College of Diplomates Manual For Candidates for Certification as a



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Seltzer and Bender’s The Dental Pulp, Hargreaves and Goodis

Arens DE, Torabinejad M, Chivian N, Rubinstein R. Practical lessons in endodontic surgery. Carol Stream (IL): Quintessence Publishing Company, 1998.


Cohen S, Burns RC. Pathways of the pulp. St. Louis: Mosby.
Gutmann JL, Harrison JW. Surgical endodontics. St. Louis: Ishiyaku EuroAmerica 1991.
Little JW, Falace DA, Miller CS, Rhodus NL. Dental management of the medically compromised patient. St. Louis: Mosby.
Andreasen JO, Andreasen FM. Textbook and color atlas of traumatic injuries to the teeth. St. Louis: Mosby.
Neidle EA, Yagiela JA. Pharmacology and therapeutics for dentistry. St. Louis: Mosby.

Essential Endodontology, Orstavik and Pitt Ford

● The mentor should advise the candidate to keep current on the literature with special attention to the following journals: Journal of Endodontics; Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics; International Endodontic Journal; Dental Traumatology.




Helpful Hints from the Spring 2007 Diplomate Newsletter

Eager to share their success and excitement, every new group of Diplomates offers their tips and insights to help those who have yet to get through the difficult yet rewarding Board Certification process. New Diplomates routinely referred to the various examinations as “fair” and “rewarding.” Their specific observations and helpful hints are below.


Reading Materials New Diplomates Recommended

  • Inflammation: A Review of the Process by Henry O. Trowbridge and Robert C. Emling

  • Pathways of the Pulp by Stephen Cohen and Kenneth M. Hargreaves

  • Seltzer and Bender’s Dental Pulp by Kenneth M. Hargreaves, Harold E. Goodis and Samuel Seltzer

  • Dental Management of the Medically Compromised Patient by Donald A. Falace and James W. Little

  • Journal of Endodontics, especially the last two to three years

  • Medically Compromised Patient by J.O. and F.M. Andreasen

  • Essentials of the Traumatic Injuries to the Teeth by J.O. and F.M. Andreasen

  • Endodontic Topics at http://www.blackwell-synergy.com/loi/etp

  • ABE web site

  • College of Diplomates web site, particularly the abstracts

  • AAE web site


Suggested Study Methods

  • Flashcards

  • In a quiet and secluded study location

  • Review courses

  • Utilize a mentor and/or study partner

  • Set aside time for study and reflection on a regular basis

  • Listen to CD-ROM’s of CE courses while commuting


Suggested Study Resources

  • ABE web site

  • Abstracts published on the College of Diplomates web site

  • PubMed search

  • ABE Boardwalk held annually at the AAE’s annual session

  • Local study groups – organize or join one


Mentors

  • A common thread among the Candidates is the importance of having at least one mentor.

  • I encourage all Candidates to seek out mentors, a most valuable tool that is available to you. If you do not know anyone that can help you, place a quick call to Dr. Andre Mickel from the College of Diplomates who is ready and available to assist you. Dr. Bobby Caruso

  • I cannot emphasize enough how much help it was to study with another person. – Dr. Stephen Tsoucaris

  • It is strongly advised to seek out one or more mentors for each phase of the process. Different opinions will develop insight into topics and expose areas needing more investigation. – Dr. Marc Levitan

  • It was extremely beneficial for me to utilize that experiences of current Diplomates to guide, suggest and motivate. They served as role models, sounding boards and examples through the process. – Dr. James Jostes


Review Courses

  • The value of attending review courses throughout the Board Certification process is mentioned over and over.

  • Take all the endodontic review programs that you can. – Dr. Joseph Morelli

  • The Board review courses are great for the Written and Oral Examination. – Dr. Jaime Silberman

  • A Board review course is indispensable in helping to put it all together. – Dr. Timothy Kirkpatrick


Residency Program

  • Remember that preparation for the Board Certification process starts in your residency program. Make the most of you literature review and case analysis sessions. – Dr. Nooshin Katebzadeh

  • Take the Written Exam while in your residency program or shortly afterward while the biological principles are still fresh in your mind. This test is a natural extension of material learned in residency. – Dr. John P. Smith IV.

  • Start early during your residency to gather all the cases that fit each one of the categories in your Portfolio. – Dr. Francisco Banchs

  • Keep all the notes from your residency, they will be very useful. – Dr. Francisco Banchs

  • There will never be a better time to take the exam. You have spent the last two – three years reading, discussing and practicing endodontics, you have all the information you need. – Dr. Randolph Todd

  • Begin preparation at the start of your program; prepare and maintain records in the Case Portfolio format; look for potential cases throughout your program. – Dr. Khalid Al Fouzan


General Suggestions

  • READ!

    • The most common suggestion? Read all major texts and current literature – recommendations ranged from 2-5 years of recent articles.

