· Acquire competence and confidence in the various restorative clinical disciplines (operative...

COPYRIGHTS AND AMENDMENTS

2 SAUDI BOARD RESTORATIVE DENTISTRY CURRICULUM

COPYRIGHT AND AMENDMENTS

All rights reserved. © 2016 Saudi Commission for Health Specialties.

This material may not be reproduced, displayed, modified, or distributed without prior written permission of the copyright holder. No other use is permitted without prior written permission of the Saudi Commission for Health Specialties.

Any amendment to this document shall be approved by the Specialty Scientific Council and the Executive Council of the commission and shall be considered effective from the date of updating the electronic version of this curriculum published on the commission website unless different implementation date has been mentioned.

For permission, contact the Saudi Commission for Health Specialties, Riyadh, Kingdom of Saudi Arabia.

Correspondence: P.O. Box: 94656 Postal Code: 11614 Consolidated Communication Center: 920019393 International Contact Call: 00-966-114179900 Fax: 4800800 Extension: 1322

Website: www.scfhs.org.sa

Formatted and Designed by: Manoj Thomas Varghese, CMT/Salem Al Tamimi (SCFHS)

http://www.scfhs.org.sa/

mailto:[email protected]

mailto:[email protected]

TABLE OF CONTENTS

SAUDI BOARD RESTORATIVE DENTISTRY CURRICULUM 3

TABLE OF CONTENTS

INTRODUCTION _____________________________________________________________________________ 7

Rationale and educational objectives of the program _____________________________________________ 9

General training requirements ______________________________________________________________________ 10

Program framework __________________________________________________________________________________ 10

Minimum training requirements for SBRD residency ___________________________________________ 11

Differences between proposed and existing curriculum ________________________________________ 11

Abbreviations __________________________________________________________________________________________ 13

OUTCOMES AND COMPETENCIES ________________________________________________________ 14

Clinical competencies and learning objectives ____________________________________________________ 14

Medical Expert _________________________________________________________________________________________ 14

Communicator _________________________________________________________________________________________ 80

Collaborator ____________________________________________________________________________________________ 81

Leader___________________________________________________________________________________________________ 83

Health Advocate ________________________________________________________________________________________ 84

Scholar __________________________________________________________________________________________________ 85

Professional ____________________________________________________________________________________________ 87

Integration of disciplines _____________________________________________________________________________ 89

Milestones and continuum of learning _____________________________________________________________ 89

Top ten conditions in the specialty _________________________________________________________________ 93

Top ten causes of a visit to accident and emergency _____________________________________________ 94

Top ten procedures performed _____________________________________________________________________ 94

Common complications or malpractice ____________________________________________________________ 94

Procedural requirements upon completion of residency according to level of training: ___ 95

TEACHING AND ACADEMIC ACTIVITIES ________________________________________________ 98

General principles _____________________________________________________________________________________ 98

Core educational program ___________________________________________________________________________ 98

Universal topics ________________________________________________________________________________________ 98

TABLE OF CONTENTS


Core specialty topic ____________________________________________________________________________________ 99

Trainee-selected topics ______________________________________________________________________________ 119

Research ______________________________________________________________________________________________ 119

Educational methods and professional development topics ______________________________________ 126

Practice and work-based learning _________________________________________________________________ 129

Clinical-based learning ______________________________________________________________________________ 129

Presentation of advanced cases _____________________________________________________________________ 131

Treatment plan sessions or case-based learning __________________________________________________ 132

Literature review in RD and Journal Club __________________________________________________________ 132

Self-directed learning ________________________________________________________________________________ 133

Community service __________________________________________________________________________________ 133

Elective (special interest) module __________________________________________________________________ 134

Supplementary courses and workshops ____________________________________________________________ 134

ASSESSMENT ______________________________________________________________________________ 135

Annual promotion assessment _____________________________________________________________________ 135

End of year in-training report (continuous appraisal) ____________________________________________ 135

End of year in-training evaluation: formative continuous evaluation ____________________________ 136

Regional treatment plan oral presentation (CBD): summative continuous evaluation _________ 136

Oral clinical examination/OSCE/SOE: summative continuous evaluation _______________________ 136

End of year written examination ___________________________________________________________________ 136

Final in-training evaluation report ________________________________________________________________ 137

Principles of restorative dentistry examination (Saudi Board Examination: Part I) _______ 137

Final restorative dentistry board examination (Saudi Board Examination: Part 2) _______ 137

Written examination _________________________________________________________________________________ 137

Clinical oral examination ____________________________________________________________________________ 137

Certification ___________________________________________________________________________________________ 138

Assessment tools _____________________________________________________________________________________ 138

Trainee support (mentorship) _____________________________________________________________________ 140

Portfolio and logbook ________________________________________________________________________________ 140

REFERENCES ______________________________________________________________________________ 141

APPENDICES ______________________________________________________________________________ 142

TABLE OF CONTENTS


Appendix I _____________________________________________________________________________________________ 142

Appendix II ____________________________________________________________________________________________ 143

Appendix III ___________________________________________________________________________________________ 145

Appendix IV ___________________________________________________________________________________________ 152

Appendix VI ___________________________________________________________________________________________ 153

Appendix VII __________________________________________________________________________________________ 155

Appendix VIII _________________________________________________________________________________________ 157

Appendix IX ___________________________________________________________________________________________ 158

Appendix X ____________________________________________________________________________________________ 160

Appendix XI ___________________________________________________________________________________________ 162

ACKNOWLEDGEMENTS


ACKNOWLEDGEMENTS

First and foremost, we would like to thank Allah, the Almighty, for helping us to complete this curriculum. We also express our deepest appreciation to the Saudi Commission for Health Specialty for helping and guiding us in this curriculum, especially Dr. Saud Orfali and Dr. Reem Al Dhalaan. Their recommendations and suggestions have been invaluable for this project. It is also a pleasure to thank the Supervisory Committee and the resident representative Dr. Mohammed Al Essa, who assisted us in the development of this curriculum. We appreciate the valuable contributions and feedback from Dr. Helal Sunbul while compiling this curriculum. Special thanks are also given to our families and colleagues for their encouragement and ongoing assistance, which have been a tremendous support throughout this project. Finally, we acknowledge and extend our gratitude to the Royal College of Physicians and Surgeons of Canada for allowing us to benefit from their expertise in designing a competency-based curriculum. On behalf of the Saudi Board in Restorative Dentistry, it is a pleasure to be able to utilize and implement the CanMEDS 2015 competency framework .

INTRODUCTION


INTRODUCTION

Foreword Nowadays, medical and dental schools and institutions are experiencing a variety of challenges in medical education, which stem from the health care needs of society, the patient’s expectations of high quality and safe-care, new generations of learners, a well-developed health care environment, and new approaches to medical education. To face these important challenges, postgraduate medical training programs need to modify their practices by implementing a well-structured and innovative curriculum. Recognizing the growing demand for this comprehensive, explicit, innovative health training curriculum, the SCFHS has adopted the CanMEDS 2015 framework as a medical education guide in terms of the essential competencies that residents need to have for improved patient care, and has set up the core curriculum of all training programs, including the SBRD. CanMEDS is an innovative, competency-based framework that involves implementation of outcomes-driven education and assessment to ensure that physicians and dentists have the knowledge, skills, and attitudes they need for every stage and role in their career. The framework is based on seven roles that all physicians and dentists need to have in order to meet the needs of society: medical expert, communicator, collaborator, leader, health advocate, scholar, and professional. This framework will provide a more personalized learning experience for residents, who can be expected to develop into self-directed and lifelong learners who can provide effective care during their future practice. Development of this curriculum was a dynamic, interactive process that started with selection of curriculum development committee members who were qualified medical educators. After reviewing the old curriculum and conducting several formal and informal interviews with the program stakeholders, including a resident representative, as well as conducting meetings with curriculum advisory members, the needs were assessed and the goals, objectives, contents, educational strategies, and assessment methods of the curriculum were set according to a curriculum template recommended by the SCFHS, integrating the CanMEDS framework. Finally, the curriculum’s first version was submitted to the SBRD Scientific Committee for approval. The curriculum is intended to be used by SBRD program stakeholders, including educators, program directors, teachers, trainees and researchers, as a guide to learning, training, educational strategy, assessment, and certification. To implement the curriculum successfully and help it achieve its potential, the curriculum developers must ensure that sufficient resources, financial support, faculty development programs, and administrative strategies have been developed. These require collaborative work and support from the SCFHS, program-supervising committees, training centers, program directors, and contributing tutors or supervisors. Finally, periodic formative and summative program evaluation should be conducted by the SBRD Scientific Council to allow for future refinement and continuous quality improvement of the curriculum.

