The National Dental Examining Board of Canada Le Bureau National dExamen Dentaire du Canada

EQUIVALENCY PROCESS

ASSESSMENT OF CLINICAL SKILLS

PROTOCOL

June 8 & 9, 2013

The National Dental Examining Board of Canada Le Bureau National dExamen Dentaire du Canada

TABLE OF CONTENTS
PAGE

CONTENT AND FORMAT ...................................................................................................... 1 SCHEDULE ............................................................................................................................... 1 VALIDATION OF REGISTRATION ....................................................................................... 2 ASSESSMENT REQUIREMENTS .......................................................................................... 2 EQUIPMENT, INSTRUMENTS AND SUPPLIES .................................................................. 3 INSTRUCTIONS ....................................................................................................................... 3 REGULATIONS ........................................................................................................................ 7 EVALUATION CRITERIA ...................................................................................................... 8 GRADE DERIVATION GRID FOR INDIVIDUAL REQUIREMENTS .............................. 21 FINAL RESULT GRADE DERIVATION GRID ................................................................... 21 RESULTS................................................................................................................................. 22 APPEAL ................................................................................................................................... 22 REPEATS................................................................................................................................. 22

1 ASSESSMENT OF CLINICAL SKILLS

CONTENT AND FORMAT During the two day Assessment of Clinical Skills, participants will be evaluated on their performance of dental procedures on simulated patients (manikins) in a clinical setting. Each day participants will receive a 1. typodont mounted in a manikin on a dental chair. The typodont will be labelled with the participants ID number. list of teeth for practice preparations. detailed list of required procedures specifying tooth numbers and surfaces. scheduled time to perform the Rubber Dam Requirement (1/2 of participants). Participant Communication form which may be used to provide comments to Evaluators.

2. 3. 4. 5.

II

SCHEDULE DAY 1 Validation of registration Orientation and instructions Set up Clinical procedures on simulated patients DAY 2 Validation of registration Set up Clinical procedures on simulated patients * 7:30 a.m. - 8:00 a.m. 8:00 a.m. 8:30 a.m. 8:30 a.m. - 4:30 p.m.* 7:30 a.m. - 8:00 a.m. 8:00 a.m. - 8:30 a.m. 8:30 a.m. - 9:00 a.m. 9:00 a.m. - 4:30 p.m.*

Participants who are scheduled for their Rubber Dam requirement will finish one half hour later.

III

VALIDATION OF REGISTRATION During the validation of registration, participants will be issued an Identification (ID) badge. To receive the ID badge, participants will be required to show current government photo identification (i.e. a current passport or drivers licence) for comparison to the ID badge. The participants name on the government photo identification must match the name used by the participant to register with the NDEB for the Equivalency Process. Participants who do not provide government photo identification will not be admitted. Participants must have their ID card and ID badge visible at all times and must submit them as directed at the end of the Assessment. Participants who fail to submit their ID card and ID badge may receive an E for all requirements in the Assessment.

IV

ASSESSMENT REQUIREMENTS Participants will be required to perform the following procedures: Class II amalgam preparation. Class III composite resin preparation. Full metal crown preparation. Metal-ceramic (porcelain fused to metal) crown preparation. Endodontic access preparation on a molar tooth. Direct Class II composite resin restoration on a pre-prepared* tooth Direct Class IV composite resin restoration on a pre-prepared* tooth Class II amalgam restoration on a pre-prepared* tooth Provisional crown restoration for a pre-prepared* metal-ceramic (porcelain fused to metal) crown preparation on Day 2 of the Assessment. The original unprepared tooth will be in the typodont used on Day 1 of the Assessment. Rubber dam application Participants will also be evaluated on the following: Record keeping. Infection control and material hygiene. * a pre-prepared tooth will be supplied.

EQUIPMENT, INSTRUMENTS AND SUPPLIES The dental clinic at the Assessment Centre will provide the following items: A typodont mounted in a manikin on a dental chair An overhead dental operating light An operator stool Amalgamators Saliva ejectors Air/water syringe tips High speed suction tips Amalgam waste and sharps disposal containers Participants must supply ALL OTHER equipment, instruments and supplies needed to complete the required procedures, including but not limited to: Handpieces and burs Curing lights All restorative materials including amalgam, composite resin and provisional crown materials Gloves, masks, protective eyewear and appropriate clinic attire Dental hand instruments Rubber dam, frames, clamps, forceps and dental floss Materials to place and finish restorative materials (matrix bands, matrix holders, wedges polishing supplies, etc.) Information regarding handpiece configuration (connectors) at each centre will be forwarded to participants prior to the Assessment. The dental clinic at the Assessment Centre will not be accessible prior to the Assessment.

