Restorative Auxiliary Clinical Examination

Restorative Auxiliary Examination The Restorative Clinical Examination consists of the following procedures: Class III Composite Finished Restoration *Candidate must choose one: Class II Posterior Composite Finished Restoration Class II Amalgam Finished Restoration Each treatment is evaluated by four competency levels which are defined by specific written descriptions (criteria). The criteria themselves are the scorable items. Penalties assessed during the course of the examination are computed into the score. The Restorative Clinical Examination consists of the following procedures: Class III Composite Preparation & Finished Restoration *Candidate must choose one: Class II Posterior Composite Preparation & Finished Restoration Class II Amalgam Preparation & Finished Restoration Each of the treatment criteria is evaluated according to four competency levels which are defined by specific written descriptions. An analytical, criterion-based scoring model is used in which the criteria themselves are the scorable items. Three examiners independently evaluate all rated treatment criteria for the examination and the median competency level in each category is determined. These median competency levels are translated by computer into a numerical score. Penalties assessed by Clinic Floor Examiners for such categories as patient management and infection control will also be computed into the score. In addition, critical errors are given special consideration. Critical errors are procedures that could lead to patient injury or may jeopardize overall treatment of the patient. A critical error, such as a fractured restoration will result in failure of the Restorative Examination even though other rated treatment criteria are acceptably completed.

Competency Scales for Criteria SATISFACTORY The treatment is of good to excellent quality, demonstrating competence in clinical judgment, knowledge and skill. The treatment adheres to accepted mechanical and physiological principles permitting the restoration of the tooth to normal health, form and function. MINIMALLY ACCEPTABLE The treatment is of acceptable quality, demonstrating competence in clinical judgment, knowledge and skill to be acceptable; however, slight deviations from the mechanical and physiological principles of the satisfactory level exist which do not damage the patient nor significantly shorten the expected life of the restoration.

Competency Scales for Criteria MARGINALLY SUBSTANDARD The treatment is of poor quality, demonstrating a significant degree of incompetence in clinical judgment, knowledge and skill of the mechanical and physiological principles of restorative dentistry, which if left unmodified, will cause damage to the patient or substantially shorten the life of the restoration. CRITICALLY DEFICIENT The treatment is of unacceptable quality, demonstrating critical areas of incompetence in clinical judgment, knowledge or skill of the mechanical and physiological principles of restorative dentistry. The tooth must be temporized, or the treatment plan must be altered and additional care provided in order to sustain the function of the tooth and the patient’s oral health and well-being. Generally the points that are assigned to each rating level are 5 points for Satisfactory, 4 points for Acceptable, 3 points for Substandard and 0 points for Critically Deficient. A Critically Deficient rating that is independently marked by two or more examiners will result in a score of zero for the procedure and for the entire Restorative Part of the examination.

Amalgam Restoration

Amalgam Restoration 2. Contour, Contact and Occlusion 1. Margin Integrity and Surface Finish 2. Contour, Contact and Occlusion 3. Treatment Management -Penalty Points Only

Categories Evaluated for Amalgam Restoration Margin Integrity and Surface Finish Margin Deficiency Margin Excess Gingival Overhang Surface Finish Contiguous Tooth Structure

AMALGAM RESTORATION Margin Integrity and Surface Finish > 1.0 mm AMALGAM RESTORATION Margin Integrity and Surface Finish > 1.0 mm Margin Deficiency > 1.0 mm DEF

AMALGAM RESTORATION Margin Integrity and Surface Finish > 1.0 mm 1mm Margin Excess ARS SAT There is no detectable excess at the cavosurface margin either visually or with the tine of an explorer. ACC There is a detectable excess at the cavosurface margin either visually or with the tine of an explorer, but it is no greater than 1.0 mm. SUB The cavosurface margin is detectable visually or with the tine of an explorer. There is evidence of marginal excess of more than 1.0 mm and up to 2.0 mm. DEF There is evidence of excess at the cavosurface margin of more than 2.0 mm. DEF – Marginal Excess > 1.0 mm

AMALGAM RESTORATION Margin Integrity and Surface Finish Detected clinically with floss and/or an explorer Gingival Overhang SAT- The restoration exhibits no gingival overhang. ACC- The restoration exhibits a slight gingival overhang but would not be expected to adversely affect the tissue health. DEF - The restoration exhibits a significant gingival overhang and would be expected to adversely affect the tissue health. ACC