  • Establish Milestones

    • Develop and adhere to a timeline that includes progress ‘milestones’ for all three parts of the exam. Your planning should be tailored to allow for ‘retakes,’ if needed, to avoid starting all over again. – Dr. Robert A. Caruso

  • Manage Your Time

    • Organization/time management is the most difficult part of the process. – Dr. Derik P. DeConinck

    • The entire process can, and ideally should, be completed within five years of graduation. ‘Older’ endodontists can start and complete the entire process in one year, thus only studying once for the Boards. – Dr. Lester J. Quan

    • As in everything that we do, preparation is the key to success. – Dr. David Rosenbaum

    • Make sure that you review and understand your deadline set by the ABE for each section. Your planning should be tailored to allow for “retakes” if needed, to avoid starting all over again. For any part of the exam, do not, repeat do not wait until the last minute to prepare. – Dr. Bobby Caruso



  • Get Organized

    • Organize all your academic materials beginning while in residency. Keep good, organized files of all endodontically related articles and update constantly. – Dr. Joseph M. Morelli

    • Organize clinical cases according to ABE’s categories for case presentations. – Dr. Joseph M. Morelli

  • Stay Focused

    • Try to stay focused on the specific tasks. It is easy to look at all three parts of the exam and become overwhelmed. – Dr. Mickey Zuroff

  • Find Support

    • Don’t travel the road alone. Any or all of the following – significant other, mentor, fellow candidate – will help move you along. – Dr. David M. Kenee

  • Utilize the Helpful Hints

    • I read and tried to remember all the hints from prior examinees. The best one “Have a conscientious, explicit and judicious reasoning for everything you do clinically.” – Dr. Lester Quan


Written Examination

  • DO IT ASAP!

    • The most universal piece of advice was to take the exam as soon as possible.

    • Basic science is very easy to forget in private practice! – Dr. Jaime Silberman

    • Twenty years after my residency, I felt like I was starting from the very beginning of dental school. – Dr. Lester J. Quan

  • Know Your Literature

    • If possible, allow enough time to go back to the basics and integrate with classic and current literature. – Dr. Claudia I. Holt


Case History Examination

  • FOLLOW DIRECTIONS!

    • The key suggestion for this examination was to follow instructions very carefully.

    • Details, Details, Details – Life and the success of your case submissions are all in the details. – Dr. Randolph Todd

    • Keep an eye on your write-ups; they are as important as the quality of the cases. – Dr. Francisco Banchs

    • The instructions are very specific and should be closely followed. – Dr. Steven Card

    • Take advantage of the ABE’s detailed information about each case. Follow their instructions. – Dr. Leandro Britto

    • Follow the directions given to a “T”. – Dr. Bart Rizzuto

    • Follow the guidelines, be brief and do anything you can do make it easier for the Directors to read the cases quickly! – Dr. Jay Jacobson

  • Search for Potential Cases

    • Amass 25+ cases and then wean. – Dr. David M. Kenee

    • Look for cases that are not easy to come by first. – Dr. Helmut Walsch

    • It is important as you go through your day-to-day practice that you treat each patient as though they could be a part of your Portfolio. – Dr. David Rosenbaum

    • Start to identify cases in residency and create a “follow-up” log complete with all the necessary contact data for the patient (including the contact information for a relative of the patient who might be able to help you locate your patient at a future time). – Dr. Bobby Caruso

    • Keep a log on a notebook or computer file of potential Board cases. Anytime you come across a potential Board case, write the patient’s name, tooth number and reason why you feel it is a Board case. – Dr. Ariel Diaz

    • Try to accumulate about two – three as many cases as needed per category and pick the best for submission. – Dr. Mark Dinkins

    • Keep track of which categories you already have a sufficient number of cases for submission, so that your energy is spent towards finding those that are more difficult to complete (diagnosis, medically compromised patient and the molar surgery). – Dr. Francisco Banchs

    • Treat every case as a potential Board case with appropriate documentation and quality radiographs. – Dr. Timothy Kirkpatrick

  • Radiographs

    • Take all the intra-oral radiographs and pictures you can. I don’t know how many successful cases I examined when preparing for this portion of the Board only to find that I didn’t have the adequate radiographic representation. – Dr. Timothy Bodey

    • During a patient treatment, if you ever ask yourself the question, Should I expose an x-ray? -you should! That radiograph will be the one that you need to support your case. – Dr. Colleen Shull

    • Take at least two (preferably three) pre-op and post-op films. Take working films even if you don’t routinely do so, it strengthens your cases. – Dr. Ariel A. Diaz

    • Always take high quality radiographs from multiple angles; you never know if that case may be needed as part of your Portfolio. – Dr. Manish Garala

  • Get an Early Start

    • Start early, it’s easier on the family relationships. – Dr. David Koelliker

    • Be systematic. It takes time to organize all the information. – Dr. Jaime J. Silberman

    • When you have cases that qualify, start writing them up because they take more time than you think to write and edit them. – Dr. Katherine Kuntz Jakuc

    • Start case selection early. Every patient is a possible Board case. – Dr. Geoffrey Okada

    • Keep a folder on your PC desktop that keeps reminding you everyday to enter interesting cases to follow-up on! – Dr. Jay Jacobson

    • This portion of the Certification process takes a lot of time, maybe more than you can imagine. Set aside time to write up your cases, scan your images, etc. – Dr. Anne Williamson

  • Contact Patients

    • I found the majority of my patients could be found for follow-up and were quite receptive. – Dr. Bobby. Caruso

    • Keep track of potential Board cases in each category and recall as soon as possible. – Dr. Claudia I. Holt

    • Make certain your office staff realizes the importance of the Boards and works hard with you in getting patients back into the office for necessary recalls. – Dr. David Rosenbaum

    • I found that if I explained to my patients what I was trying to achieve and made them a part of the process, they were more than happy to help me by following through with permanent restorations and coming back for recall appointments. – Dr. Samuel Mesaros

  • Get a Second Opinion

    • Have colleagues and a mentor help review your cases. – Dr. Joseph M. Morelli

    • Have a mentor review your cases for complexity and content. – Dr. Geoffrey Okada

    • Having other review my Portfolio was an extremely valuable experience. Their suggestions and advice were priceless. – Dr. Anne Williamson

  • Be Careful

    • The ABE template does not have grammar and spell check, so you must type and do all editing in Word, correct, then past into the ABE template. I learned this the hard way! – Dr. Lester J. Quan

    • The worst is a beautiful case with insufficient documentation. – Dr. Helmut Walsch

    • Make certain that all radiographs are of excellent quality and are archivable. – Dr. David Rosenbaum

    • When preparing your cases, it’s important to be obsessive about checking dates; spelling, and your write-up for organization. Your goal is for the cases to be black and white. Don’t leave any question marks. – Dr. Lauren Mitchell

  • Proof Read

    • Have dental, but also non-dental proofreaders. – Dr. Margot Kusienski

    • Evaluate and grade each case yourself by following the scoring criteria used by the Directors. – Dr. Tarathorn Sundharagiati

    • Proofread your cases. Have your mentor proofread your cases. Proofread your cases again. – Dr. Ariel Diaz


Oral Examination

  • RELAX!

