my entire treatment plan, and that further restorative and/or periodontal treatment may be necessary. I have been informed of the availability of services to complete treatment.

I understand that if I am taking certain medications (as indicated on the Medical History form) that are associated with chronic conditions following dental treatment, I may not be accepted as a patient for this examination. Patients who are taking oral bisphosphonate medications may be at risk for oral osteochemonecrosis of the jaws after dental treatment or as a result of dental infections.

I consent to the taking of appropriate radiographs (X-Rays) and dental examinations.

I consent to having CRDTS examiners or school personnel take photographs of my teeth and gums for use in future examiner calibration provided my name is not in any way associated with these photographs.

I understand that as a part of the dental procedure(s), it may be necessary to administer anesthetics and I consent to the use of such anesthetics by the dental examinee.

_____________________________________ DATE _______________________________ 20_______. Patient's Signature ___________________________________________________________ ( )_____________________

Patient's Address, City, State, Zip Patient’s Phone

This form may be copied as necessary for each patient utilized in the examination.

Candidate Number

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103

104

105

106

107

108

109

110

111

112

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I N D E X

Amalgam Procedure, 56 Analgesia, 43 Anesthetic Record, 43, 52

Premedication, 43 Application, 45

Policies, 80 Auxiliary Personnel, 24, 44

Candidate Assistants, 18 Bases, Liners, Varnishes, 10, 58

Criteria defined, 59 Blood Pressure Requirements, 46 Candidate

Disabled, 87 Cast Metal Crown Preparation, 6, 23 Check-Out Procedure, 79 Class II Procedure, 57, 58 Class III Procedure, 60 Clinic Floor Examiner (CFE), 27 Communications

Instructions from Examiners, 43 Instructions to Candidate, 56 Progress Sheet, 18, 21, 27, 43, 52, 53, 58, 79

Complaint Review Process, 86 Composite Procedure, 56 Content of Examination

Outline, 6 CRDTS Status, 3 Criteria

Endodontics Anterior, 28 Posterior, 31, 62

Periodontal Examination, 48 Prosthodontic

Cast Gold Crown, 35 Ceramic Crown, 38 Porcelain-fused-to-metal, 33

Restorative Posterior Composite, 66, 70

Endodontic Examination, 25 Endodontics

Treatment, 26 Ethics Policy, 2

Evaluation Criteria, 45 Evaluation Station, 56, 57, 58 Examination

Fees, 79, 80 Guidelines, 19 Standards, 10 Violation of Guidelines, 22

Examination Guidelines, 21 Examination Parts

Outline & Overview, 6 PARTS IV & V-Periodontal & Restorative, 41 Schedule, 15

Examination Process Final Evaluation, 47

Examination Standards, 18 Examiners, 4 Floss

Standardized, 51 Follow-Up, 22 Format

Exam, 4 Forms

Examination, 99 Gingival Recession, 50 Glossary, 90 Health History, 47

Medical Clearance, 42 Indirect pulp cap, 59 Infection Control, 20, 24, 44, 46, 47

Manikin Procedures, 24 Instrument Requirements, 50 Instruments, 46, 47

Checklist, 89 Periodontal Requirements, 20 Restorative Requirements, 51

Insurance Liability, 82

Legal Consent, 43 Local Anesthesia, 20 Manikin Procedures, 10, 23

Crown Preparations, 27 Endodontics, 25

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Typodont, 25, 26 Margins

Prosthodontic Procedures, 27 Medical History, 46, 56 Modification Requests, 53 Orientation, 12, 13, 14, 15 Patient Acceptability, 47 Patient Acceptability Requirements, 41 Patient Check-In, 47 Patient Selection, 41, 45 Patient-based Procedures, 41 Patient-Based Requirements, 10, 79 Penalties, 9, 11, 22

Deductions, 9, 10 Periodontal Examination, 41

Guidelines, 45 Instruments, 45

Periodontal Measurements, 47, 49 Progress Folder, 47 Progress Sheet. See Communications Prosthodontic Examination, 26 Radiographic Requirements, 52

Digital, 44 Radiographs, 21, 24, 46

Pre-Op Requirements, 45 Re-examination, 81, 83 Remediation, 84 Requests for Modifications. See Modification

Requests

Restorative Examination, 44 Radiographic Requirements, 52

Post-op, 51 Requirements, 51

Rubber Dam, 26 Rubber Dam Requirements, 56 Scaling, 50 Schedule

CIF Format, 12 Trad Format, 14

Scores, 85 Distribution, 1 Penalty Deductions, 9 Scoring System, 7 Voided, 10

Simulated Patient Treatment Clinical Exercise, 13, 14, 15

Test Development, 4 Test Site, 3, 79, 88 Tissue Management, 50 Tooth

Damage to Adjacent, 10, 24 Treatment Plan

Individualized, 22 Treatment Selection, 21, 49 Treatment Selection Worksheet, 46 Treatment Selections Restorative, 51 Typodont Requirements, 23