VI

INSTRUCTIONS 1. At the beginning of each day, the list of requirements for that day will be distributed. Participants may perform the requirements for the day in any order, except for the application of the rubber dam, which will have an assigned time for each participant. It is not necessary to use rubber dam to perform any of the other requirements. 2. Participants are not permitted to remove teeth from typodonts, nor are they permitted to remove typodonts from the manikins. 3. Participants are not permitted to have extra typodont teeth in the Assessment area. 4. Interocclusal openings on typodonts will be pre-set. Participants must not alter the pre-set openings.

5. Participants must wear appropriate clinic attire, including eye protection, masks and gloves. Open toed shoes are not allowed. 6. Participants may use magnification aids and may take breaks whenever needed. 7. Participants who start or complete a procedure other than an identified requirement on an identified tooth or practice tooth will receive an E for that requirement. During the Assessment, participants must demonstrate competency in performing procedures in a clinical environment. Although there are no criteria for evaluating the posture of a participant, procedures must be performed in anatomically acceptable positions. Examples of unacceptable positions include: the manikins head positioned so that a patient would be uncomfortable the manikins neck extended so that a patient would be uncomfortable the participant leaning on or inappropriately contacting the patients torso or head. Invigilators will direct participants to correct unacceptable positions. Any participant who continues to work with the manikin in an unacceptable position may be dismissed from the Assessment and receive an E for all requirements. 9. Participants must leave their work areas clean at the end of each day. Any participant who does not do so may receive an E for all requirements.

8.

10. Participants must manage excess amalgam appropriately. Any participant who does not do so may be dismissed from the Assessment and receive an E for all requirements. 11. Participants are responsible for their own instruments and supplies. The NDEB and the Assessment Centre will not be held responsible for instruments or personal supplies left unattended. 12. Participants are financially responsible for any damage caused to any supplied equipment. 13. The NDEB uses the series 200 typodont and simulated teeth from Kilgore International (www.kilgoreinternational.com - 1-800-892-9999). i. Series A21-200 pre-prepared teeth will be provided for the: Class II Amalgam Restoration Class IV Composite Resin Restoration Class II Composite Resin Restoration Provisional Crown Restoration

ii.

Series S12-200 teeth with simulated enamel, dentin and pulp will be provided for the: Endodontic Access Preparation Simulated enamel and dentin: The simulated enamel and dentin in the crown of the teeth are white in colour and are made of a uniform composite resin material with no demarcation between the simulated enamel and dentin. The simulated dentin in the root of the teeth is made of clear resin. The teeth have been manufactured so that procedures may be performed using normal pressure with a dental bur and, if desired, finishing can be done using normal pressure with sharp hand instruments. Fractures may occur if an attempt is made to remove a large section of tooth structure or if excessive force and/or dull instruments are used. Simulated pulp chamber and canals: The simulated dental pulp chamber and canals are hollow spaces lined with red colouring.

iii.

Series A22-200 with simulated enamel, dentin and pulp will be provided for the: Full Metal Crown Preparation Metal-ceramic Crown Preparation Simulated enamel: The simulated enamel is white in colour and is made of composite resin that is harder than the simulated dentin. The teeth have been manufactured so that procedures may be performed using normal pressure with a dental bur and, if desired, finishing can be done using normal pressure with sharp hand instruments. Fractures may occur if an attempt to remove a large section of enamel is made or if excessive force and/or dull instruments are used. Simulated dentin: The simulated dentin is light beige and is softer than the simulated enamel. Simulated pulp chamber and canals: The simulated dental pulp chamber and canals are hollow spaces lined with red colouring. Participants are cautioned not to use mechanical tooth separators and not to be aggressive with the use of interproximal wedges, as these may cause fractures to the simulated teeth.

iv.

Series A27-200 teeth with simulated enamel, dentin and caries will be provided for the: Class II Amalgam Preparation Class III Composite Resin Preparation Simulated enamel: The simulated enamel is white in colour and is made of composite resin that is harder than the simulated dentin and simulated caries. The teeth have been manufactured so that procedures may be performed using normal pressure with a dental bur and, if desired, finishing can be done using normal pressure with sharp hand instruments. Fractures may occur if an attempt to remove a large section of enamel is made or if excessive force and/ or dull instruments are used. Simulated dentin: The simulated dentin is yellow in color and is softer than the simulated enamel.