    • Despite initial fears, Candidates found the Oral Examination to be a fair and relaxed conversation with peers.

    • I found this to be the most rewarding part of the exam. – Dr. Bobby. Caruso

    • Stay calm, feel relaxed and be confident of yourself at the time of examination. – Dr. Iejaz Shahid

    • There is no substitute for a good night’s sleep. – Dr. David Rosenbaum

    • There were no trick questions or unanticipated strategies. – Dr. Lester J. Quan

    • Examiners are very fair (and comprehensive) in their questioning. – Dr. Derik DeConinck.

  • Be Prepared

    • During the week, while I was treating patients, I would cite the literature that supports what and why I am doing a particular treatment procedure. Dr. Bobby Caruso

    • Keep updated with current literature throughout. – Dr. Helmut Walsch

    • Know all you can about medically compromised patients. – Dr. Claudia I. Holt

    • Start organizing early at least six months before the examination. Whether you study alone, with a partner or through a mentor, create a schedule that gradually increases as you near the exam. Starting three months out, I got up an hour early to study. – Dr. David Kenee

    • The Oral Exam is a clinical exam and as such it requires evidence-based knowledge to support every procedure you do when you treat a patient. While treating patients in your practice review every single one of the steps you are taking and support them with literature. – Dr. Francisco Banchs

    • Pay attention to the 10 areas in which you are tested. Know the literature and justify your clinical decisions with the literature. When you are seeing patients review in your mind what you are doing and why. – Dr. Ariel Diaz

    • Follow the instructions/tips given at the review courses, diagnosis, and prognosis. Know the literature to substantiate your answers. Dr. Kimberly Kochis

    • During a workday in private practice use each patient case as if it were a Board case. Do this from early diagnosis to final recall. This will be a great experience in tying together your clinical knowledge and literature reference. Demonstrate evidence-based treatment. – Dr. Joseph Quevedo

    • We all know where each of our weaknesses and strengths are. Define your weaknesses early and challenge them before you sit for the Oral Exam. – Dr. Shahrokh Shabahang

    • When preparing for the Oral Examination, remember that the exam can and will encompass more that clinical endodontics. Special patient management should be as important in your preparation as is endodontic literature. – Dr. Jay K. Taylor

  • Practice

    • Have a study partner…hold mock exams…be both examiner and examinee. – Dr. Helmut Walsch

    • My mentor gave me mock orals. This was probably the most helpful single thing in preparing for the Orals. – Dr. Joseph M. Morelli

    • Having a mentor provided different opinions and developed insight into topics and exposed areas needing more investigation. – Dr. Marc Levitan

    • Practice orally with a recent Diplomate. Knowing this info is one thing…..putting it to words is another. Like anything else in life, PRACTICE!! – Dr. Jason Bergman

    • Have conscientious, explicit and judicious reasoning for everything you perform in your practice, and provide the research(s) to support those principles. Practice, practice, practice. Verbalizing your thoughts is paramount to succeeding, and mock boards are the best way to do that. Dr. Anita Aminoshariae

    • Have a colleague or mentors quiz you, this forces you to verbalize your answers and allows for feedback. Lt. Col. Brian Bergeron

    • Not only is studying important, but you need to be able to eloquently verbalize that knowledge. Utilize your mentor to do the mock Oral Exams through the preparation process. – Dr. Margot Kusienski

    • The Orals require that you organize your thoughts and responses rapidly in front of some very big names. Practice with someone who makes you feel slightly intimidated. You will get flustered; the trick is to recover rapidly and move on to the next question. – Dr. Vincent R. Jones

    • You have to be 200% familiar with the literature because you do not have much time to organize your thoughts during the examination. Basically, make the literature pop into your head like a reflex. – Dr. Ming-LI Emily Kuo

    • As you treat your patients throughout your day ask yourself and write down questions such as, why do I use this material, procedure or what options exist? What evidence is there to support or dispute certain options or alternatives? Why is this patient on this or that drug? What could go wrong and how would I handle it? – Dr. Patrick W. White

    • The Oral is a case-based question and answer period. The cases are meant to reflect clinical practice. They have some amount of complexity but are not impossible. After a day at the office, write down the medical history or case complications encountered. Review that topic; make note cards, list cures (medications) and complications. Repetition of disease processes, case types will develop. Repeated review will prepare you and over time, a breadth of information will be reviewed. – Dr. James Stich

  • Strategies for Taking the Exam

  • When taking the exam it is important to have an organized way to gather all initial information when the test starts. It should be practiced in a way to consistently not leave out any critical information, i.e. medial history, blood pressure, etc. Do not forget to ask for more information from the examiners as necessary, whether it is a radiograph(s), or even a clinical picture, if indicated. Try to get the first part of the exam off to as smooth a start as possible. This will help you to stay calm and recall information as the exam progresses. Try to find a study partner and or ask someone qualified to conduct a mock exam. The right strategy in taking the Oral Exam is as important as what you know. Dr. John M. Lies

