College of Diplomates Manual For Candidates for Certification as a



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Radiographs

Radiographs/images must be placed in the order of sequence they were taken. Radiographic/image documentation must be original and of high quality. Copies of radiographs/images are not permitted. The case number, Candidate number and all X-ray dates need to be indicated on the X-ray mount form. Patient names cannot be listed.


It is strongly suggested that a sufficient number of diagnostic quality radiographs/images be presented for each case. Proper film/sensor placement, use of altered angulations to permit visualization of superimposed structures such as canals or roots, and adequate processing are essential. Xeroradiographs/digital images are acceptable as long as the above criteria are met. Interim treatment radiographs/images are suggested but not required. All treated canals must be visible on at least one postoperative radiograph/image.
Digital Images

Guidelines for Submission of Digital Images

Quality and image clarity of digital images are dependent upon three primary factors:


Digital images submitted must be of high diagnostic value, and therefore, must follow the same guidelines used for evaluation of standard radiographs.


A high-grade paper such as document quality paper or photo-quality paper (glossy type) provides exceptional resolution and is required. Thermal paper, thermal printers, and normal copy paper are not acceptable.
High quality ink jet printers in conjunction with document or photo quality paper have proven to be excellent choices for digital images
The individual size of a digital image should be minimally equivalent to a 2x3 size film but no larger than 5” by 7”. Images larger than 5” by 7” tend to lose their clarity and detail. Images can be printed onto 8 ½” x 11” document or photo quality paper or individually mounted on standard copy paper so long as the mounting medium does not interfere with the respective image. All digital images must be void of any identifying information and must be properly dated and coded by case number and protected with a transparent plastic cover.

Laboratory and Biopsy Reports

Photocopies of laboratory and biopsy reports are acceptable. All supplemental reports must be masked to prevent identification of the Candidate, institution(s), geographic location, and patient’s name. All information must be in English, if the original document is not in English, a notarized translation as well as a copy of the original document must be included.



Recall

Clinical evaluations and recall radiographs (one year minimum from the date treatment is completed) are required for each case. The required one year recall must be from the time definitive endodontics was completed. Cases requiring calcium hydroxide therapy require a one-year radiograph recall examination following completion (obturation) of root canal treatment. Cases in the diagnostic category must have an one year follow up evaluation regardless of whether endodontic treatment was instituted. The recall evaluation must include a comprehensive narrative including comments on any change in the original condition.


Is the Case Complex Enough for Submission

The following requirements are the basis for scoring



Excellent


Required the highest level of knowledge and technical skill.

Required the highest level of patient management.

Treatment consultations were required.

The treatment sequence was a critical component.



Acceptable


High technical skill required.

Adequate patient management.

Treatment sequence important but not critical.

Deficient


Routine diagnostic and technical difficulty requiring average skills.

Unacceptable


The knowledge and technical skills required were within the scope of the general dentist.

Reviewing the Case History Portfolio before submission

It is strongly suggested that prior to submission a thorough review is completed. Common errors are inconsistent dates. Compare the dates on the front and back of the Case History Report form, biopsy reports, radiographs and/or digital images for consistency with each case.


Guidelines for Submission of the Case History Portfolio
Before submitting your notebook, try using the following guide to thoroughly review your notebook, case by case. This can also be performed by someone that is not a dentist !


Check List
Tooth Identification:

 Are the teeth properly identified?


Procedure(s):

  • Is the procedure properly recorded?

  • Is the subcategory completed for the three “Other” cases?

Chief Complaint:

 Is the patient’s chief complaint noted prior to treatment?
Medical History


  • Was the patient’s history or medication record considered?

  • Is the medical history adequate?

  • Is it documented that appropriate medical consultations were obtained?

  • Were dental procedures appropriately modified to meet medical problems?

  • Are all medications documented (include dosages, frequency of dosing and the condition for which the drug is being given)?

  • Are vital signs recorded?

Dental History



  • Is the dental history comprehensive – does it provide a thorough synopsis of the patient’s dental history, including symptoms pertinent to the endodontic treatment

Clinical Evaluation (Diagnostic Procedures):

 Were the patient’s chief complaint, clinical signs and symptoms, and general dental condition recorded?

 Were reasonable and proper diagnostic tests and examinations performed?

 Were pre-treatment radiographs adequate?

 Were radiographic interpretations consistent with films presented?


Pre-treatment:

 Were pulpal and periapical diagnoses consistent with medical, dental histories and results of diagnostic tests?

 Were all essential diagnostic procedures properly interpreted?


  • Has the ABE Pulpal & Periapical Diagnostic Terminology approved April, 2007 been used?

  • If other terminology was used, is it listed on a cover sheet and were the definitions given?

  • Have all terms been used consistently throughout the documentation?

Treatment Plan:

 Was appropriate emergency and definitive treatment recommended? Was it performed?

 Were alternative treatment plans acceptable?