Simulated caries: The simulated caries in dentin is dark brown in colour and is softer than the simulated enamel but is of similar hardness to the simulated dentin. In anterior teeth, there is also a cavitation (hole) in the simulated enamel on the proximal surface. This cavitation extends through the simulated enamel into the simulated dentin and must be included as part of the preparation. Participants are cautioned not to use mechanical tooth separators and not to be aggressive with the use of interproximal wedges, as these may cause fractures to the simulated teeth. The manufacturing process for teeth with simulated caries ensures that caries depth and extent is standardized for each tooth used as part of the Assessment. As a result of the manufacturing process, there may be a small cement-filled space between the simulated enamel and the simulated dentin which may appear grey in colour. This is not simulated caries. Please Note: The use of metal hand instruments in cavity preparations will leave a grey stain. 14. The FDI two digit tooth numbering system (below) is used for all Assessments.
FDI NUMBERING SYSTEM PERMANENT DENTITION
1.8 4.8 1.7 4.7 1.6 4.6 1.5 4.5 1.4 4.4 1.3 4.3 1.2 4.2 1.1 4.1 2.1 3.1 2.2 3.2 2.3 3.3 2.4 3.4 2.5 3.5 2.6 3.6 2.7 3.7 2.8 3.8

RIGHT PRIMARY DENTITION

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

LEFT

RIGHT

LEFT

7 VII REGULATIONS 1. Participants must be punctual for both days of the Assessment. Participants arriving late for an Assessment may not be admitted. Family or friends must not accompany participants as space at the Assessment centre is provided ONLY for participants and staff. Participants must not bring devices with recording abilities, radios, cameras, cell phones, pagers or other electronic aids/devices into the Assessment room. Participants may not use dictionaries, calculators or other informative material. Participants may have printed copies of the Assessment of Clinical Skills Protocol in the clinic. Food and/or drink (including water) are not allowed in the Assessment room unless special consideration for medical reasons has been granted by the NDEB office. The request must include a medical certificate signed by a physician indicating the diagnosis and accommodation measures required. The ability of participants to read, interpret and comply with instructions and other written material is part of the Assessment. Assessment Supervisors and Invigilators will not answer questions involving content. Participants requiring special Assessment accommodation, including accommodation due to a diagnosed medical condition must request special consideration in writing to the NDEB office within two (2) weeks of the Registration deadline date. The request must include original documentation indicating the accommodation measures required. Additional supporting documentation may be requested by the NDEB office. Participant Communication forms must be completed within the Assessment session time. Additional time will not be allowed. Participants must stop working at the indicated ending time. Participants must exit the clinic when asked to by Invigilators at the indicated ending time. Participants must abide by the above Regulations. Participants who do not do so may be given an E for all requirements that day. A participant who considers themself disadvantaged by a personal circumstance beyond the participants control, occurring either immediately before or during the Assessment may, within one week of this personal circumstance occurring, request that the NDEB make a special consideration to void the results of the Assessment. The NDEB may grant permission for the participant to withdraw from the Assessment. The participant may also request special consideration for a refund of up to 50% of the Assessment fee.

2.

3.

4.

5.

6.

7.

8.

9. 10. 11.

12.

8 VIII Evaluation Criteria

Class II Amalgam Preparation The criteria below describe a preparation for a tooth with minimal caries. Evaluation of preparations will consider the extent of caries present. Score External Outline Form Internal Form Finish Proximal and/or gingival margins clear adjacent teeth 0.5mm or Optimal resistance and retention form Smooth cavosurface A+
less - Gingival margin supragingival - Optimal buccal-lingual width based on location and extent of caries present - No damage to adjacent teeth, Assessment tooth beyond preparation or gingiva based on location and extent of caries present with no unnecessary removal of internal tooth structure - Gingival and occlusal floors parallel to occlusal plane - All internal line angles rounded - Minor overpreparation occlusally - Minor overpreparation axially margins - All unsupported enamel removed - No debris or caries (infected dentin)

- Adjacent tooth cleared 0.5 - 1.0mm - Minor overextension - Minor damage to adjacent tooth corrected by enameloplasty - Minor damage to Assessment tooth beyond preparation margin corrected by enameloplasty - Proximal margin not cleared - Proximal margin cleared 1.0 - 1.5mm - Proximal wall flared - Gingival margin at gingiva - Unacceptable isthmus junction - Unacceptable buccal-lingual width - Minor damage to adjacent tooth - Minor damage to Assessment tooth beyond preparation margin - Minor damage to gingiva - Proximal margin cleared > 1.5mm - Gingival margin subgingival - Significant overextension - Significant underextension - Major damage to adjacent tooth - Major damage to Assessment tooth beyond preparation margin - Major damage to gingiva