    • Try not to get flustered if you don’t know every answer – you are not supposed to! They are trying to quickly determine the depth and breadth of your knowledge, so they keep asking questions until you run out of answers. – Dr. Lester J. Quan

    • My suggestions are: 1) Think through the questions before answering,

. 2) Answer only the information asked in the questions, 3) Be succinct but thorough when answering, 4) Cite literature to correlate with responses whenever possible, and 5) Candidates will not be able to answer every question. Don’t linger or focus on questions you cannot answer. Instead, pass on the question and concentrate on answering the next one! - Dr. Marc Levitan

    • The approach I had taken for the Oral Exam was to know and justify everything I do clinically. Be able to support your statements with the literature. Quiz yourself with a mentor. You don’t want to be flustered under stress. You need to know things inside and out. – Dr. Lauren Mitchell

    • Use literature citations to answer every question – Dr. Rory Mortman





Mentoring a Candidate for the Written, Case and or Oral Examinations and

Incorporating the approved Diagnostic Terminology



New American Board of Endodontics Pulpal & Periapical Diagnostic Terminology
On April 22, 2007, the ABE voted to accept and strongly encourage all candidates to use the following clinical diagnostic terms and definitions for all examination phases.
PULPAL:
Normal pulp – A clinical diagnostic category in which the pulp is symptom free and normally responsive to vitality testing.
Reversible pulpitis – A clinical diagnosis based upon subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal.
Irreversible pulpitis – A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.
Additional descriptions:

Symptomatic – Lingering thermal pain, spontaneous pain, referred pain

Asymptomatic – No clinical symptoms but inflammation produced by caries,

caries, excavation, trauma, etc.


Pulp necrosis – A clinical diagnostic category indicating death of the dental pulp. The pulp is non-responsive to vitality testing.
Previously Treated – A clinical diagnostic category indicating that the tooth has been endodontically treated and the canals are obturated with various filling materials, other that intracanal medicaments.
Previously Initiated Therapy – A clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy (e.g. pulpotomy, pulpectomy).
APICAL (PERIAPICAL):
Normal apical tissues – Teeth with normal periradicular tissues that will not be abnormally sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact and the periodontal ligament space is uniform.
Symptomatic apical periodontitis – Inflammation, usually of the apical periodontium, producing clinical symptoms including painful response to biting and percussion. It may or may not be associated with an apical radiolucent area.
Asymptomatic apical periodontitis – Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area and does not produce clinical symptoms.
Acute apical abscess – An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues.
Chronic apical abscess – An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort and the intermittent discharge of pus through an associated sinus tract.




PREPARING FOR THE WRITTEN EXAMINATION



The Written Examination
The Written Examination consists of 200 multiple choice questions. It is administered as a computer-generated exam and candidates can choose from a four-hour morning or afternoon session on any of the dates during the week the exam is offered. The questions are designed to test recall, the application of knowledge, interpretation, and problem solving skills. Subject areas include anatomy, biochemistry, embryology, general and oral pathology, microanatomy, immunology, inflammation, microbiology, pharmacology, vascular and neurophysiology, pulpal and periradicular pathobiology, radiology, oral medicine, biostatistics, clinical endodontics, dental materials related to endodontics, related dental disciplines, and classic and current literature. Included in the examination are clinical case histories, clinical photographs, and radiographs. Questions on the clinical material require interpretation by the Candidate. Given specific clinical information, Candidates must determine appropriate diagnostic procedures, establish a differential diagnosis and definitive diagnosis, determine appropriate methods for management of the patient, outline methods for prevention of treatment of a particular condition, outline the sequencing of procedures, and assess the outcomes of treatment. There is no one single text or review course that can totally prepare one for the Written Examination. Because of the contemporary and constantly developing nature of a number of critical areas, particular study should be directed towards basic concepts of cellular and molecular biology; inflammation, immunology and virology; management of medically compromised patients; pharmacology of antibiotics, analgesics, and local anesthetics to include drug interactions; microbiology to include anaerobic bacteria and current genus and species identification; differential diagnosis of radiolucent and radiopaque lesions; pulpal and periradicular pathosis; wound healing; bone regeneration; and the literature.



HOW TO SUCCEED WITH THE CASE HISTORIES PORTFOLIO

The path to successful completion of the case histories portfolio requirement is straightforward but rigorous. The cases must be the clinician’s finest effort. In addition to being high quality, they should demonstrate the broadest scope possible of diagnosis and treatment in the specialty practice of endodontics. They should convey the message that a Diplomate of the American Board of Endodontics (ABE) is someone special and worthy of the recognition that only Board certification can confer. Approval of the case histories portfolio by the Board will give you, the mentor, and the candidate a lasting sense of shared accomplishment and pride.


Read, understand and follow all current instructions and guidance published by the American Board of Endodontists on preparing a case histories portfolio. The Case History Portfolio Submission Guidelines can be downloaded as a PDF document on the ABE’s website. Using these guidelines is essential in preparation of the Case History Portfolio.
GUIDELINES FOR DEVELOPING AN ACCEPTABLE

CASE HISTORIES PORTFOLIO


  1. Demonstrate mastery in a wide variety of complex nonsurgical and surgical

cases.


  1. Ensure all documentation is complete and dates are accurate. Have a non-endodontist review the radiograph dates and clinical entry dates for accuracy. Technical errors tend to detract from the portfolio because it suggests inattention to detail expected of a Diplomate.




  1. Have at least a one-year recall examination and documentation, longer if possible




  1. Use only original high quality radiographs, or direct digital radiographs. Mixtures of film and digital images are acceptable.