INTRODUCTION


Definition SBRD is a unique program in the region designed to provide didactic, clinical and hospital training to upgrade the standards of the dental profession in Saudi Arabia. The instruction and experience provided in the SBRD can prepare residents to be highly qualified restorative dentists who are able to treat complex cases of restorative dentistry, endodontics, and fixed prosthodontics. History The prevalence of dental caries is on the rise in a number of nations around the world. The adult Saudi population has demonstrated a higher prevalence and greater severity of caries and secular trends over the past decades. This alarming dental public health problem warrants the immediate attention of the government and officials in the dental profession. Unfortunately, current estimates indicate that the World Health Organization 2000 goals are still unmet for Saudi Arabia. Thus, it has been critical to design a unique program tailored specifically to meet that goal in addition to the specific demands of the Saudi population, including identifying intervention targets and improving oral health. From here, the concept of the SBRD developed in an effort to prepare qualified restorative specialists to outline and execute a treatment plan for prevention and control of dental disease, along with dental rehabilitation and maintenance. The SBRD is the backbone of all scientific dental board programs recognized by the SCFHS. Further, it is the major podium adopted by the Scientific Dental Board for all current programs, and in 2016 has 95 current residents distributed across 29 accredited training centers within the Kingdom of Saudi Arabia. The program is the brainchild of Professor Abdullah R. Al-Shammery, and was officially launched in October 1999. The inaugural SBRD commenced with ten residents in the three major training centers, i.e., King Saud University in Riyadh, King Abdul-Aziz University in Jeddah, and Dammam Ministry of Health Dental Center, with a single Regional Training Committee, and Professor Al-Shammery as the first chairman of the SBRD Scientific Committee. Vision The vision of the SBRD is to be a leading program for training professionals in restorative dentistry using the best approaches and strategies in medical education, and to ensure outstanding quality in dental care services in the Kingdom of Saudi Arabia. Graduates of the SBRD program are trained to implement high-quality skills, advanced techniques, and modern technology for the treatment of a range of dental diseases. Mission The mission of the SBRD is to create an ideal work environment that will provide trainees in the program with the tools necessary for excellence in dental care. The SBRD program aims to boost the academic achievement of its residents by implementing strategic, measurable, and effective learning methods.

INTRODUCTION


The goals of the SBRD are: to supply the community with qualified dental restorative specialists; to provide a designated training program for dental restorative specialists and related professions; to maintain an environment of excellence for residents and apply the measures required for academic success as well as clinical achievement; to offer the advanced techniques and modern technology required for oral health research and other related scientific endeavors; and to provide consulting dental restorative services for local as well as international agencies. The SBRD oral health program is dedicated to providing the community with efficient, effective, and up-to-date resources. We anticipate that our graduate specialists will be important members of the oral health community and perform to an outstanding level in clinics and in research.

Rationale and educational objectives of the program

As a restorative dentistry program, SBRD aims to train and graduate competent, knowledgeable specialists in restorative dentistry (operative dentistry, endodontics and fixed prosthodontics) capable of functioning independently to provide an educational environment that promotes a high standard of delivery of health care. Specifically, the Saudi Specialty Certificate in Restorative Dentistry (SSC-[Dent]) program prepares residents to:

Plan and provide both routine and complex restorative dental care for a wide variety of patients by applying advanced knowledge and clinical skills.

Acquire competence and confidence in the various restorative clinical disciplines (operative dentistry, endodontics, fixed prosthodontics, and implantology) that are integral components of restorative dentistry.

Reinforce the ability to make judgments in arriving at a diagnosis, planning treatment, and assessing treatment outcomes.

Keep abreast with modern technology in dentistry and practice management.

Communicate, understand and function effectively with other health care professionals and understand the setting of their organizational system.

Acquire experience in teaching and research to upgrade clinical knowledge. At the end of this program, the resident will have acquired the following competencies and can function effectively in these roles as per CanMEDS framework competencies:

Medical expert

Communicator

Collaborator

Leader

Health advocate

Scholar

Professional

INTRODUCTION


General training requirements

1) Admission into the program is in accordance with the commission training rules and regulations.

2) Trainees shall abide by the training regulations and obligations established by the SCFHS, and that of the training center.

3) Training is a full-time commitment. Residents shall be enrolled in full-time, continuous education for the entire duration of the program.

4) Training is to be conducted in institutions accredited by the SCHS. 5) Training shall be comprehensive and in fulfillment of promotion requirements and

comprehensive patient management. 6) Trainees shall be actively involved in patient care with gradual progression of responsibility.

Program framework

1) Structure of training program

The SBRS is a program that runs for a period of 4 years.

Didactic clinical sciences and advanced clinical training are integrated into the program.

Documentation of progress in the program and all resident activities must be maintained by the program director and available for review.

Comprehensive restorative dental care is divided into two parts: junior residency (the first 2 years), which is dependent (under supervision), and senior residency after passing the Part 1 examination (the final 2 years), which is independent.

Members of the training committee will evaluate residents every 3 months by an ITER.

The trainee shall be promoted from one level to the next level of training based on o The total average of three periodic evaluations in addition to the result of any

assessment methods used during the residency year (represents 50%). o The results of an end of year examination (represents 50%; excluding R4) o Each resident scoring a general average percentage of not less than 60% in the

assessments outlined in (a) and (b), and not less than 50% in each of these.

o Covering the minimum academic and clinical requirements approved by the SBRD

Scientific Committee. After successful completion of all program requirements during the 4-year training period

and obtaining the final ITER, candidates will receive a training completion certificate issued by the regional supervising training committee.

The candidate will then be eligible to undertake the Final Saudi Board Certification Examination in Restorative Dentistry.

2) Supervision of the program

The residency program is supervised by various layers of authority, including the following:

Chairman of the Scientific Board Committee

Director of the Regional Supervisory Committee

Director of the Examination Committee

Director of the Case Evaluation Committee

Program Director at the Training Center

Secretary of the SBRD

INTRODUCTION


Minimum training requirements for SBRD residency

The SCFHS requires 4 years of training, and completion of the allocated requirements for eligibility to sit in the SBRD examination:

Clinical requirements (comprehensive cases, single procedures). Refer to Appendix II for guidelines on clinical requirements

Research project

Community service

Participation in teaching activities (minimum one year)

Submission of the universal topics completion certificate (minimum eight topics)

Conduct a topic activity selected by the trainee (minimum one) Residents should rotate through more than one training center during their residency. SBRD training rota policy Approved annual SBRD training rota policy:

The Chairperson of the Regional Training Committee should prepare a rota annually and present it to the Scientific Committee for approval no more than 4 months before the end of the current rota (i.e., in May).

Residents will be informed of their rota no more than 3 months before the end of the current rota (i.e., in June).

Each resident will spend no more than 2 years at one training center regardless of category of SCHS accreditation.

Peripheral areas may be exempt and can extend to 3 years, provided the center fulfills all requirement supplements, but can be a year in specific cases. The chairs of the regional committees will evaluate each case independently.

Each rota will follow a preset map in accordance with pre-assigned seats at the training centers.

Training centers should respect the number of seats assigned and accredited by the SCHS. The chairperson of each regional committee should be notified of any changes, and s/he should follow up each center annually.

Differences between proposed and existing curriculum

CanMEDS 2015 is a curriculum that utilizes a concept of competency-based medical education. In this new curriculum: Educators will be able to:

Identify the abilities of individual learners at different stages of their training throughout the program and provide constructive feedback to improve their knowledge and skills.

Use a range of assessment methods, such as formative, summative, self, and workplace assessment.

INTRODUCTION


Learners will be able to:

Provide high-quality care to patients and communities in a safe environment.

Continue to update their knowledge and skills.

Conduct scientific research to support clinical decision-making and patient management.

Identify their limits and what they should achieve in each stage of training.

Select elective topics in the program.

Increase their abilities to that expected of a health professional at a stage of expertise reflecting the milestones concept and a continuum of learning in CanMEDS 2015.

Inclusion of a preclinical course (transition to discipline stage) is a unique feature of the new curriculum that will provide residents with the knowledge and skills essential for starting practice in a dental clinic. Furthermore, integrating scientific research across all levels will help residents to utilize the evidence-based dentistry concept in their dental clinic.