- Small area of roughness

- Pulpal floor too deep 2.5 - 3.0mm - Pulpal floor too shallow 1.0 - 1.5mm - Axial wall too deep 1.5 - 3.0mm - Axial wall too shallow < 0.5mm - Unnecessary removal of tooth structure - Divergent walls - Sharp line angle - Undefined line angle - Additional retention required - Pulpal floor too deep > 3.0mm - Pulpal floor too shallow < 1.0mm - Axial wall too deep > 3.0mm - Excessive overpreparation. Alternate design or RCT required

- Unacceptable roughness - Unacceptable unsupported enamel - Presence of debris

- Gross roughness - Grossly unsupported enamel - Caries remaining on axial or pulpal - Caries remaining at dentinoenamel junction

Class III Composite Preparation The criteria below describe a preparation for a tooth with minimal caries. Evaluation of preparations will consider the extent of caries present. Score External Outline Form Internal Form Finish Optimal extension based on location and extent Optimal resistance and retention form based on Smooth cavosurface margin A+
of caries present - Gingival margin supragingival - No damage to adjacent teeth, Assessment tooth beyond preparation or gingiva extent of caries present with no unnecessary removal of tooth structure - All internal line angles rounded - No debris or caries (infected dentin)

- Minor overextension - Minor damage to adjacent tooth corrected by enameloplasty - Minor damage to Assessment tooth beyond preparation margin corrected by enameloplasty - Underextended < 0.5mm - Overextended < 0.5mm - Gingival margin at gingiva - Minor damage to adjacent tooth - Minor damage to Assessment tooth beyond preparation margin - Minor damage to gingiva - Overextended > 0.5mm - Cavitation not included - Gingival margin subgingival - Major damage to adjacent tooth - Major damage to Assessment tooth beyond preparation margin - Major damage to gingiva

- Minor overpreparation

- Minor roughness

- Too deep 2.0 - 3.0mm - Unnecessary removal of internal tooth structure

- Unacceptable roughness - Presence of debris

- Too deep > 3.0mm - Excessive overpreparation. Alternate design or RCT required

- Caries remaining on axial or pulpal - Caries remaining at dentinoenamel junction

10 Full Metal Crown Preparation Appropriateness of occlusal clearance will be measured from opposing teeth in maximal intercuspation and excursions. Score Path of Draw and Axial Preservation of Tooth Vitality & Structural Finish and Margin Convergence Durability - Margin optimally placed, defined, smooth and - Optimal path of insertion - Optimal preparation has been performed to permit A+
- No undercuts - Axial convergence 6 - 10 fabrication of a functional restoration - Axial reduction 0.5 1.0mm - Occlusal clearance 1.5mm - Margin width 0.5mm - No sharp angles - No damage to adjacent teeth - Axial reduction 1.0-1.5mm - Occlusal clearance >1.0 but < 1.5mm or >1.5 but < 2.0mm - Minor damage to adjacent tooth corrected by enameloplasty - Axial reduction < 0.5mm - Occlusal clearance 0.5 1.0mm or 2.0 3.0mm - Sharp cusps - Sharp line angles - Minor damage to adjacent tooth identifiable - Margin smooth, continuous and has no steps - Positioned 0.5mm supragingival - Preparation walls are smooth - No damage to gingiva

- Minor undercuts. Manageable by lab. - Axial convergence 10 - 20

- Margin continuous with minor irregularity - Located supragingival < 0.5mm or 0.6 - 1.0mm - Located subgingival < 0.5mm

- Will not draw. Modification required. - Axial convergence 20 - 25

- Indistinct, discontinuous or rough - Located supragingival 1.0 - 2.0mm - Located sub-gingival 0.5 - 1.0mm - Incorrect form - Unsupported enamel (lipping) - Unacceptable roughness of axial walls - Minor damage to gingiva - Grossly indistinct, discontinuous or rough - No discernible margin - Located supragingival > 2.0mm - Located subgingival > 1.0mm - Grossly unsupported enamel (lipping) - Major damage to gingiva

- Will not draw. Major modification required. - Axial convergence >25

- Axial reduction no reduction or >1.5mm - Occlusal clearance < 0.5 or > 3.0mm - Pulp exposure - Major damage to adjacent tooth - Alternative preparation or RCT needed