  1. Clearly label supporting documentation.




  1. Justify treatment selection and annual treatment approaches.




  1. Provide definitive clinical diagnosis and use consistent, approved terminology.




  1. Be precise, clear, thorough and concise.




  1. Keep abbreviations to a minimum.




  1. Use acceptable grammar and correct spelling. All entries should be spell checked outside of the document and then pasted into the final template. The spell-checker feature of Microsoft does not function in the Case History Report template.




  1. Duplicate the entire portfolio.




  1. Submit the case histories portfolio early in the eligibility period.



SELECTION OF CASES

When compiling cases for the notebook the candidate should file or store them alphabetically. It is helpful to arrange them by case type. For example, you can suggest that the candidate put all potential surgical cases together in one category. Place hemisections, root amputations, anterior root end resections with and without root-end fillings, posterior root-end resections with and without root end fillings, and exploratory surgeries in one section. This will allow a review of similar cases. Then a decision can be made to select the best cases.


After the candidate writes a case report, suggest that it be put away for a few days and then reviewed again. Make any deletions or additions at that time. This approach will provide a more objective point of view. This can be repeated two or three times, if necessary.
The Board specifies the case types and sequencing of the cases in the portfolio. The order, procedure categories, and the number of cases REQUIRED in EACH category are listed below (also see Tab 6, Case Histories Portfolio Instructions):

DIAG (1 Case)

Diagnostic evaluation of the patient (dental or systemic) is the most significant feature of this case. One year evaluation is required with appropriate images and/or radiographs.


EMERG (1Case)

These cases must show emergency treatment procedures in addition to endodontic

procedures. For example, an incision and drainage, trephination, and prescription of

medications with the rationale for their usage fit into this case type.


MED COMP (1 Case)

These cases must show endodontic management of a medically compromised patient.

This requires MODIFICATION of treatment timing or procedures. Simply recognizing

and/or documenting a medical problem does not meet the criteria, nor does prescribing

prophylactic antibiotic coverage or treating patients with common medical conditions.

Patients on anticoagulant therapy or those receiving chemotherapy or radiation

treatments may fulfill this category if your treatment has to be modified in some way.

NS RCT (5 Cases)

These cases must demonstrate difficult nonsurgical root canal therapy. This includes teeth with calcified canals, curved and/or long canal systems, unusual anatomy, etc. These FIVE nonsurgical cases MUST include at least one maxillary molar and one mandibular molar.


RETX (2 Cases)

These cases must include nonsurgical retreatment of previously endodontically treated teeth. At least one case MUST be a molar.


S RCT (2 Cases)

These cases must demonstrate surgical root canal treatment. A posterior (molar) surgery with root-end resection and root-end fillings MUST be included.


OTHER (3 Cases)

The cases presented in this category are cases that do not qualify for the previous 12 cases. The three Other cases must be different from each other and may include, but are not limited to the following: trauma (management of traumatic injuries and their sequelae, such as crown/root fractures, luxations, avulsions, open apices, resorptions, etc.); perforations, hemisections, root amputations, endodontic endosseous implants, replants, transplants, endo-perio, endo-pedo, endo-ortho, removal of separated instrument, decompression and vital pulp therapy (including apexogenesis). Osseointegrated implants are not acceptable. No more than one case from each category is permissible.



As the candidate prepares the case histories portfolio, remind him/her that the goal is to present the highest quality endodontic care possible. The portfolio is the only means by which the candidate can communicate to the examiners the excellence of his or her abilities as an endodontic clinician. In preparing the cases for submission to the Board, strict attention to detail will give the candidate the best chance to successfully complete this phase of the Board certification process.
SUGGESTIONS FOR THE PREPARATION OF

A CASE HISTORIES PORTFOLIO
The case histories portfolio is a direct reflection of the candidate’s skills as a practitioner. Only the highest quality cases should be submitted to the Board for review. Preparation of the case history reports is time consuming and possibly the most demanding of the Board requirements. All case histories need to have complete documentation, proper diagnosis and treatment, and recall documentation. Without exception, excellent quality radiographs should be the standard. Selected photographic 2x3 slides are highly recommended to document unusual or complex procedures. The portfolio should portray the abilities of the clinician and clearly communicate to the Board that the quality of the candidates work is the reason why Diplomate status should be awarded. It is the exclamation point that sets this specialist practitioner apart and justifies Board certification. The case histories portfolio MUST demonstrate the broad range of the candidate’s endodontic abilities and MUST be their best!!!
Although reasons for failure of the case portfolios are varied, the more common problems are poor case selection, poor documentation and poor quality radiographs.
The Board provides the candidate with a Case History Evaluation Form that serves as a table of contents to identify and classify the cases in the portfolio. The fifteen cases must be placed in the proper order and include all of the required categories. The Board requires that each case be reported as one category only and focus only on one tooth, even if multiple procedures were performed and multiple teeth were involved. Furthermore, even though a case is complex (multiple categories, multiple teeth), it cannot be used more than once in the portfolio. You can assist the candidate in determining the predominant category for each case and tooth to be reported.

Example: (from the case history evaluation form)

A B C

Patient No.

Tooth No.

Operation Performed

1

23

DIAG

2

15

EMERG

3

2

MED COMP

4

3

NS RCT

5

32

NS RCT

6

31

NS RCT

7

17

NS RCT

8

8

NS RCT

9

19

RETX

10

7

RETX

11

19

SCRT

12

13

SCRT

13

15

OTHER

14

19

OTHER

15

30

OTHER

If the candidate decides to use abbreviations in the portfolio in addition to the ones required by the Board, they should be listed on a separate sheet of paper and placed at the front of the portfolio. It is best to remember that many abbreviations have been used for so long or are so commonplace in endodontics and dentistry that they can be categorized as boilerplate. Abbreviations such as MB, ML, PDL, PRM, BP, Ca (OH )2 , IRM and those specified by the Board such as NS RCT and S RCT fall into this category. These abbreviations should not be included on a front-page listing. Abbreviations such as NKDA (no known drug allergies) or RAS (right arm sitting) that are not universal in the use or are outside common usage in Endodontics should be included in the front-page list. In general, abbreviations should be kept to a minimum because the examiners have to refer the list several times when they review the cases.