AMALGAM RESTORATION Margin Integrity and Surface Finish SAT- The surface of the restoration is uniformly smooth and free of pits and voids. ACC- The surface of the restoration is slightly grainy or rough, but it is free of significant pits and voids. SUB- The surface of the restoration is rough and exhibits surface significant irregularities, pits or voids. SUB

AMALGAM RESTORATION Margin Integrity and Surface Finish Contiguous Tooth Structure SAT- There is no evidence of unwarranted or unnecessary removal, modification, or recontouring of tooth structure adjacent to the restoration. ACC- There is minimal evidence of unwarranted or unnecessary removal, modification, or recontouring of tooth structure adjacent to the restoration. (Enameloplasty) SUB- There is evidence of unwarranted or unnecessary removal, modification, or recontouring of tooth structure adjacent to the restoration. (Enameloplasty) DEF- There is gross enameloplasty resulting in the exposure of dentin. SUB

Categories Evaluated for Amalgam Restoration Contour, Contact and Occlusion Interproximal Contact Centric/Excursive Contacts Anatomy/Contour

AMALGAM RESTORATION Contour, Contact and Occlusion Interproximal Contact SAT- Interproximal contact is present, the contact is visually closed and is properly shaped and positioned; and there is definite, but not excessive, resistance to dental floss when passed through the interproximal contact area. ACC- Interproximal contact is visually closed, and the contact is adequate in size, shape, or position but demonstrates little resistance to dental floss. SUB- Interproximal contact is visually closed, but the contact is deficient in size, shape, or position and demonstrates little resistance to dental floss or shreds the floss. DEF- The interproximal contact is visually open or will not allow floss to pass through the contact area. DEF

AMALGAM RESTORATION Contour, Contact and Occlusion Centric/Excursive Contacts SAT- When checked with articulating ribbon or paper, all centric and excursive contacts on the restoration are consistent in size, shape and intensity with such contacts on other teeth, in that quadrant. SUB- When checked with articulating ribbon or paper, the restoration is in hyper- occlusion inconsistent in size, shape and intensity with the occlusal contacts on surrounding teeth, and requires adjustment. DEF- There is gross hyperocclusion so that the restoration is the only point of occlusion in that quadrant. SAT

AMALGAM RESTORATION Contour, Contact and Occlusion Anatomy/Contour SAT- The restoration reproduces the normal physiological proximal contours of the tooth, occlusal and marginal ridge anatomy. ACC- The restoration does not reproduce the normal occlusal anatomy, proximal contours of the tooth or marginal ridge anatomy, but would not be expected to adversely affect the tissue health. DEF- The restoration does not reproduce the normal occlusal anatomy, proximal contours of the tooth or marginal ridge anatomy, and would be expected to adversely affect the tissue health DEF

Categories Evaluated for Amalgam Restoration Treatment Management - Penalty Points Only Adjacent Tooth Damage Soft Tissue Damage

AMALGAM RESTORATION Treatment Management Adjacent Tooth Damage SAT - The adjacent teeth and/or restorations are free from damage. ACC- Damage to adjacent tooth/teeth can be removed with polishing without adversely altering the shape of the contour and/or contact. SUB- Damage to adjacent tooth/teeth requires recontouring which changes the shape and/or contour and/or contact. DEF- There is gross damage to adjacent tooth/teeth which requires a restoration. SAT

AMALGAM RESTORATION Treatment Management Soft Tissue Damage SAT- The soft tissue is free from damage or there is tissue damage that is consistent with the procedure. SUB- There is iatrogenic soft tissue damage that is inconsistent with the procedure. DEF- There is gross iatrogenic damage to the soft tissue inconsistent with the procedure and pre-existing condition of the soft tissue. SAT

Critical Errors Fractured Restoration YES NO

Posterior Composite Restoration

Categories Evaluated for Post Composite Restoration Margin Integrity and Surface Finish Margin Deficiency Margin Excess Gingival Overhang Surface Finish Contiguous Tooth Structure

POST COMPOSITE RESTORATION Margin Integrity and Surface Finish < 0.5 mm Margin Deficiency ACC

POST COMPOSITE RESTORATION Margin Integrity and Surface Finish Margin Excess 1.5 mm SAT

POST COMPOSITE RESTORATION Margin Integrity and Surface Finish Gingival Overhang SAT- The restoration exhibits no gingival overhang. ACC- The restoration exhibits a slight gingival overhang but would not be expected to adversely affect the tissue health. DEF - The restoration exhibits a significant gingival overhang and would be expected to adversely affect the tissue health. DEF