11 Metal-ceramic Crown Preparation Appropriateness of occlusal clearance will be measured from opposing teeth in maximal intercuspation and excursions. Score Path of Draw and Axial Preservation of Tooth Vitality & Structural Finish & Margin Convergence Durability - Margin is optimally placed, defined, smooth and - Optimal path of insertion - Optimal preparation has been performed to permit the A+
- No undercuts - Axial convergence 6 - 10 fabrication of an esthetic and functional restoration - Reduction: Buccal, mesial, distal 1.2mm Lingual 0.5mm - Incisal /occlusal clearance 2.0mm - Width of margin: Buccal 1.2mm - 1.5mm Lingual 0.5mm - Preparation is smooth and has no sharp areas - No damage to adjacent teeth - Axial reduction: Buccal, mesial, distal 1.2 - 1.5mm Lingual 0.3 1.0mm - Incisal/occlusal clearance 2.1- 2.5mm - Minor damage to adjacent tooth corrected by enameloplasty - Axial reduction: Buccal, mesial, distal 0.5 - 1.1mm or 1.5 - 2.5mm Lingual < 0.3mm or 1.0 1.5mm - Incisal/occlusal clearance 1.0 2.0mm or 2.5 - 3.0mm - Sharp cusps - Sharp line angles - Minor damage to adjacent tooth identifiable - Margin is smooth, continuous and has no steps - Margin positioned 0.5mm supragingival - Preparation walls are smooth - No damage to gingiva

- Minor undercuts. Manageable by lab - Axial convergence 10- 20

- Margin continuous with minor irregularity - Located supragingival < 0.5mm or 0.6 - 1.0mm - Located subgingival < 0.5mm

- Will not draw. Modification required - Axial convergence 20 - 25

- Indistinct, discontinuous or rough - Incorrect form - Unsupported enamel (lipping) - Located supragingival 1.0 2.0mm - Located subgingival 0.5 - 1.0mm - Unacceptable roughness on axial wall - Minor damage to gingiva

- Will not draw. Major modification of tooth required - Axial convergence > 25

- Axial reduction: Buccal, mesial, distal < 0.5 or > 2.5mm Lingual - no preparation or >1.5mm - Incisal/occlusal clearance < 1.0 or > 3.0mm - Major damage to adjacent teeth - Pulp exposure - Alternate preparation or RCT needed

- Grossly indistinct, discontinuous or rough - No discernible margin - Grossly unsupported enamel (lipping) - Located supragingival > 2.0mm - Located subgingival > 1.0mm - Major damage to gingiva

12

Endodontic Access Preparation Score A+ External Outline Form

- Optimal extension to obtain straight line access to all canals - Optimal removal of any unsupported structures - No overextension - Adequate extension to permit removal of pulp horns - Slightly underextended < 1.0mm - Slightly overextended < 1.0mm

Internal Form
- Optimal internal tooth structure removed to allow straight line access to canals - Optimally tapered access preparation walls - Canals accessed to a depth of 2.0mm

Finish
- Optimal smoothness of walls and cavosurface - No pulp material left on walls or floor of chamber - No debris

- Slightly excessive removal of internal tooth structure - Slightly inadequate taper

- Smoothness not optimal - Minor pulp material present on walls or floor of chamber - Minor debris present - Inadequate smoothness - Significant pulp material present on walls or floor of chamber - Unacceptable debris present

- Underextended - obstructed access to canals - Significantly overextended 1.0 2.0mm

- Excessive removal of internal tooth structure - Inadequate taper - Gouging of tooth walls - Canal(s) not accessed to depth of 2.0mm - Over-instrumentation of canals - Grossly excessive removal of internal tooth structure - Perforation - Canal(s) not accessed - Reverse taper - Excessive gouging of walls - Excessive over-instrumentation of canals - Separated instrument in canal

- Chamber not accessed - Excessively underextended > 2.0mm - Excessively overextended > 2.0mm

- Excessive roughness - Excessive pulp material present on walls or floor of chamber - Debris obscuring chamber or canals

13 Provisional Crown Restoration Score Margin Contour and Adaptation - Margin not over/under extended A+
- Margin not over/under contoured - No excess material in/on soft tissue - No excess material on hard tissue - Preparation margin, adjacent teeth and gingiva intact

Morphology and Occlusion

- Optimal contour for gingival health, esthetics and durability - Optimal interproximal contacts - Optimal occlusal contact - Restoration can be removed - Slightly overcontoured - Slightly undercontoured - Slight infraocclusion

Polish
- Optimal polish - No roughness or porosities - Restoration material is hard setting, tooth coloured plastic resin