To avoid confusion, recommend to the candidate that he/she should be as brief as possible in their write-ups without compromising thoroughness. If the candidate deviates from standard diagnostic terminology (not a good idea), especially in pulpal and periradicular diagnosis, the terms and a brief definition should be included on the page with the list of abbreviations. Stress to the candidate the importance of using the approved ABE Terminology. The terminology or nomenclature should be consistent throughout the portfolio.
Avoid phrases such as “within normal limits.” Explain what normal is, e.g., “The probing depths were 1-2 mm with no bleeding on probing” rather than “WNL.”
As the candidate prepares the cases, remind him/her that a thorough and accurate representation of the way the cases were treated is the goal. Make every effort to limit the narrative to the spaces provided on the form. The examiners have many cases to review, so verbosity is verboten. Be PRECISE and CONCISE.
The case history report form used for case submission may be downloaded from the ABE website at www.aae.org/certBoard.com
Instructions for the Case History Report Form and Addendum Page

To Create the Case History Report Template


  1. Open the Case History Report Form Template

Click on File then click on Save As

Save in Desktop – leaving the filename as is – click Save

Click File then Close – then close out of Word


  1. On your desktop screen you will have an icon for the Case History Report Template. This template is now ready to be used to create your fifteen Case History Report Forms.


To Create Case History Report Forms


  1. Double-click on the Case History Template Icon

Click yes to open as read only

Click File – click on Save As

If you receive the Before you Save prompt, click on Don’t Save As Suggested Format. Change the file name appropriate to the case report you are making (you will use this template to create each Case History Report Form Case 1 through Case 15). Save as a Word Document.

Use this procedure to create your 15 Case History Report Forms.


General Instructions

Tool Bar

Be sure the Form Toolbar is locked. When the Form Toolbar is locked, the other symbols (abl – the check box – etc., are grayed out). The form will not work properly if the Form Toolbar is not locked. If the Form Tool Bar is not visible – click on View – then Toolbars - then Forms.


Tab Button

Use the Tab button to navigate from one section to another.


Select Buttons –

Please note the following information regarding the Procedure Category

In the Patient Sex and Procedure Category click on select pull-down menu box – then click on the appropriate response. Use the pull-down menu for all Procedure Categories. In addition, the OTHER category has a text box below the Select pull-down box to describe the type of OTHER treatment (i.e., Apexification, Root Amputation, and Intentional Replantation).




    1. Procedure Category: OTHER

_______ Type the subcategory in this text box

(tab through it for the remaining cases)


Spell Check

The Case History Evaluation Form does not provide the functionality of “spell check.” A work-a-round solution is to type your report in a Word document and then copy the text and paste it into the appropriate section in the form. Please remember that “spell check” is a great tool, but it is the responsibility of the writer to present an error free report. Please proof read your report for content and then re-proof your report strictly for spelling errors.


Allowed Space

While typing a report on this form, you will be restricted to the allowed space for each section of the form. If you exceed the limits of the space, what you type will not appear on the form. The form has been created to allow you to enter information up to the end of each section. However, due to capital letters, lower case letters and spaces being different sizes, you may find that you are stopped before reaching the end of the last line. Do not try to change this or the font to squeeze the typing into the form. The lines will not accommodate any font other than Arial, regular, size 10. Continue your report on the Addendum Page.


Changes

Creating each Case History Report from the template will allow you to make changes and additions to the form as needed. When you need to make a change to your created Case Form – open the form and click no when asked if you want to open as Read Only and then enter your changes and save before closing the document.


Addendum Page

The two pages of the form should accommodate most case reports. However, for an occasional case, you may need more room. Use the Addendum page for this. When you have exceeded the limits of the current section you are working on, you will no longer be able to enter information. Use the backspace to allow enough room to enter “See Addendum Page” at the end of that particular section. Scroll down to the Addendum page; indicate the area you are continuing, i.e. “C. Medical History continued:” then continue with your narrative of that area. All areas continued for a case can be on the same Addendum page. Using an Addendum page for every case, or using more than 2 Addendum pages for any case, probably indicates a need to edit your narrative to make it brief and concise.


Backup Copies

As an additional safeguard, make backup copies of this file and of any reports you write.


Printing

The margins have been made wide enough on this form to accommodate any inkjet or laser printer.


Assembling the Case History Report Notebook

Place your completed Case History Report form in a plastic protector front to back. The Addendum page should be placed in a plastic sheet protector and be placed behind the appropriate Case History Report form in the notebook.


Be certain the candidate removes or blacks out the names of schools, institutions, laboratories, oral pathologists and any other identifying features to ensure anonymity.
Case History Report Form

The following information relates directly to the preparation of the case history form. As a mentor you can offer the candidate many reminders and suggestions for each section of the Case History Report Form that will enhance the quality of the report and the portfolio.


A. Tooth #: Use the 1-32 system. One tooth number only must be used per case.
B. Procedures:
Use the dropdown list in the form to select the procedure category. For “Other” cases explain the type of case in the Other Subcategory area of the form.

Chief Complaint: This is self-explanatory. It should be in the patient’s own words.
C. Medical History: If “the patient is in good health,” state it that way. In addition, it is

very important to report the blood pressure for each patient. If the

blood pressure was abnormal, the candidate should describe how

the patient was managed. For example, “BP 188/110. Pressure

monitored for three successive days with no change. Patient

referred to his physician for evaluation and treatment.