POST COMPOSITE RESTORATION Margin Integrity and Surface Finish SAT- The surface of the restoration is uniformly smooth and free of pits and voids. ACC- The surface of the restoration is slightly grainy or rough, but it is free of significant pits and voids. SUB- The surface of the restoration is rough and exhibits surface significant irregularities, pits or voids. SAT

POST COMPOSITE RESTORATION Margin Integrity and Surface Finish Contiguous Tooth Structure SAT- There is no evidence of unwarranted or unnecessary removal, modification, or recontouring of tooth structure adjacent to the restoration. There is no excess restorative material present that is not contiguous with the restoration. ACC- There is minimal evidence of unwarranted or unnecessary removal, or recontouring of tooth structure adjacent to the restoration. (Enameloplasty) Excess present that is not contiguous with the restoration no greater than 0.5mm. SUB- There is evidence of unwarranted or unnecessary removal, or recontouring of tooth structure adjacent to the restoration. (Enameloplasty) Excess present that is not contiguous with the restoration greater than 0.5mm. DEF- There is gross enameloplasty resulting in the exposure of dentin. SAT

Categories Evaluated for Post Composite Restoration Contour, Contact and Occlusion Interproximal Contact Centric/Excursive Contacts Anatomy/Contour

POST COMPOSITE RESTORATION Contour, Contact and Occlusion Interproximal Contact SAT- Interproximal contact is present, the contact is visually closed and is properly shaped and positioned; and there is definite, but not excessive, resistance to dental floss when passed through the interproximal contact area. ACC- Interproximal contact is visually closed, and the contact is adequate in size, shape, or position but demonstrates little resistance to dental floss. SUB- Interproximal contact is visually closed, but the contact is deficient in size, shape, or position and/or demonstrates little resistance to dental floss or shreds the floss. DEF- The interproximal contact is visually open or will not allow floss to pass through the contact area. SAT

POST COMPOSITE RESTORATION Contour, Contact and Occlusion Centric/Excursive Contacts SAT- When checked with articulating ribbon or paper, all centric and excursive contacts on the restoration are consistent in size, shape and intensity with such contacts on other teeth, in that quadrant. SUB- When checked with articulating ribbon or paper, the restoration is in hyper- occlusion inconsistent in size, shape and intensity with the occlusal contacts on surrounding teeth, and requires adjustment. DEF-There is gross hyperocclusion so that the restoration is the only point of occlusion in that quadrant. SAT

POST COMPOSITE RESTORATION Contour, Contact and Occlusion Anatomy/Contour SAT- The restoration reproduces the normal physiological proximal conours of the tooth, occlusal and marginal ridge anatomy. ACC- The restoration does not reproduce the normal occlusal anatomy, proximal contours of the tooth or marginal ridge anatomy, but would not be expected to adversely affect the tissue health. DEF- The restoration does not reproduce the normal occlusal anatomy, proximal contours of the tooth or marginal ridge anatomy, and would be expected to adversely affect the tissue health. DEF

Categories Evaluated for Post Composite Restoration Treatment Management - Penalty Points Only Adjacent Tooth Damage Soft Tissue Damage

Critical Errors Fractured Restoration Yes No Debonded Restoration Yes No

Anterior Composite Restoration

Anterior Composite Restoration 1. Margin Integrity and Surface Finish 2. Contour, Contact and Occlusion 3. Treatment Management – Penalty Points

Categories Evaluated for Anterior Composite Restoration Margin Integrity and Surface Finish Margin Deficiency Margin Excess Gingival Overhang Surface Finish Contiguous Tooth Structure Shade Selection

ANTERIOR COMPOSITE RESTORATION Margin Integrity and Surface Finish Margin Deficiency ACC ** NOTE** If flash is identified by the 1st examiner, be sure to take care not to remove it so subsequent evaluations are accurate.

ANTERIOR COMPOSITE RESTORATION Margin Integrity and Surface Finish >2mm ANTERIOR COMPOSITE RESTORATION Margin Integrity and Surface Finish Margin Excess DEF ** NOTE** If flash is identified by the 1st examiner, be sure to take care not to remove it so subsequent evaluations are accurate.