INTRODUCTION


Abbreviations

BPE Basic periodontal examination

CR Centric relation

CRA Caries risk assessment

RD Restorative dentistry

FPD Fixed partial denture

IDP Interdental papillae

RDITN Restorative dentistry index of treatment need

RCT Root canal treatment

SDL Self-directed learning

PBC Posterior bite collapse

FPD Fixed partial denture

IDP Interdental papillae

RDITN Restorative dentistry index of treatment need

RCT Root canal treatment

SDL Self-directed learning

PBC Posterior bite collapse

CAMBRA Caries management by risk assessment

SCFHS Saudi commission for health specialties

SBRD Saudi board in restorative dentistry

CanMEDS Canadian medical education directions for specialists

SSC-(Dent) Saudi specialty certificate in restorative dentistry

(S) Clinical skill

VD Vertical dimension

TMJ Temporomandibular joint

Practicing skill independently

Practicing skill under supervision

Skill is not required

CBD Competency by design

WSA Weekly scientific activities

MCQ Multiple-choice questions

Mini-CEX Mini-clinical evaluation exercise

DOPS Direct observation of procedural skills

WPA Workplace-based assessment

ITER In-training evaluation report

JC Journal club

FITER Final In-training evaluation report

CbD Case-based discussion

CEP Core education program

OUTCOMES AND COMPETENCIES



Clinical competencies and learning objectives

Medical Expert

Definition As medical experts, SBRD residents integrate all of the CanMEDS roles, applying medical knowledge, clinical skills, and professional values in their provision of high-quality and safe patient-centered care. Being a medical expert is the central role of the dentist in the CanMEDS framework and defines the clinical scope of practice for SBRD residents.

SN

Key competencies (Residents are

able to)

Enabling competencies (Residents are able to)

Junior (R1&R2)

Senior (R3&R4)

1

Practice dentistry within their defined scope of practice and expertise

1.1 Demonstrate a commitment to high-quality care for their patients.

1.2. Integrate the intrinsic roles of CanMEDS into their dentistry practice.

1.3 Apply knowledge of the clinical and biomedical sciences relevant to their discipline.

Module 1: Basic science

This module provides the essential knowledge required in the program, including different topics in anatomy, embryology, oral biology, oral pathology, oral microbiology, pharmacology, oral medicine, radiology, and biomaterials. It is delivered in a style that facilitates easy learning of the essential facts of basic science.

1.1. Head and neck anatomy

1.1.1. List the structures and blood supply of the head and neck.

1.1.2. Explain the structure of the tongue, oropharynx, teeth,

and TMJ.

1.1.3. Describe the masticatory muscles.

1.2. Craniofacial development and growth

1.2.1. Explain embryology and development of the face.

1.3. Oral biology

1.3.1 Explain the structures relevant to oral biology, especially

the microstructure and physiology of oral tissues.

1.4. Oral pathology

1.4.1. Discuss the oral pathology, etiology and pathogenesis of

oral and para-oral disease.

1.5. Oral microbiology

1.5.1 Explain the composition of the oral flora and factors

influencing its structure.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

1.6. Dental radiology

1.6.1. Explain radiation physics and radiation biology.

1.6.2. Discuss radiation hazards and protection.

1.6.3. Recognize imaging techniques and diagnostic oral

radiology.

1.7. Pharmacology

1.7.1. Discuss agents commonly used to treat oral and systemic

diseases.

1.7.2. List the indications, contraindications and potential

adverse reactions of medication used.

1.7.3. Prescribe medications for patients under their care. (S)

1.8. Dental biomaterials

1.8.1. Discuss the physical, chemical, and mechanical properties

of dental materials.

1.8.2. Select and manipulate various dental material systems

used in the oral cavity.

1.8.3. General properties and classes of dental materials

1.8.3.1. Differentiate between the different classes of dental

materials.

1.8.3.2. Define ceramics, polymers, and metals.

1.8.3.3. Describe the atomic structure of each material category.

1.8.4. Basic material categories and structure

1.8.4.1. Describe how atomic bonding and atomic structure affect

the general properties of different classes of dental

materials.

1.8.5. Biocompatibility and biological properties of dental

biomaterials

1.8.5.1. Define biocompatibility, toxicity, systemic toxicity, local

reactions, and allergic reactions to all dental materials

(including dental amalgam, cements, dental alloys,

composites, etc).

1.8.5.2. List the indication and types of biocompatibility tests.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

1.8.6. Mechanical, physical and chemical properties of dental

biomaterials

1.8.6.1. Define stress, strain, and forces, and illustrate how they

differ.

1.8.6.2. Discuss different types of stresses.

1.8.6.3. Explain the stress-strain curve and related properties.

1.8.6.4. Define dimensional change and the linear coefficient of

thermal expansion, and give examples of their importance

to clinical dentistry.

1.8.6.5. Describe how elastic modulus, yield strength, ultimate

strength, and elongation are important in the selection of

dental materials.

1.8.6.6. Compare the elastic modulus of different dental

materials, enamel, and dentine.

1.8.6.7. Describe how resilience, ductility, and toughness differ

from strength properties.

1.8.6.8. Describe fracture toughness and its clinical importance.

1.8.6.9. Define flexural strength and its clinical significance.

1.8.6.10. Discuss time-dependent mechanical properties (creep and

fatigue).

1.8.6.11. Describe and compare viscous and viscoelastic materials.

1.8.6.12. Define hardness and compare different testing

techniques.

1.8.6.13. Define and compare thermal coefficient, thermal

expansion, and thermal diffusivity.

1.8.6.14. Discuss the clinical significance of thermal properties of

materials.

1.8.6.15. Define corrosion of metals and discuss different types of

corrosion mechanisms.

1.8.6.16. Differentiate between electrical conductivity and

resistivity.

1.8.6.17. Explain galvanism and how to overcome it.

1.8.6.18. Discuss electrochemical corrosion of metallic restorations.

1.8.6.19. Compare water solubility and water sorption and discuss

their clinical importance in the success of dental

restorative materials.

1.8.6.20. Describe the rheologic properties of dental materials.

1.8.6.21. Discuss shear thinning and the pseudoplastic behavior of

dental materials.

1.8.6.22. Discuss the clinical significance of pseudoplastic behavior.

1.8.6.23. Explain dilatant and Newtonian pseudoplastic behavior of

materials.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

1.8.7. Principles of adhesion and surface chemistry

1.8.7.1. Define and compare adhesion and cohesion.

1.8.7.2. Differentiate between absorption, adsorption, and

sorption.

1.8.7.3. Describe factors affecting adhesion to tooth structures.

1.8.7.4. Discuss wettability of restorative dental materials.

1.8.7.5. Define surface energy and surface tension.

1.8.7.6. Discuss chemical bonding to a tooth structure.

1.8.7.7. Describe wettability of a tooth structure or dental

materials and mention their clinical significance.

1.8.7.8. Discuss the capillary rise and its clinical significance in

dentistry.

Module 2: Case history, examination, diagnosis and treatment plan

This module provides and trains residents in the essential knowledge

and skills needed to take a medical and dental history and perform a

physical examination using a number of methods and tools. This will

give residents the chance to build and estimate comprehensive

treatment strategies to provide high-quality treatment to their

patients.

2.1. Patient assessment, examination, diagnosis, and treatment

planning

2.1.1. Use a number of tools for examination and diagnosis. (S)

2.1.2. Identify the best evidence for treatment planning.

2.1.3. Discuss the elements of a problem-oriented treatment

plan model.

2.1.4. Analyze patient problems and construct a treatment

plan based on those problems.

2.1.5. Formulate a main treatment plan and an alternative. (S)

2.2. Diagnosis, differential diagnosis, and management of

endodontic emergencies



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

2.2.1. Explain the challenges encountered in the diagnostic

process.

2.2.2. Compare the efficacy rates for different clinical

diagnostic tests in identifying pulp conditions.

2.2.3. Outline the diagnostic steps needed to diagnose a

cracked tooth.

2.2.4. Organize diagnostic steps in a sequential manner.

2.2.5. Classify pulpal and periapical diseases according to their

clinical presentation.

2.2.6. Identify problems that require modification of

treatment.

2.2.7. Integrate clinical cases to the appropriate level of

difficulty.

2.2.8. Compare true emergencies and urgent cases.

2.2.9. Compare emergency treatment of symptomatic

irreversible pulpitis with/without symptomatic apical

periodontitis.

2.2.10. Compare emergency treatment of necrotic pulp with

that given for a localized or diffuse swelling.

2.2.11. Identify emergency conditions in need of antibiotic

treatment.

2.2.12. Perform oral examination in an emergency clinic. (S)

2.2.13. Interpret dental radiographic film. (S)

2.2.14. Select the correct diagnosis in an emergency case. (S)

2.2.15. Perform an emergency case appropriately. (S)

2.3. Periodontal examination and diagnosis

2.3.1.1 Perform a clinical periodontal examination and data

collection.

2.3.1.2 Explain the procedures involved in clinical periodontal

examination and data collection:

-General periodontal examination

-Assessment of probing depth

-Assessment of furcation involvement

-Assessment of tooth mobility

-Assessment of loss of attachment

-Bone sounding (to evaluate bony defects or for

immediate implant placement in the esthetic zone).

2.3.3. Diagnose and classify the periodontal diseases.

2.3.4. Compute essential periodontal indices (plaque, bleeding,

gingival disease).



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

Module 3: Cariology

This module provides a deeper understanding of dental caries,

including its etiology, progression, and epidemiologic and clinical

aspects. There is a focus on diagnosis, prevention, and treatment

plan strategies. This module is designed to increase further each

resident’s understanding of the importance of factors such as

lifestyle, general health, and social and cultural circumstances to oral

health. It covers the different methods used for the prevention of

caries, including immunization, fluoridation, antimicrobial agents,

and sugar substitutes.