If the patient was on a medication, be sure to list the drug,

dosage, frequency and duration of administration. Describe what

this medication does for the patient. For example, “Sandimmune is

a cyclosporine and a cyclic polypeptide immunosuppressant

agent.”
If the medication impacted upon the management of the patient,

report how. If it didn’t have an impact, state that it didn’t.

If a medical condition required any alteration of the treatment plan,

state what the modification was. Explain how any treatment was altered to accommodate a medical condition.


Did the patient require pre-op or post op antibiotics. Which antibiotics were selected and why? Was it an American Heart Association recommendation or a physician recommendation? Remember to include the dosage and number. Have lab reports, radiation reports; and MRI, CAT scan, or bone scan results available. Include these as attachments to the case report if they influenced diagnosis or treatment. All vital signs must be recorded.

D. Dental History: This should tell the story behind the referral. State who the

referral came from: general practitioner, specialist, and physician.

Report the treatment that was provided before the specialist saw

the patient, such as non-surgical root canal therapy or pulpotomy,

and the time since the last treatment. Report the signs and

symptoms at the time of the referral and then at the time the

specialist first saw the patient. Have the candidate include such

things as a history of trauma, caries, carious exposure,

mechanical exposure, restorations and pulp capping procedures.

If the referring practitioner obtained a microbiological culture,

include this in the report.
E. Clinical Evaluation: (Diagnostic Procedures)
Exam: Describe the condition of the tissues. For probing depths, list the

measurements, e.g., 1-2 mm. Report any sinus tracts, their

location and how they were traced, e.g., gutta-percha point, silver

point, wire. Report the results of the overall exam including cancer

screening, soft, and hard tissue exam, e.g. mandibular tori. If

photographs were taken at this time, indicate this and include a

2x3 photographic slide or digital photo.
Tests: Identify the teeth involved (by number and the results of

endodontic diagnostic tests such as percussion, palpation,

electric pulp test (record the scale), cold or heat. Report the

results of any traced sinus tracts. It is important to indicate

whether the sensation from the heat or cold lingers or disappears

rapidly. This differentiates a reversible pulpitis from an irreversible

pulpitis. Also indicate whether the response was delayed or

immediate. A table can be used to arrange the results of

diagnostic tests for easy review by the examiners. The meaning of

symbols used in the table of test results can be explained on the



cover sheet.
Example:

TESTS


Tooth #

6

7

8

9

10

11






















Percussion

-

-

+

-

-

-

Palpation

-

-

+

-

-

-

Mobility

0

0

1+

0

0

0

Cold

+

+

-

+

+

+

EPT

28/80

24/80

80/80

26/80

25/80

27/80

Heat

+

+

+

+

+

+

Transil.

n/a

n/a

n/a

n/a

n/a

n/a

Biting

-

-

-

-

-

-

Sinus Tract

-

-

-

-

-

-



Radiographic Interpretation: Describe the appearance of the periodontal ligament, lamina dura and surrounding bone. Report any abnormalities within the bone or in the periradicular area. If the radicular portion of the tooth is altered, for instance an immature apex or dilacerated root, state this. Besides interpreting the radiograph, be certain to examine the quality of the radiograph. This is critical. The quality of the radiograph must be excellent. It should be as parallel to the occlusal plane as possible, properly exposed and processed, and have no fixer stains, cone cuts, elongation or foreshortening. Besides a straight-on exposure, there should be an altered angle or shift shot exposure of pre-op, working and post-op films, especially for posterior teeth. The same guidelines for excellent quality apply to xeroradiographs and radiovisiography films. Remember, the quality of the radiograph is critical. It is a main source of information for the examiners.
F. Pretreatment Diagnosis: There must be a pulpal diagnosis and a periradicular

diagnosis. Terminology must be consistent throughout the portfolio and acceptable to the American Board of Endodontics. If it varies from the terminology published in the Glossary of Endodontics Terms, or in the Case History Portfolio Instructions provided by the Board, or those found in a standard endodontic text, identify the source and enter the diagnostic terms along with their definitions on the same sheets as the list of abbreviations. Again, be certain that the candidate uses these terms consistently throughout the case histories portfolio.


G. Treatment Plan:

Emergency: If there was an emergency procedure, explain what was done,

e.g., pulp cap, pulpotomy, and trephination.


Definitive: Include the primary treatment, e.g. NS RCT

Alternative: The next best treatment: e.g., S RCT, intentional replantation,

extraction


Restorative: Although this part of the treatment plan is just a recommendation

to the referring dentist, it is best to put down what the best

treatment would be, not necessarily the most affordable.
Prognosis: Ensure the candidate uses favorable, questionable, and unfavorable for the prognosis. This is the system the Board requires. Explain briefly why the prognosis is appropriate based on what factors are present or absent.
H. Clinical Procedures: (Treatment Record)
The treatment record should be very comprehensive, yet PRECISE and CONCISE.

It is a chronological record of all treatment rendered. It begins with the initial referral and any emergency treatment rendered. The blood pressure should be recorded at the initial appointment. State that the medical history was reviewed and note any abnormalities. Explain how abnormalities were handled. If any other consultations were required, state this, e.g., referring dentist, prosthodontist, periodontist. Include a copy of the consult, if appropriate.