- Overextended < 0.5mm - Underextended < 0.5mm - Overcontoured < 0.5mm - Undercontoured < 0.5mm - Minor damage to adjacent tooth corrected by enameloplasty - Overextended 0.5 - 1.0mm - Underextended 0.5 - 1.0mm - Overcontoured 0.5 - 1.0mm - Undercontoured 0.5 - 1.0mm - Excess material in/ on soft tissue - Excess material on hard tissue - Damage to preparation margin - Minor damage to adjacent tooth - Minor damage to gingiva -- Overextended > 1.0mm - Underextended > 1.0mm - Overcontoured > 1.0mm - Undercontoured > 1.0mm - Gross amount of excessive material in/on soft tissue - Gross amount of excessive material on hard tissue - Major damage to adjacent tooth - Major damage to gingiva - Needs major revision or new provisional

- Polish not optimal

- Overcontoured - Undercontoured - Proximal contact too light - Proximal contact too occlusal - Proximal contact too gingival - Proximal contact too tight - No proximal contact < 0.5mm open - Supraocclusion <1.0mm - Infraocclusion <1.0mm - Significantly overcontoured - Significantly undercontoured - No proximal contact > 0.5mm open - Supraocclusion > 1.0mm - Infraocclusion > 1.0mm - Broken or cracked restoration - Restoration cannot be removed

- Unacceptable roughness - Porosities

- Gross roughness - Gross porosity - Inappropriate restorative material

14 Class II Composite Resin Restoration These criteria do not include shade matching, which is NOT part of the evaluation. Restoration Quality and Polish Score Margin A+
- Uniform smoothness - Uniform polish matching tooth surface - No contamination of resin (no stain or inclusions) - Junction of tooth/ restoration not detectable or slightly detectable with explorer - No excess resin past preparation margin - No damage to adjacent teeth, Assessment tooth or gingiva - Minor amount of resin beyond preparation margin - Minor damage to adjacent tooth corrected by enameloplasty - Minor damage to Assessment tooth corrected by enameloplasty

Contours and Function

- Physiologic tooth contours of occlusal and proximal surfaces optimally restored - Optimal proximal contact restored - No excess resin in/on soft tissue - No excess resin on hard tissue - Undercontoured < 0.5mm - Overcontoured < 0.5mm - Proximal contact slightly too occlusal - Proximal contact slightly too gingival - Proximal contact slightly too broad - Slight marginal ridge disharmony - Undercontoured 0.5 - 1.0mm - Overcontoured 0.5 1.0mm - Poor occlusal morphology - Light proximal contact - Proximal contact too occlusal - Proximal contact too gingival - Proximal contact too broad/concave - Proximal contact too tight/rough - Marginal ridge disharmony < 1.0mm - Excess resin in/on soft tissue - Excess resin on hard tissue - Excessive occlusal contact - Undercontoured > 1.0mm - Overcontoured > 1.0mm - Lack of physiologic contour - No proximal contact - Marginal ridge disharmony > 1.0mm - Gross amount of excess resin in /on soft tissue - Gross amount of excess resin on hard tissue - Restoration fractured or loose

- Areas needing more polish - Minor contamination of resin not affecting durability or esthetics

- Unacceptable roughness, scratches or voids - Contamination of resin that needs correction

- Deficiency/void at margin < 0.5mm - Excess resin beyond preparation margin requiring correction - Minor damage to adjacent tooth - Minor damage to Assessment tooth - Minor damage to gingiva

- Excessive roughness, scratches or voids - Excessive contamination of resin requiring replacement of entire restoration.

- Deficiency/void at margin > 0.5mm - Gross amount of excess resin beyond preparation margin - Major damage to adjacent tooth - Major damage to Assessment tooth - Major damage to gingiva

15 Class IV Composite Resin Restoration These criteria do not include shade matching, which is NOT part of the evaluation. Score Restoration Quality and Polish Margin - Junction of tooth/ restoration not detectable or slightly - Uniform smoothness A+
- Uniform polish matching tooth surface - No contamination of resin (no stains or inclusions) detectable with explorer - No excess beyond preparation margin - No damage to adjacent teeth, Assessment tooth or gingiva - Minor excess resin beyond preparation margin - Minor damage to adjacent tooth corrected by enameloplasty - Minor damage to Assessment tooth corrected by enameloplasty - Deficiency/void at margin < 0.5mm - Excess resin beyond preparation margin requiring correction - Minor damage to adjacent tooth - Minor damage to Assessment tooth - Minor damage to gingiva