3.1. Dental caries: etiology, clinical characteristics, and risk

assessment

3.1.1. Discuss the dynamics of the caries process.

3.1.2. Explain the role of risk factors contributing to

development of caries.

3.1.3. Correlate the risk factors for caries with the patient’s risk

status.

3.1.4. Formulate a customized preventive regimen according

to the estimated risk of caries. (S)

3.2. Diagnosis of caries and detection methods

3.2.1. Identify early carious lesions.

3.2.2. Demonstrate recent methods used to detect caries.

3.2.3. Master the technique for diagnosis of caries. (S)

3.2.4. Examine and detect dental caries in the clinic. (S)

3.3. Prevention and management of caries

3.3.1. Plan a clinical protocol to manage caries based on risk

and diagnosis. (S)

3.3.2. Manipulate different protocols for prevention of caries

according to the clinical situation. (S)

3.3.3. Distinguish between different oral health product

formulations.

3.3.4. Interpret and use a synthesis of epidemiologic evidence

carried out for the purpose of making clinical decisions

and developing clinical practice guidelines.

3.3.5. Explain modern conservative management of dental

caries.

3.3.6. Build a comprehensive treatment plan for prevention

and treatment of an oral condition. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

3.3.7. Conduct a caries prevention program/community

project to enhance promotion of oral health. (S)

3.4. Tooth surface loss: diagnosis and management

3.4.1. Explain the treatment strategies used to treat non-

carious cervical lesions and type of restorative material

used.

3.4.2. Evaluate the etiology and clinical presentation of

bruxism.

3.4.3. Demonstrate how to diagnose and prevent tooth loss.

3.4.4. Recognize different modes of management for worn

dentition.

3.4.5. Diagnose and manage a patient with non-carious cervical

lesions using different methods. (S)

Module 4: Oral and facial pain and pain control

This module teaches the basic mechanisms and principles of diagnosis

and management of pain so that residents can be competent in

performing an appropriate assessment and developing a management

plan for patients with oral and facial pain using evidence-based

dentistry and the recent scientific literature.

Additionally, this module exposes the resident to many drugs and

agents used in dental clinics for management of pain.

4.1. Mechanisms of odontogenic and non-odontogenic pain

4.1.1. Compare and contrast somatic and neural structures.

4.1.2. Differentiate between primary afferent and second

order neurons.

4.1.3. Distinguish between mechanisms of odontogenic and

non-odontogenic pain.

4.1.4. Define hyperalgesia and allodynia.

4.1.5. Compare peripheral and central sensitization.

4.1.6. Explain how pain can be referred to a distant site.

4.1.7. Define and describe heterotopic pain.

4.1.8. Recognize features of non-odontogenic toothache.

4.1.9. Differentiate between sources of odontogenic

toothache.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

4.2. Endodontic pharmacology

4.2.1. Recognize the trigeminal pain system.

4.2.2. Classify steps of pain perception.

4.2.3. Identify predictors of postoperative endodontic pain.

4.2.4. Classify analgesics.

4.2.5. Recognize the limitations and drug interactions of

acetaminophen.

4.2.6. Differentiate between non-narcotic and narcotic

analgesics.

4.2.7. Select a suitable type of analgesia and dose appropriate

for a presented condition.

4.2.8. Compare intracanal versus systemic administration of

corticosteroids.

4.2.9. Prescribe suitable and timely antibiotics in required

cases. (S)

4.2.10. Recognize pain management strategies.

4.2.11. Select the most suitable methodology for intraoperative

and postoperative pain control.

4.2.12. Design an effective, evidence-based, flexible prescription

plan.

4.2.13. Prescribe appropriate analgesic drugs for dental patients

to control dental pain. (S)

4.3. Local anesthesia in endodontics

4.3.1. Recognize mechanisms of action of anesthetics.

4.3.2. Classify clinically available local anesthetics.

4.3.3. Select the most suitable local anesthetic for different

case presentations on the basis of medical history and

preoperative level of anxiety. (S)

4.3.4. Recognize the possible adverse effects of local

anesthetics.

4.3.5. Identify the effects of systemic diseases or conditions on

local anesthetics.

4.3.6. Identify traditional methods of confirming anesthesia.

4.3.7. Determine pulpal anesthesia in painless and painful vital

teeth.

4.3.8. Recognize a patient who has had previous difficulty with

anesthesia.

4.3.9. Distinguish failure to achieve anesthesia in patients with

pain.

4.3.10. Differentiate between success and failure of anesthesia.

4.3.11. Identify alternative anesthetic solutions for inferior



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

alveolar nerve block.

4.3.12. Identify alternative injection sites.

4.3.13. Compare and contrast different attempts to increase the

success of inferior alveolar nerve block.

4.3.14. Recognize factors leading to failure of inferior alveolar

nerve block.

4.3.15. Determine methods for enhancement of mandibular

anesthesia in symptomatic patients.

4.3.16. Determine methods for extending the duration of

maxillary infiltrations.

4.3.17. Perform topical anesthesia and local infiltration to

anesthetize the upper teeth (buccal or palatal). (S)

4.3.18. Perform an inferior alveolar nerve block for lower teeth

(S)

4.3.19. Perform an intrapulpal injection for anterior or posterior

teeth. (S)

4.3.20. Perform an alternative injection technique for local

anesthesia under supervision. (S)

Module 5: Dental and clinical material

This module provides knowledge of the basic science of dental

biomaterials, including their physical, biological, mechanical, and

chemical properties. Selection and manipulation of dental materials

and longevity of dental restorations in the clinic are discussed.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

5.1. Dental amalgam

5.1.1 Define dental amalgam.

5.1.2 Describe the types of dental amalgam alloys available in

terms of their copper content and particle shape, and

explain the clinical consequences of using these different

types of alloy.

5.1.3 Describe the amalgamation reaction and related phases

and metallurgical symbols.

5.1.4 Explain why y2 is important in the clinical performance

of amalgam.

5.1.5 Explain the importance of the eta prime phase in

modern amalgam alloys.

5.1.6 Explain how y2 has been eliminated from modern

amalgam.

5.1.7 Describe how manipulation of amalgam affects its

strength, dimensional change, creep, and corrosion.

5.1.8 List the goals of appropriate condensation of amalgam

into a cavity preparation and why these goals are

important clinically.

5.1.9 List the precautionary measures that can be taken by a

dental team to limit exposure of the patient and dental

personnel to mercury and mercury vapor.

5.1.10 Classify types of dental amalgam.

5.1.11 Apply steps in manipulation for dental amalgam

restoration. (S)

5.1.12 Mix dental amalgam. (S)

5.2 Composites

5.2.1 Indicate and discuss the components of dental

composites.

5.2.2 Classify dental composites according to their filler

contents.

5.2.3 List the advantages and disadvantages of composite

resins.

5.2.4 Discuss silorane-based composites.

5.2.5 Describe the uses of all-purpose, flowable, composite

inlays (laboratory composite), and packable composites.

5.2.6 Describe the properties of composites and indicate their

clinical importance.

5.2.7 Describe the manipulation of direct composite

restorations.

5.2.8 List the factors affecting depth of cure for light-activated

composites.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

5.2.9 Discuss polymerization shrinkage of dental composites.

5.2.10 Explain wear of dental composites.

5.3 Light-curing units

5.3.1 List the different types of light-curing units.

5.3.2 List the desirable features of light-curing units.

5.3.3 Describe precautions for protecting the eyes of patients

and staff.

5.3.4 Cure a composite restoration using different types of

light. (S)

5.4 Glass ionomers

5.4.1 Indicate the components of glass ionomers.

5.4.2 Discuss the chemical reaction of glass ionomer cements.

5.4.3 Classify the types and modifications of glass ionomers

and their uses.

5.4.4 Describe the uses of glass ionomers.

5.4.5 Describe the properties of glass ionomers.

5.4.6 Describe the manipulation of glass ionomers.

5.4.7 Mix a glass ionomer. (S)

5.5 Hybrid ionomers

5.5.1 Describe the uses of hybrid ionomers.

5.5.2 Indicate the components used in hybrid ionomers.

5.5.3 Describe the properties of hybrid ionomers.

5.5.4 Describe the manipulation of hybrid ionomers.

5.5.5 Manipulate hybrid ionomers according to the

manufacturer's instructions.

5.6 Intermediate restorative materials

5.6.1 Identify the different types of intermediate restorative

material.

5.6.2 Discuss the indications and contraindications of the

different types of intermediate restorative material.

5.7 Fluoride gels, rinses, and varnishes

5.7.1 Indicate the components in fluoride gels, rinses, and

varnishes.

5.7.2 Compare the characteristics of the different types of

fluoride treatment.