  • Were appropriate recommendations for post endodontic treatment made?

  • Was the prognosis consistent with the plan?

  • Have the following terms been used for the prognosis – Favorable, Questionable, or Unfavorable?

Clinical Procedures:



  • Was sequencing of appointments and timing of operations reasonable?

  • Has it been recorded that informed consent was obtained

  • Are dates listed in sequential order?

  • Were clinical procedures performed at the highest level of skill?

  • Were all essential procedures performed in the appropriate sequence?

Was emergency care, (if any), appropriate?

  • Have the clinical procedures performed been described and justified (where necessary)?

  • Does the report indicate if treatment was modified in accordance with the medical and dental history?

  • Has the emergency care rendered (if any) been described?

  • Have complications encountered (if any and how managed) been described?

  • Are the radiographs/images adequate and do they demonstrate quality treatment?

  • Does the report contain quality radiographs/images? Films that are too dark, too light, not clear, digitals that are too small should not be used.

  • Are their sufficient radiographs? Included should be angled views, working length measurements, cone fits, etc.).

  • Does the notebook include radiographs that show, the entire periradicular lesion, what is described in the narrative and all of the canals and their apical terminations.

  • Have anesthetic(s) administered and amounts in milligrams been recorded?

  • If anesthetic was not used, is it clear why?

  • Was the pharmacological management appropriate and justified?

  • Was treatment modified in accordance with the medical and dental history

  • Have the medications prescribed (including dosages, time intervals, method of administration, and rationale) been included?

  • Does the report include the following?

Instrumentation techniques

Length and size of intracanal instrumentation at each visit

Intra-canal irrigants and medicaments,

Microbiologic findings (if any),

Obturating materials (including sealers) and techniques used,


  • Do the reports of biopsy findings and immediate post-treatment history provide a summary of signs, symptoms and radiographic findings?

  • Is the application of biologic principles demonstrated?

  • Have the canal, working length, master apical file, filling core, sealer, and obturation technique been recorded in the table provided?

  • Was overall case management and treatment adequate and justifiable?

Post-Operative Evaluation(s):



  • Are recalls one or more years in duration following completion of treatment?

  • Are reported results consistent with recall data provided?

  • Is long-term prognosis consistent with data provided?

  • Are the criteria for healing clear?

  • Biopsy was obtained when tissue was removed

General Documentation:



  • Is written documentation clear and precise?

  • Is data arranged in a neat orderly fashion using correct spelling and proper

grammar

  • Have you recorded dates consistently and accurately?

  • Does your completed Case History Report form exactly duplicate the

enclosed form.

protectors?

  • If an Addendum page was used is it inserted into a page protector?

  • Are the radiographs mounted in sequential order, identified with a label

maker or white label and inserted into a page protector?

  • Are all patient, doctor names and identifying locations completely masked at

the top, bottom and in the body of the report?

information reported?
Complexity

  • Did this case require the highest level of technical skill?

  • Did this case require the highest level of patient management?

  • Did this case require the highest level of expertise in endodontic treatment?

Submission of the Portfolio
Policy requires that the Case History Portfolio is sent to the Central Office of the American Board of Endodontics via certified mail with a return receipt, FedEx, UPS, or other similar services that provide tracking information. Candidates are strongly advised to duplicate and retain a copy of their Case History Portfolio before mailing. While portfolios are circulated by FedEx to Directors of the Board for evaluation, we cannot be responsible for Case History Portfolios lost in transit.
Examination Scoring

The Board has modified the evaluation method for the Case History Portfolios to give equal weight to the components that make up the presentation of a case. Three categories are evaluated for each case presented. The Candidate’s clinical evaluation, diagnosis and treatment plan make up the first score. Treatment procedures and post treatment evaluation (recall of at least twelve months) form the basis for the second category. The overall complexity of the case is the third category. This process is completed on each of the fifteen cases. During the portfolio evaluation by three Board Directors, the Candidate’s identity is always strictly protected. Evaluation of the fifteen prescribed cases gives the Directors knowledge and insight into the level of the Candidate’s diagnostic and clinical skills. The ABE uses a multi-facet analysis performed by an independent testing service. The impact of all facets of the examination is accounted for, including rater severity, case difficulty, and skill difficulty. This provides examination results that are reliable, as well as valid.



Candidate Notification
The Secretary of the Board will notify the Candidate by letter whether the Case History Portfolio is acceptable or unacceptable. The Case History Portfolio will be returned to the Candidate after evaluation. A Candidate has three (3) years to successfully complete the Case History Examination. Candidates who exceed the three (3) year time limit for the Case History Examination, or who fail to pass the examination within two tries, are required to re-apply by submitting another Preliminary Application and are required to repeat the entire certification process. An endodontist can be declared Board Eligible only two times during his/her career. Candidates are required to pay an annual registration fee to retain their “active” status. 
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