Contours and Function

- Physiologic tooth contours restored - Optimal proximal contact restored - No excess resin in/on soft tissue - No excess resin on hard tissue - Appropriate occlusal contact - Undercontoured < 0.5mm - Overcontoured < 0.5mm - Proximal contact slightly too incisal - Proximal contact slightly too gingival - Proximal contact slightly too broad - Undercontoured 0.5 - 1.0mm - Overcontoured 0.5 1.0mm - Light proximal contact - Proximal contact too incisal - Proximal contact too gingival - Proximal contact too broad/ concave - Proximal contact too tight/rough - Excess resin in/on soft tissue - Excess resin on hard tissue - Excessive occlusal contact - Undercontoured > 1.0mm - Overcontoured > 1.0mm - Lack of physiologic contour - No proximal contact - Gross amount of excess resin in /on soft tissue - Gross amount of excess resin on hard tissue - Restoration fractured or loose

- Areas needing more polish - Minor contamination of resin not affecting durability or esthetics

- Unacceptable roughness, scratches or voids - Contamination of resin that requires correction

- Excessive roughness, deep scratches or excessive voids - Excessive contamination of resin requiring replacement of entire restoration.

- Deficiency/void at margin > 0.5mm - Gross amount of excess resin beyond preparation margin - Major damage to adjacent tooth - Major damage to Assessment tooth - Major damage to gingiva

16

Class II Amalgam Restoration Score Surface quality - Uniform smoothness A+ Margin

- Junction of tooth/restoration not detectable with explorer - No debris/loose amalgam in soft tissue - No damage to adjacent teeth, Assessment tooth or gingiva - Margin slightly detectable - Minor damage to adjacent tooth corrected by enameloplasty - Minor damage to Assessment tooth corrected by enameloplasty

Contours and Function

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

- Some areas of roughness

- Slightly undercontoured - Slightly overcontoured - Proximal contact slightly too occlusal - Proximal contact slightly too gingival - Proximal contact slightly too broad - Slight marginal ridge disharmony - Undercontoured < 0.5mm - Overcontoured < 0.5mm - Poor occlusal morphology - Light proximal contact - Proximal contact too occlusal - Proximal contact too gingival - Proximal contact too broad/concave - Proximal contact too tight/rough - Marginal ridge disharmony < 1.0mm - Excessive occlusal contact - Undercontoured > 0.5mm - Overcontoured > 0.5mm - No proximal contact - Marginal ridge disharmony > 1.0mm - Restoration fractured or loose

- Roughness or scratches requiring correction

- Excess amalgam at margin < 0.5mm - Debris/loose amalgam in soft tissue - Minor damage to adjacent tooth - Minor damage to Assessment tooth - Minor damage to gingiva

- Excessive roughness or scratches - Deep or excessive voids other than at margin - Restoration must be replaced because of surface quality

- Excess amalgam at margin > 0.5mm - Deficiency/void at margin requiring replacement - Grossly excessive debris/loose amalgam in soft tissue - Major damage to adjacent tooth - Major damage to Assessment tooth - Major damage to gingiva

17

Rubber Dam Application

A+

Appropriate and stable clamp Clamp secured with an appropriate length of dental floss Orientation provides an unrestricted airway Dam inverted on all isolated teeth All punch holes in appropriate positions Dam, frame and clamp positioned for optimal access, safety and moisture control and patient comfort

Dam is inverted on teeth in operative area only Minor deviations in punch hole locations Minor tears or holes not affecting moisture control in operative area Dam, frame or clamp positioning needs minor adjustment for optimal access, safety, moisture control or patient comfort

One or two of the following deficiencies: - Unnecessary trauma to gingiva or teeth - Unstable clamp - Unsecured or inadequately secured clamp - Patient airway compromised - Dam caught on wings of clamp - Inappropriate number of teeth isolated - Frame incorrectly oriented - Dam not inverted in operative area - Dam not through all interproximal contact points - Punch holes improperly positioned - Tears or holes compromising moisture control - Dam, frame or clamp positioning must be altered for access, safety, moisture control or patient comfort

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

18 RECORD OF PROCEDURES Participants will perform the Record of Procedures on one of the Assessment days. Participants will record all procedures performed on that day (except the Rubber Dam application), on the supplied Record of Procedures form. The Record of Procedures should be completed assuming that: - each procedure is performed on a different patient. - the patient has no changes in medical history. - local anesthesia has been administered for each procedure. - any prepared teeth were restored during the session. - any restored teeth were prepared during the session. - provisional crowns were cemented during the session. In order to preserve anonymity, do NOT sign the Record of Procedures. Participants should use their NDEB ID number in place of a signature. Scoring Grid: A+

- Appropriate and accurate record of all procedures.