5.7.3 Describe the clinical effectiveness of fluoride gels.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

5.8 Pit and fissure sealants

5.8.1 Describe the uniqueness of pit and fissure sealants.

5.8.2 List the components in light-activated and amine-

accelerated resin sealants, and indicate their function.

5.8.3 Describe factors that affect penetration of a sealant into

a fissure.

5.9 Bonding and bonding agents

5.9.1 Classify dentin bonding agents.

5.9.2 Define hybridization.

5.9.3 Indicate factors affecting the performance of dentin

bonding agents.

5.9.4 Indicate the components used in bonding agents.

5.9.5 Describe the properties of bonding agents, and indicate

their clinical importance.

5.9.6 Describe the manipulation of bonding agents.

5.10 Dental cements – liners and bases

5.10.1 Differentiate between cement bases and liners.

5.10.2 Classify dental cements according to the chemical

reaction involved.

5.10.3 Classify dental cements according to the matrix bonding

involved.

5.10.4 List the uses of each type of cement.

5.10.5 List the components of each type of cement, and

indicate their function.

5.10.6 Describe the setting reaction, and indicate any variables

that may affect the setting of each type of cement.

5.10.7 Describe the clinical importance of film thickness,

working and setting times, compressive strength,

retention, and type of bond to tooth structure and

fluoride release for each type of cement.

5.10.8 Describe the biocompatibility of each type of cement.

5.10.9 Describe the manipulation factors affecting the setting

time of each type of cement.

5.10.10 Mix dental cement according to the manufacturer’s

instructions. (S)

5.10.11 Apply appropriate dental cement to indicated teeth. (S)

5.11 Ceramics

5.11.1 Describe the composition of feldspathic porcelain.

5.11.2 Discuss the different phases (vitreous and crystalline) of

dental porcelain.

5.11.3 Explain the relationship between the specific physical



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

properties of ceramics and the clinical performance of

all-ceramic and ceramic-alloy restorations.

5.11.4 Describe the mechanism of the bonding between alloys

and porcelain and what factors may contribute to failure

of this bond. Explain how to reduce the risk of bond

failure.

5.11.5 Describe the manipulation of ceramic-alloy restorations.

5.11.6 Describe all-ceramic restorations, i.e., core and veneer.

5.11.7 Classify all-ceramic restorations according to their

structure and method of fabrication.

5.11.8 Discuss all ceramic-resin bonded restorations.

5.11.9 Discuss the different types of digital ceramic restoration,

explain the indications, advantages and shortcomings of

each type.

5.11.10 Compare glass and polycrystalline ceramics.

5.11.11 Explain the high fracture toughness of partially stabilized

zircon.

5.12 Impression materials

5.12.1 Describe the purpose of impression materials.

5.12.2 Classify impression materials.

5.12.3 List the requirements for an ideal impression material.

5.12.4 List the composition of different types of impression

materials and the role of each ingredient.

5.12.5 Describe the appropriate dispensing and mixing of each

type of impression material.

5.12.6 Discuss the disadvantages of hydrocolloid impression

materials.

5.12.7 Discuss the reaction mechanism for each type of

impression material.

5.12.8 Compare the properties of hydrocolloid and elastomeric

impression materials.

5.12.9 Describe the advantages and disadvantages of each type

of impression material.

5.12.10 Compare the properties and reactions of the four major

elastomeric impression materials, and indicate their

clinical applications.

5.12.11 Describe the disinfection technique used for each type.

5.12.12 Select appropriate impression materials based on

intended use. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

5.13 Gypsum products 5.13.1 Discuss the physical and chemical characteristics of

gypsum products.

5.13.2 Describe the physical properties important to model and

die materials, and explain why they are important.

5.13.3 Compare the advantages and disadvantages of the

different models and die materials in terms of resistance

to abrasion, ease of use, time and equipment needed,

and other relevant properties.

5.13.4 Compare the physical and chemical characteristics of

model plaster, dental stone, and high-strength dental

stone.

5.13.5 Describe the setting reaction of gypsum materials and

the effect of excess water on the set mass.

5.13.6 Name the accelerator, retarder, and operator variables

that affect the gypsum setting reaction.

5.13.7 Define the water-powder ratio, its values for the various

types of gypsum, and its effect on the physical

properties of gypsum.

5.13.8 Describe the factors that influence the ability of gypsum

to reproduce detail in an impression.

5.13.9 Explain the concept of wetting and its importance to

gypsum materials.

5.13.10 Define the properties of strength, hardness, resistance

to abrasion, and dimensional accuracy, and explain why

they are important for gypsum materials clinically.

5.13.11 Describe the manipulation of gypsum materials.

5.13.12 Pour a primary and final impression with dental stone.

(S)

5.14 Casting investments

5.14.1 Classify dental investments and their setting reaction.

5.14.2 Compare different types (gypsum-bonded phosphate

versus silicate-bonded investments).

5.14.3 Define setting, hygroscopic, and thermal expansion.

5.14.4 Discuss investment for all ceramic restorations.

5.14.5 Discuss quick heat investments.

5.14.6 Discuss the causes of casting defects.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

5.15 Dental waxes

5.15.1 Classify dental waxes, and describe their composition

and related physical properties.

5.15.2 Describe the difference between pattern waxes and

processing waxes.

5.15.3 Discuss the properties of melting range, residue, thermal

expansion, and residual stress, and cite the clinical

relevance of these properties.

5.15.4 Define the solid transition temperature of waxes.

5.15.5 Describe the composition and uses of inlay wax, casting

wax, and baseplate wax. Explain the properties of these

waxes.

5.16 Dental casting alloys and soldering

5.16.1 Classify dental alloys according to their content of noble

and non-noble elements.

5.16.2 Identify noble metals and base metals.

5.16.3 Discuss dental gold alloys with reference to the alloying

elements and explain the role of each element.

5.16.4 Explain the gold-copper binary phase diagram with

reference to age-hardening mechanisms.

5.16.5 Outline the American Dental Association classification

system.

5.16.6 Describe the general composition and properties of high-

noble, noble, and base metal casting alloys.

5.16.7 Compare the properties of low and medium gold alloys

with those of alloys with a high gold content

5.16.8 Describe alloys for ceramic bonding and discuss the

mechanism of bonding.

5.16.9 Explain the clinical problems associated with the

different types of ceramic-bonding alloys.

5.16.10 Explain how solders are used in dentistry.

5.16.11 Discuss base metal alloys and their applications.

5.16.12 Explain the passivation phenomenon.

5.16.13 Discuss the properties of titanium and titanium alloys.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

5.16.14 Casting procedures, casting defects, and the lost-wax

technique

5.16.15 Describe the dimensional changes that occur during the

casting process, and explain how they affect the clinical

performance of the cast.

5.16.16 Describe the lost-wax technique and its accuracy in

producing a dental casting.

5.16.17 Explain the process of investing and how the properties

of the investment affect the fitness of cast restorations.

5.16.18 Describe different casting techniques.

5.16.19 Explain the causes of casting defects associated with

dental castings and how to overcome them.

5.16.20 Observe a demonstration done by laboratory production

staff on:

- Wax-up - Investing - Casting - Finishing and polishing cast restorations.

5.17 Abrasive and polishing materials

5.17.1 Define finishing, polishing, cutting, and grinding.

5.17.2 List the purpose and principles of finishing and polishing

techniques.

5.17.3 Distinguish finishing, polishing, and cleansing abrasives

and techniques, and recognize common abrasives.

5.17.4 Define abrasion and contrast abrasive tools or slurries

with cutting instruments.

5.17.5 Compare two-body and three-body abrasion.

5.17.6 Discuss the factors influencing the rate of abrasion and

indicate which factor is easiest to control clinically.

5.17.7 Describe surface roughness and gloss.

Describe the finishing and polishing techniques used for common restorative materials and indicate the precautions associated with these techniques. Includes dental amalgam, composite, compomer, hybrid ionomer, and acrylic denture resin.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

5.18 Dental implants

5.18.1 Explain how oral forces applied to an endosseous

implant stress bone differently when compared with oral

forces applied to natural teeth.

5.18.2 List the types of material that have been used for

endosseous implants, and explain which of these

osseointegrate or biointegrate with bone.

5.18.3 Describe the alloys of titanium that are used for

endosseous implants in terms of their composition,

physical properties, and surface properties.

5.18.4 Describe bioactive and bioresorbable ceramics.

5.18.5 Explain calcium phosphate ceramics and their clinical

applications.

5.18.6 Explain the different techniques available for surface

treatment of titanium implants, and their advantages

and disadvantages.

5.18.7 Discuss the advantages of titanium-zirconium alloy as an

implant material.

5.18.8 Explain why ceramic coatings are applied to endosseous

implants.

5.19 Toxicity of amalgam

5.19.1 List the American Dental Association recommendations

for mercury hygiene and safety.