Give a brief description of the proposed treatment and any complications that might be encountered. Be explicit that informed consent was obtained. For example: “Treatment options were reviewed. The plan included calcium hydroxide to promote apexification. It was explained that this procedure may take a year or longer. If an adequate apical seal could not be accomplished, SRCT would be an alternative. The treatment plan was accepted and potential complications acknowledged.” If a candidate is treating a patient under the age of 18, he/she must be certain to have written consent, from a parent or a guardian, to treat the patient. The adult must fully understand the treatment and potential complications.
Include dosages and amounts of local anesthetic administered, e.g., local anesthesia (LA) (36 mg. of 2% lidocaine HCL with .018 mg. of 1:100.000 epinephrine).

It is preferable to use milligram dosages of anesthetic in addition to a concentration notation such as 1:100,000 epinephrine. Consultation with physician colleagues requires amounts of a drug, including local anesthetics, to be communicated in metric terms. In addition, maximum dosages for individual patients are calculated on the basis of a patient’s weight in metric units (mgs/kgs).


Record any untoward reactions to treatment procedures, e.g., “After injection the pulse rate increased and the patient became faint. The patient was placed in a supine position and O2 administered at 6 liters per minute until she returned to normal.” If a patient has a reaction to an antibiotic or any other drug, it should be reported along with the treatment rendered.
Be sure to record the type and concentration of irrigant, working lengths, type and method of instrumentation, canal obturation materials and any other medicaments used. Be specific. Make sure all the data is arranged in an orderly, neat, clear and precise manner. Remember, the candidate’s goal is to present a detailed report of the case. Make any appropriate comments on clinical appearance as well as radiographic changes. Include appropriate 2x3 photographic color slides or digital photographs, especially with surgical cases.
Be certain all conventional and/or digital radiographs, photographic slides and /or digital photographs and other pertinent materials are clearly labeled and dated, and that the dates of all materials correspond to the dates in the narrative.
If biopsies were obtained or bacteriological cultures taken, include a copy of the results with the case report form. The Board does not require original copies of the pathology or microbiology reports. A copy of the original will suffice.
The candidate should have emphasized the importance of the recall to the patient at the end of the treatment. Be sure to include this in the procedure section. Have the candidate indicate whether a six month recall was recommended. If there was a need for more frequent recalls, state why this was appropriate.
I. Post Operative Evaluations (1 year minimum)
For recalls, report any radiographic or clinical changes. If the recall was performed by someone else, state this fact. If there have been restorative changes since the endodontic treatment was completed, describe what they were. Although a one year follow-up is the minimum requirement, the longer a case is followed the better. Recall radiographs need to be of the highest quality. Appropriate 2x3 photographic slides or digital clinical photos can be included to demonstrate any clinical observations.
Remember, the recall examination is not a cursory exam. It is a thorough radiographic and clinical examination that elucidates as completely as possible the current state or condition of the tooth and the patient. The recall report should convey to the examiner the results of the thorough clinical exam and the interpretation of those results.
AMERICAN BOARD OF ENDODONTICS

CASE HISTORY EVALUATION FORM
Candidate Number: ________ Prefix #: Date Received:

Examiner: Date Mailed:





CANDIDATE USE ONLY:

TYPE the Following:


Enter your Candidate Number above
Type the Tooth Number opposite the

Required Procedure in column three


EXAMINER'S USE ONLY:

Enter evaluation scores as indicated for each of the three categories.

Excellent 3

Acceptable 2

Deficient 1

Unacceptable 0



Case No.

Required

Procedures

Tooth No.

Clinical Evaluation,

Diagnosis,

Treatment Plan

Treatment,

Post Treatment Evaluation

Complexity

1.

DIAG













2.

EMERG













3.

MED COMP













4.

NS RCT













5.

NS RCT













6.

NS RCT













7.

NS RCT













8.

NS RCT













9.

RETX













10.

RETX













11.

S RCT













12.

S RCT













13.

OTHER













14.

OTHER

















Case Submission Dates
May 1

October 1
Portfolios are accepted for review twice a year – May 1st and October 1st (portfolios must be received in the Central Office on or before the current submission date (listed above) to be included in that examination review cycle). Notebooks received after the current submission date will not be reviewed until the next submission date provided the candidate’s eligibility has not expired.



Portfolio Preparation

Detailed instructions and materials for the Case History Portfolio are sent from the headquarters office. Candidates are required to submit documentation of fifteen specific cases (as outlined in the Case History Evaluation Form) from their specialty practice of endodontics that demonstrate a broad spectrum of diagnostic, treatment, and evaluative procedures, and the ability to manage complex clinical problems at a specialist’s level. The diversity and complexity of the cases must thoroughly document exceptional knowledge, skill, and expertise in the specialty of endodontics. Each case should contribute added dimension to the portfolio. The portfolio should also demonstrate that the Candidate is practicing the full scope of the specialty of endodontics.

Narrative

The narrative documentation must computer-generated.


It is essential that the narrative include proper and consistent diagnostic terms, acceptable grammar, and correct spelling. Data should be arranged in a neat and orderly fashion in proper alphabetical or numerical sequence. The narrative reports must be complete and prepared according to instructions. Failure to follow instructions is a frequent reason for failure. A cover sheet describing routine policies and procedures and defining abbreviations is permitted. The use of abbreviations is acceptable but should be limited, especially when sufficient space is available on the Case History Report Form.
Medical histories for all cases should document previous and present illnesses, allergies, and medications the patient is taking. Alterations in your normal treatment regimen should be explained and justified. Biopsy reports of surgically excised tissue must be included.
It is also recommended that Candidates be specific in providing clinical diagnoses. Most cases require a pulpal and a periapical/periradicular diagnosis and both must be provided. Signs and symptoms are not acceptable as clinical diagnoses. The ABE approved terminology should be used.
All supportive or supplemental materials must be masked to prevent identification of the candidate, institution(s), geographic location, and patient’s name (e.g., pathology reports, medical lab reports, kodachromes, and photos).

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