- One error

- Two or three errors

- More than three errors - No entries

Errors on Record of Procedures: Incorrect or incomplete record of procedures. No or inappropriate date. No or inappropriate record of updating medical history. No or inappropriate record of type, quantity or location of local anesthesia. No or incorrect tooth number identified. No or incorrect restored surfaces identified. No or inappropriate type of restorative / provisional material or cement identified. No or inappropriate restorative / provisional material or cement brand identified.

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Incorrect technique or improper use of material identified. No shade recorded. Record not written in ink. Record not legible. Inappropriate correction of entry (original entry not visible through correction). No ID number or ID number in inappropriate location.

INFECTION CONTROL Participants will perform all requirements as if they were working on actual patients. Infection control and material hygiene procedures will be observed by Assessment Invigilators. Participants will NOT be informed of any recorded violations. It will be assumed that all instruments are sterile at the beginning of Day 1. If an instrument or treatment material is dropped during a procedure, a participant must notify an Invigilator who will ask the participant to describe how the situation should be handled in actual patient treatment and give permission to pick up the instrument or material. The following modifications to infection control procedures for the purposes of this Assessment: - participants are allowed to wear treatment gloves while: loosening the clamp that allows the patients head position to be adjusted and adjusting the head. using the amalgamators. walking to and from the Rubber Dam Requirement operatories. - participants do not need to wear treatment gloves while Mixing, placing and removing putty materials used in the making of stents.

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Scoring Grid: A+ A D E - No violations of infection control or material hygiene errors - One infection control violation or material hygiene errors - Two infection control violations or material hygiene errors - Three or more infection control violations or material hygiene errors

Infection control and material hygiene errors include: Gloves not worn. Gloves worn outside of the operatory. Gloves have holes or tears. Unacceptable infection control procedures involving gloves such as wearing treatment gloves when retrieving an article from a non-sterile area such as a storage bin or cabinet or touching masks, glasses or hair. Mask not worn or not worn appropriately. Use of contaminated instruments or materials. Hands not washed. Contamination of operating area or instruments. Eye protection not used. Hair not appropriately controlled. Inappropriate attire. Unacceptable amalgam handling and disposal. Unacceptable handling and disposal of sharps. No or insufficient cooling water used with high speed handpiece.

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IX

GRADE DERIVATION GRID FOR INDIVIDUAL REQUIREMENTS Each requirement is evaluated in one or three criteria categories. Each category receives the lowest assigned grade of A+, A, D, or E. 1. Requirements with one criterion category The grade assigned for these requirements will be determined as described in the evaluation criteria. 2. Requirements with three criteria categories The grade assigned for these requirements will be determined by the grades assigned in the criteria categories. A grade of A+ will be assigned for a requirement if 2 A+ and no D or E is assigned in any category. A grade of A will be assigned for a requirement if no more than 1 D and no E is assigned in any criteria category. A grade of D will be assigned for a requirement if 2 Ds and no E are assigned in any category. A grade of E will be assigned for a requirement if 1 E or 3 Ds are assigned in any criteria category.

FINAL RESULT GRADE DERIVATION GRID ( 12 requirements) In order to be successful in the Assessment of Clinical Skills on the 12 requirements, a participant must obtain: 8 or more A / A+ and no E OR 9 or more A / A+ and no more than 1 E

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XI

RESULTS Participants will receive a score for each requirement as determined by using the evaluation criteria for the requirement and the Grade Derivation Grid. The final result for each participant will be determined using the Final Result Grade Derivation Grid. The results of the Assessment of Clinical Skills will be posted on a secure website that will be accessible using the secure code provided at the time of initial registration. Posting of results will normally be done within 6 weeks and an e-mail notification of the posting will be sent to participants. The results of the Assessment of Clinical Skills will be sent to universities in Canada offering a Qualifying or Degree Completion Program. Results will not be released by telephone, fax or email.

XII APPEAL Within three months of the release of results, a participant who has failed the Assessment of Clinical Skills may make a submission in writing to the Board setting out the grounds for requesting to have the results changed. Any such application for review must be accompanied by the filing fee. This submission must clearly identify the individual requirement results to be reviewed and must set out the grounds for requesting to have the score(s) changed. The NDEB Appeals Committee will review the participants submission, all related correspondence, score sheets and the participants submitted typodont teeth. Results of the Assessment review will be released on a participants secure online profile. Participants will receive an email notification of the posting.

XIII

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

acs protocol 2013-7.docx