5.19.2 Explain the importance and use of mercury separators in

dental clinics.

5.19.3 Critique the toxic effect of amalgam as reported in the

literature.

5.19.4 Apply percussion measures of amalgam toxicity in the

clinic. (S)

Module 6: Endodontics

This module imparts a comprehensive knowledge of endodontics,

including diagnosis and treatment of the pulp and periradicular

conditions. More emphasis is placed on improving the skills of

residents in areas related to chemomechanical debridement of the

canal system and obturation of root canals in three dimensions using

traditional and more recent tools, such as rotary instruments and

injectable gutta percha.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

6.1 Tooth morphology and preparation of the access cavity

6.1.1. Identify the objectives of preparation of the access

cavity.

6.1.2. Describe the guidelines for access preparation.

6.1.3. Describe the importance of attainment of straight-line

access.

6.1.4. Analyze the importance of conservation of tooth

structure.

6.1.5. Relate the reasons and indications for removing

remaining caries during access preparation.

6.1.6. Summarize the anatomy of the pulp chamber floor.

6.1.7. Identify the armamentaria needed for preparation of

the access cavity and the uses and role of each.

6.1.8. Prepare access opening for anterior and posterior teeth.

(S)

6.2. Management of painful tooth emergencies

6.2.1. Classify the causes of emergencies.

6.2.2. Compare a true emergency and an urgent case.

6.2.3. Identify patients who are at greater risk of experiencing

pain after an endodontic procedure.

6.2.4. Describe the emotional status of emergency patients

and explain how this might affect correct diagnosis and

treatment.

6.2.5. Recognize and classify endodontic cases according to the

American Association of Endodontists endodontic case

difficulty assessment.

6.2.6. Outline a sequential approach to endodontic

emergencies.

6.2.7. Compare the emergency treatments for symptomatic

irreversible pulpitis with/without symptomatic apical

periodontitis.

6.2.8. Describe the treatment of necrotic pulp with

symptomatic apical periodontitis.

6.2.9. Describe the emergency treatment of acute apical

abscess as well as the indications and steps for incision

and drainage.

6.2.10. Define flare-up and describe its management.

6.2.11. List the factors that relate to greater frequency of flare-

up.

6.2.12. Summarize the treatment plan for a flare-up between

appointments.

6.2.13. Describe the treatment of post-obturation apical

periodontitis.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

6.2.14. Classify and apply supportive pharmacologic therapy used

in emergencies and its role in controlling pain and

infection.

6.2.15. Manage an endodontic emergency with appropriate

treatment. (S)

6.2.16. Perform pulp extirpation for irreversible pulpitis and

necrotic pulp. (S)

6.2.17. Incise and drain an abscess. (S)

6.3. Determination of working length

6.3.1. Define the working length terminology.

6.3.2. Recognize the importance of working length.

6.3.3. Describe the apical anatomy.

6.3.4. Detail the importance of the apical limit for root canals.

6.3.5. Compare the different methods used for determination

of working length.

6.3.6. Analyze the electronic apex locator; how it works, pros and

cons.

6.3.7. Recognize the common errors associated with the

electronic apex locator and how to solve them.

6.3.8. Measure the working length of canals using different

methods. (S)

6.4. Cleaning and shaping of the root canal system

6.4.1. Differentiate between apical seat, apical stop, and open

apex.

6.4.2. List the evaluation criteria for cleaning and shaping of a

root canal system.

6.4.3. Analyze the common errors and mishaps that occur

during preparation of a root canal and explain how to

minimize them.

6.4.4. Summarize the principles for using rotary nickel-titanium

(NiTi) instruments.

6.4.5. Compare the non-traditional methods used for

preparation of a root canal.

6.4.6. Perform mechanical debridement for different types of

canal using stainless steel hand files. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

6.5. Irrigation, intracanal medication

6.5.1. Summarize the importance of irrigation in endodontics.

6.5.2. Outline the ideal characteristics of endodontic irrigants.

6.5.3. Explain the hydrodynamics of irrigation.

6.5.4. Compare and contrast the different types of irrigant

available and their properties.

6.5.5. Describe the methods used for irrigation.

6.5.6. Justify removal of the smear layer.

6.5.7. Differentiate between the types of root canal medication

and their properties.

6.5.8. Perform chemical debridements using different types of

root canal irrigants. (S)

6.6. Obturation

6.6.1. Describe the significance of homogeneity of obturation.

6.6.2. Recognize the apical position of the obturation material.

6.6.3. Analyze the importance of apical and coronal seals.

6.6.4. Identify the appropriate time for canal obturation.

6.6.5. Define and differentiate between lateral and vertical

compactions.

6.6.6. Compare the indications for each obturation technique.

6.6.7. Describe steps and tests for master cone fitting.

6.6.8. Critique the cold lateral condensation technique.

6.6.9. Identify the significance of depth of spreader penetration

during condensation.

6.6.10. Discuss the importance of removing excess sealer and

obturating material from the pulp chamber.

6.6.11. Describe and appraise the clinical and radiographic

criteria for evaluating the quality of obturation.

6.6.12. Obturate the canal with gutta percha to achieve an

apical seal using different systems/methods. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

6.7 Microbiology and treatment of endodontic infection

6.6.13. Classify microorganisms.

6.6.14. Define anachoresis.

6.6.15. Analyze the biology of microorganisms in the root canal.

6.6.16. Identify the redox potential.

6.6.17. Differentiate between synergistic and antagonistic

bacterial interaction.

6.6.18. Explain the host-parasite interaction.

6.6.19. Enumerate the characteristic features of endodontic

pathogens.

6.6.20. Compare the methods available for controlling microbes

in endodontics.

6.6.21. Discuss the presence and absence of bacteria in the

periradicular area.

6.8 Pathobiology of the peri-apex

6.8.1 Identify the ergonomics of the dental pulp.

6.8.2 Describe inflammation of the dental pulp.

6.8.3 List specific and non-specific mediators of pulpal

inflammation.

6.8.4 Classify pulpal diseases and their clinical and histologic

features.

6.8.5 Describe the pulpal immunologic response to irritation.

6.8.6 Describe the scope of pulpal diagnosis.

6.8.7 Describe the fate of the dental pulp.

6.8.8 Explain the challenges encountered in the diagnostic

process.

6.8.9 Categorize pulpal diseases.

6.8.10 Compare the efficacy of clinical diagnostic tests in

determining conditions of the pulp organ.

6.8.11 Diagnose the different pulpal and periapical diseases

clinically (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

6.9 Rotary instruments

6.9.1 Define NiTi and rotary systems.

6.9.2 Differentiate between the ultrastructure of conventional

NiTi wire and M-Wire.

6.9.3 Recognize the components of a rotary file.

6.9.4 Define the adapted pitch concept.

6.9.5 Describe the design features of the HERO Shaper rotary

system and identify the various sequences of its use.

6.9.6 Describe the design features of the Revo-S rotary

system.

6.9.7 List the advantages of a symmetrical cross-section of the

Revo-S system.

6.9.8 Name the files of the Revo-S system.

6.9.9 Describe the design features of the ProTaper rotary

system.

6.9.10 Describe the design features of the universal ProTaper

rotary system.

6.9.11 Describe the design features of the twisted file rotary

system.

6.9.12 Define the single file concept and list its advantages.

6.9.13 Identify the design features of the Wave-One rotary

system.

6.9.14 Recognize the development of NiTi files.

6.9.15 Correlate the different components of rotary NiTi files

and their mechanical properties.

6.9.16 Classify factors affecting the cutting efficiency of rotary

NiTi files.

6.9.17 Compare the different rotary systems available with

respect to properties, components, and available tip

sizes and tapers.

6.9.18 Perform a mechanical debridement for different canals

using NiTi rotary instruments. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

6.10 Tooth resorption

6.10.1 Recognize the homeostasis phenomenon of pulp and the

periodontal ligament preventing attack by osteoclasts.

6.10.2 Describe the physiology of osteoclasts.

6.10.3 Identify the mechanism for deconstruction of hard

tissue.

6.10.4 Compare and contrast the different actions of

osteoclasts and their endodontic implications:

• The osteoclast as a cell responsible for tooth eruption:

endodontic implications.

• The osteoclast as a cell involved in alveolar bone growth

and maintenance: endodontic implications.

• The osteoclast as a member of the repair team after

injury: endodontic implications.

• The osteoclast as a defense against microbial invasion:

endodontic implications.

6.10.5 Suggest methods for controlling osteoclast activity based

on evidence.

6.10.6 Explain how to eliminate the bacteria responsible for

infection-related resorption.

6.10.7 Classify and compare types of root resorption: clinical

findings, radiographic findings, differential diagnosis,

diagnosis, endodontic implications, treatment.