ANTERIOR COMPOSITE RESTORATION Margin Integrity and Surface Finish Gingival Overhang SAT- The restoration exhibits no gingival overhang. ACC- The restoration exhibits a slight gingival overhang but would not be expected to adversely affect the tissue health. DEF - The restoration exhibits a significant gingival overhang and would be expected to adversely affect the tissue health. SAT

ANTERIOR COMPOSITE RESTORATION Margin Integrity and Surface Finish 11 ML SAT- The surface of the restoration is uniformly smooth and free of pits and voids. ACC- The surface of the restoration is slightly grainy or rough, but it is free of significant pits and voids. SUB- The surface of the restoration is rough and exhibits surface significant irregularities, pits or voids. SAT

ANTERIOR COMPOSITE RESTORATION Margin Integrity and Surface Finish Contiguous Tooth Surface SAT- There is no evidence of unwarranted or unnecessary removal, modification, or recontouring of tooth structure adjacent to the restoration. There is no excess restorative material present that is not contiguous with the restoration. ACC- There is minimal evidence of unwarranted or unnecessary removal, modification, or recontouring of tooth structure adjacent to the restoration. (Enameloplasty) Excess present that is not contiguous with the restoration no greater than 0.5mm. SUB- There is evidence of unwarranted or unnecessary removal, modification, or recontouring of tooth structure adjacent to the restoration. (Enameloplasty) Excess present that is not contiguous with the restoration greater than 0.5mm. DEF- There is gross enameloplasty resulting in the exposure of dentin. ACC

Categories Evaluated for Anterior Composite Restoration Contour, Contact and Occlusion Interproximal Contact Centric/Excursive Contacts Anatomy/Contour

ANTERIOR COMPOSITE RESTORATION Contour, Contact and Occlusion Shreds floss ANTERIOR COMPOSITE RESTORATION Contour, Contact and Occlusion Interproximal Contact SAT- Interproximal contact is present, the contact is visually closed and is properly shaped and positioned; and there is definite, but not excessive, resistance to dental floss when passed through the interproximal contact area. ACC- Interproximal contact is visually closed, and the contact is adequate in size, shape, or position but demonstrates little resistance to dental floss. SUB- Interproximal contact is visually closed, but the contact is deficient in size, shape, or position and/or demonstrates little resistance to dental floss or shreds the floss or is visually open but deflects floss. DEF- The interproximal contact allows unwaxed dental floss to pass without deflection or resistance or will not allow floss to pass through the contact area. SUB

ANTERIOR COMPOSITE RESTORATION Contour, Contact and Occlusion Centric/Excursive Contacts SAT- When checked with articulating ribbon or paper, all centric and excursive contacts on the restoration are consistent in size, shape and intensity with such contacts on other teeth, in that quadrant. SUB- When checked with articulating ribbon or paper, the restoration is in hyper- occlusion inconsistent in size, shape and intensity with the contacts on surrounding teeth, and requires adjustment. DEF- There is gross hyperocclusion so that the restoration is the only point of occlusion in that quadrant. SAT

ANTERIOR COMPOSITE RESTORATION Contour, Contact and Occlusion Anatomy/Contour SAT- The restoration reproduces the normal anatomical contours of the tooth, including facial, lingual, proximal and marginal ridge anatomy when compared to contiguous tooth structure. ACC-The restoration deviates slightly from the normal anatomical contours of the tooth, when compared to contiguous tooth structure but would not be expected to adversely affect the tissue health. DEF- The restoration deviates significantly from the [_] normal anatomical contours of the tooth, including facial, lingual, proximal or marginal ridge anatomy, and/or [_]would be expected to adversely affect the tissue health. ACC

Categories Evaluated for Anterior Composite Restoration Treatment Management – Penalty Points Adjacent Tooth Damage Soft Tissue Damage

ANTERIOR COMPOSITE RESTORATION Treatment Management Adjacent Tooth Damage 11 ML SAT- The adjacent teeth and/or restorations are free from damage. ACC- Damage to adjacent tooth/teeth can be removed with polishing without adversely altering the shape of the contour and/or contact. SUB- Damage to adjacent tooth/teeth requires recontouring which changes the shape and/or contour and/or contact. DEF- There is gross damage to adjacent tooth/teeth which requires a restoration. SAT

ANTERIOR COMPOSITE RESTORATION Treatment Management Soft Tissue Damage SAT- The soft tissue is free from damage or there is tissue damage that is consistent with the procedure. SUB- There is iatrogenic soft tissue damage that is inconsistent with the procedure. DEF- There is gross iatrogenic damage to the soft tissue inconsistent with the procedure and pre-existing condition of the soft tissue. SAT

Critical Errors The Restoration is Debonded and/or Movable in the Preparation Yes No