6.11 Vital pulp therapy

6.11.1 Describe the functions of the vital dental pulp.

6.11.2 Recognize formation of reparative dentin.

6.11.3 Classify techniques for generating reparative dentin.

6.11.4 Describe direct pulp capping.

6.11.5 Describe indirect pulp capping.

6.11.6 Differentiate between pulpotomy and partial

pulpotomy.

6.11.7 List indications for vital pulp therapy.

6.11.8 Compare vital pulp therapy materials.

6.11.9 Recognize diagnostic criteria for a successful outcome of

vital pulp therapy.

6.11.10 Mention treatment recommendations for direct pulp

capping.

6.11.11 Perform one-step pulp capping. (S)

6.11.12 Mention types of final restoration after pulp capping

procedures.

Select postoperative follow-up regimen



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

6.12 Single-visit versus multiple-visit root canal treatment

6.12.1 Explain indications for single-visit and multiple-visit RCT.

6.12.2 Discuss contraindications of single-visit and multiple-visit

RCT.

6.12.3 List advantages of single-visit and multiple-visit RCT.

6.12.4 List disadvantages of single-visit and multiple-visit RCT.

6.12.5 Critique published studies related to single-visit and

multiple-visit RCT.

6.12.6 Perform single-visit and multiple-visit RCT in indicated

cases. (S)

6.13 Non-surgical retreatment

6.13.1 Design a diagnostic plan based on subjective and

objective tests with radiographic interpretation for

diagnosing non-healing cases.

6.13.2 List causes of non-healing of previous non-surgical

endodontic treatment.

6.13.3 Analyze factors influencing decision-making concerning

retreatment.

6.13.4 Summarize methods used for disassembly and their

uses.

6.13.5 Estimate complications post removal as a result of

mismanagement.

6.13.6 Summarize precautions taken during removal of gutta

percha.

6.13.7 List methods used post removal.

6.13.8 Compose a treatment plan for managing separated

instruments.

6.13.9 Estimate prognosis of separated instruments relative to

different clinical situations.

6.13.10 Recognize appropriate methods for managing separated

instruments in different circumstances.

6.13.11 Compare ledges and blockades with regard to definition,

clinical management, and prognosis.

6.13.12 Classify apical transportation and relative treatment

planning.

6.13.13 Correlate the 4D of perforations and their prognosis,

repair materials, and procedures.

6.13.14 Perform non-surgical retreatment for indicated cases. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

6.14 Trauma of mature and immature teeth

6.14.1 List the etiology of trauma and differentiate between

accidental injury (AI) and non-accidental injury (NAI).

6.14.2 List the unique aspects of dental trauma.

6.14.3 List the appropriate information needed when

examining patients with dental injuries.

6.14.4 Define the following: enamel fractures, crown fracture

without pulp exposure, crown fracture with pulp

exposure, crown root fracture, root fracture, concussion,

subluxation, luxation, lateral luxation, extrusion,

intrusion and avulsion.

6.14.5 Describe the details of radiographic examination when

examining patients with dental injuries.

6.14.6 List the limitations of a standard dental radiograph.

6.14.7 Recognize the primary aim of treatment in every case of

crown fracture.

6.14.8 Describe the various treatment options for complicated

crown fracture.

6.14.9 Describe treatment in a case of root fracture.

6.14.10 Recognize obliteration of pulp space and design a

treatment plan for it.

6.14.11 Diagnose various types of root resorption (surface,

inflammatory, replacement) and describe their

treatment strategies.

6.14.12 Describe the reasons for internal root resorption and a

treatment plan.

6.14.13 Identify the various treatment plans for an avulsed tooth

and differentiate between less and more than 60

minutes with regard to surface treatment.

6.14.14 Master management of different types of dental trauma.

(S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

6.15 Regenerative endodontics

6.15.1 Define the terms regeneration and revascularization.

6.15.2 Recall the historical background of this new era in

endodontics.

6.15.3 Describe the different modalities of vital pulp therapy.

6.15.4 Recognize the need for this new era in cases of non-vital

teeth with incompletely formed roots.

6.15.5 List requirements for regenerative endodontics with

discussion in some detail for each requirement.

6.15.6 Discuss tissue engineering: ideas and requirements for

its application.

6.15.7 Categorize the different types of stem cells and their

sources and behavior, with special attention to types of

dental stem cells.

6.15.8 Enumerate the different types of scaffold used for

regenerative endodontics.

6.15.9 Recall knowledge about morphogens and gene therapy

used in regenerative endodontics.

6.15.10 Illustrate the significance and different methods used in

delivery systems for application of regenerative

endodontics.

6.15.11 Review the application methods used for regeneration

therapy.

6.16 Periradicular surgery

6.16.1 Identify potential false and true indications and

contraindications for endodontic surgery.

6.16.2 Verify the importance of starting with conventional

endodontic treatment before deciding on the

endodontic surgical approach.

6.16.3 Outline the definition, objectives, and indications of

different periapical surgical procedures.

6.16.4 Conclude about the indications and contraindications for

different flap designs.

6.16.5 Describe how to locate the apex of the affected root.

6.16.6 Illustrate control of bleeding during a surgical procedure

to improve vision.

6.16.7 Describe the apical end of the root canal preparation.

List the advantages of using an ultrasonic system during

retro-preparation.

6.16.8 Clarify the properties of the different retro-filling

materials and be able to choose the most suitable one.

6.16.9 Describe the postoperative instructions and care needed



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

to improve the prognosis of a case.

6.16.10 Interpret the importance of using an endodontic

microscope.

Identify the differences between, the indications for, and

the contraindications to corrective surgery (including

hemi-sectioning, bicuspidation and root amputation) for

preservation of multi-rooted teeth with endodontic-

periodontal involvement.

6.17 Pulpal reaction to caries and dental procedures

6.17.1 Recognize neurogenic mediators.

6.17.2 Correlate clinical symptoms and actual pulpal

inflammation.

6.17.3 Identify causes of dentin hypersensitivity and their

management.

6.17.4 Recognize pulpal reactions to local anesthetics,

restorative procedures, restorative materials, and laser

procedures.

6.17.5 Perform direct pulp capping with mineral trioxide

aggregate proficiently (S)

6.17.6 Use of hemostatic agents and disinfectants directly on

pulp. (S)

6.17.7 Appraise pulpal reactions to cavity preparation using air

abrasion techniques.

6.17.8 Appraise pulpal reactions to vital bleaching, periodontal

procedures, orthodontic, and biomechanical irritation:

parafunctional

6.18 Protection of pulp

6.18.1 Explain the effect of various types of pulpal irritants,

such as microbial irritation, mechanical irritation,

thermal irritation, chemical irritation, and radiant

irritation.

6.18.2 Discuss the different methods used to protect pulp

against chemical, electrical, thermal, and mechanical

irritation.

6.18.3 Describe the different protective biological pulp

reactions.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

6.19 Pulp reaction to tooth preparation

6.19.1 Discuss the long-term effects of crown preparation on

pulp vitality based on scientific studies.

6.19.2 Outline the factors that influence the quantity of heat

generated such as speed of rotation, size and shape of

cutting instrument, quality of the instrument (old versus

new), type of cutting instrument (tungsten versus

diamond bur), length of contact time, amount of

pressure exerted, level of dentin thermal conductivity

and preparation depth, the coolant used, and hand piece

(turbine versus slow speed).

6.19.3 Justify the effect of local anesthesia vasoconstrictor,

ligament injections on the pulp.

6.19.4 Explain the causes and the management method of

blushing of teeth.

6.19.5 Discuss the causes of odontoblastic death during dental

procedures (e.g., negative pressure, impression,

cementation).

6.19.6 Explain the vibratory phenomenon/shockwaves.

6.19.7 Discuss the effect of desiccation of dentin.

6.19.8 Outline the sequence of pulp reactions during pulp

exposure.

6.19.9 Explain the effect of presence of a smear layer on pulp.

6.19.10 Explain the effect of remaining dentin thickness on pulp

reaction.

6.19.11 Explain the effect of acid etching on pulp reaction.

6.19.12 Explain the immune defense of the pulp during tooth

preparation.

6.19.13 Identify guidelines to decrease pulpal injury following

tooth preparation.

6.20 Pulp reaction to cements and adhesives

6.20.1 Discuss the dentinal fluid dynamics in the pulp, including

in the intratubular and peripheral regions.

6.20.2 Discuss pulpal pressures and pulpal hemodynamics.

6.20.3 Discuss crown cementation dynamics, pressure,

viscosity, and centrifugal pulpal fluid movement.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

6.21 Endodontic and periodontal interrelationship

6.21.1 Recognize the intercommunication between pulpal and

periodontal tissue.

6.21.2 Explain the effect of a pathologic pulpal condition on the

periodontium.

6.21.3 Appraise the influence of periodontal inflammation on

pulp.

6.21.4 List the theoretical pathways for formation of an

osseous lesion.

6.21.5 State the differential diagnosis of endodontic-

periodontic lesions.

6.21.6 Appraise treatment alternatives for endodontic-

periodontic lesions.

6.21.7 Identify the causes of endodontic-periodontic,

periodontic-endodontic, and mixed lesions clinically. (S)

6.22 Effect of age and systemic health on endodontics

6.22.1 Delineate the anatomic pathways of communication

between the dental pulp and periodontium.

6.22.2 Describe the effect of pulpal pathosis on the

periodontium.

6.22.3 Identify differential diagnoses of endodontic periodontal

diseases clinically and radiographically.

6.22.4 Recognize the line of treatment and prognosis for each

type of endodontic-periodontal lesion and the need for a

periodontal consultation.

6.22.5 Classify and diagnose the different types of endodontic-

periodontal lesions based on the primary source of

infection.

Module 7: Fixed partial dentures

This module imparts essential clinical knowledge and skills. It

emphasizes the practical aspects of fixed prosthodontics, starting

with the treatment plan, tooth preparation, provisionalization, and

impression technique, and ending with cementation and

management of complications.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

7.1. Treatment planning for single and multiple missing teeth

7.1.1. Discuss the strategies for selection of type of prosthesis.

7.1.2. Evaluate the abutment area.

7.1.3. Assess the supporting tissues surrounding the abutment

teeth.

7.1.4. Discuss biomechanical considerations.

7.1.5. Explain the solutions for the most common problems in

treatment planning.

7.1.6. List the types of connectors.

7.1.7. Recognize FPD configurations.

7.1.8. Discuss the options for replacing single missing teeth in

the anterior or posterior area.

7.1.9. Discuss the options for replacing multiple missing teeth

in the anterior or posterior area.

7.1.10. Select and write the most appropriate treatment plan

for replacing missing teeth. (S)

7.2. Resin-bonded FPD

7.2.2.1 List the advantages and disadvantages of resin-bonded

FPD.

7.2.2.2 List the indications and contraindications for resin-

bonded FPD.

7.2.3 Discuss the technique for preparation of abutment teeth

for resin-bonded FPD.

7.2.4 List the types of resin-bonded FPD.

7.2.5 Describe the cementation method for resin-bonded FPD.

7.2.6 Explain postoperative care after cementation.

7.3. Cantilever FPD

7.3.1 List the advantages and disadvantages of cantilever FPD.

7.3.1.1 List the indications and contraindications for cantilever

FPD.

7.3.1.2 State the factors that can influence the success of

cantilever FPD.

7.3.1.3 Review recent studies demonstrating the success of

cantilever FPD.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

7.4. Pier abutment

7.4.1. Explain the concept of pier abutment.

7.4.2. List the indications and contraindications for non-rigid

connectors.

7.4.3. Explain the role of a non-rigid connector in pier

abutment.

7.4.4. List the components of a non-rigid connector.

7.4.5. Mention the location of the keyway on a non-rigid

connector.

7.5. Prosthetic treatment of dentition with periodontal disease

7.5.1. Discuss modifications of tooth preparation for

periodontally weakened teeth with regard to type and

location of the finish line for anterior and posterior

teeth.

7.5.2. Discuss the factors affecting the likelihood of success or

failure of prosthetic treatment for teeth with root

resection.

7.5.3. Compare recent studies with older ones with regard to

the prognosis of prosthetic therapy for periodontally

weakened teeth.

7.5.4. Prepare periodontally weakened teeth. (S)

7.6. Principles of tooth preparation

7.6.1. Discuss the biological considerations of oral tissues and

tooth structure.

7.6.2. Explain the concept of marginal integrity.

7.6.3. Discuss preservation of the periodontium.

7.6.4. Explain the types of margin placement and margin

designs.

7.6.5. Discuss the esthetic considerations with regard to the

patient’s appearance.

7.6.6. Discuss the mechanical considerations with regard to

integrity and durability of the restoration.

7.6.7. Recognize factors affecting the retention and resistance

of a cemented restoration.

7.6.8. List the types of bur used for prosthodontic preparation.

7.6.9. Prepare a tooth according to tooth preparation

principles. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

7.7. Fluid control, soft tissue management, and impression

techniques

7.7.1. Be aware of the methods used for fluid control.

7.7.2. Discuss the mechanical, chemomechanical, and

electrosurgical methods used for soft tissue

management.

7.7.3. List the types of retraction cord available.

7.7.4. Explain the technique used for application of retraction

cords.

7.7.5. Discuss different types of impression techniques.

7.7.6. Make upper and lower impressions using different

impression materials. (S)

7.7.7. Use the different methods for clinical soft tissue

management when indicated. (S)

7.8. Pontics and the edentulous ridge

7.8.1. Evaluate residual ridge contour.

7.8.2. Recognize the Siebert classification of residual ridge

deformities.

7.8.3. List the different classifications of pontic design and their

advantages and disadvantages.

7.8.4. Discuss the indications and contraindications for various

pontic designs.

7.8.5. Outline the procedure for pretreatment assessment of

pontic space.

7.8.6. Discuss the biological, mechanical, and esthetic

considerations for successful pontic design.

7.9. Preparation for severely debilitated teeth

7.9.1. List the principles for preparation of substitutions for

severely debilitated (destroyed) teeth.

7.9.2. Explain the orthodontic adjuncts available for restoring

damaged teeth.

7.9.3. Describe the characteristics of endodontically treated

teeth.

7.9.4. Discuss the restoration of endodontically treated teeth

(rationale for restoring these teeth and factors

influencing choice of treatment).

7.9.5. Discuss the treatment plan for anterior and posterior

endodontically treated teeth.

7.9.6. Restore severely damaged teeth using different

methods. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

7.10. Type of post and core

7.10.1. Explain the meaning of post and core.

7.10.2. List the types of post and core according to their use,

material composition, and technique.

7.10.3. State the indications, contraindications, advantages, and

disadvantages of each type.

7.10.4. Describe the techniques used for fabrication, try-in, and

cementation.

7.10.5. Select and fabricate the appropriate post and core

according to indication (S)

7.11. Provisional restoration

7.11.1. Define provisional restoration and the relevant criteria.

7.11.2. List the types and characteristics of the ideal provisional

restoration.

7.11.3. List the types and techniques of construction and

cementation.

7.11.4. Explain the effect of different provisional materials on

gingival health.

7.11.5. Discuss critical areas in provisional restorations that

maintain the health and position of the gingiva (marginal

fit, contour, surface finish).

7.11.6. Select, construct, and cement the different provisional

restorations. (S)

7.12. Diagnostic wax-up

7.12.1. State the value and purpose of dental wax-up.

7.12.2. Describe the steps in diagnostic wax-up.

7.12.3. Explain the importance of wax-up in esthetic analysis.

7.12.4. Use diagnostic wax-up in treatment planning.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

7.13 Try in, adjustment, polishing, and cementation

technique

7.13.1 Describe the sequence of metal and porcelain try-in.

7.13.2 State the types of material used in try-in.

7.13.3 Explain the technique and kit use in adjustment of the

prosthesis.

7.13.4 List the types of finishing kit and their methods of use.

7.13.5 Describe the cementation technique using different

types of cementation.

7.13.6 Apply the steps of try-in, adjustment, polishing, and

cementation clinically. (S)

7.13.7 List the advantages and disadvantages of each type of

ceramic restoration.

7.13.8 Mention the indications and contraindications for each

type.

7.13.9 Describe the criteria for preparation and type of

cementation.

7.13.10 Select a type of ceramic restoration and adapt the

ceramic preparation principles clinically.

7.14 Causes and management of failed crowns and fixed

partial dentures

7.14.1 State the causes of failure of a fixed prosthesis.

7.14.2 Classify the types of fixed prosthesis failure as biological,

mechanical, and esthetic.

7.14.3 Discuss the causes, prevention, and management of

biological failures.

7.14.4 Discuss the causes, prevention, and management of

mechanical failures.

7.14.5 Discuss the causes, prevention and management of

esthetic failures:

at the time of cementation

in the event of delayed esthetic failure.

7.14.6 Outline the common failures associated with ceramic

metal crowns/bridges, and their prevention and

management.

7.14.7 List the common failures related to impression materials

and technique used, and explain their causes and

treatment.

7.14.8 List the common failures related to stone model

discrepancies and explain their causes and treatment.

7.14.9 Explain the common failures associated with pontic

selection and how to avoid them.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

7.14.10 Explain the causes of retentive failures and their

prevention.

7.14.11 Explain the causes of connector failure.

7.14.12 Explain in details how to avoid failures.

7.14.13 Describe the steps in postoperative recall and

maintenance.

7.14.14 Estimate the results of an incorrect contact area,

overextended crowns, a short crown, and incorrect

contour.

7.14.15 Identify factors effecting longevity of the crown.

7.14.16 Describe the methods used for removal of a failing fixed

prosthesis.

7.14.17 Compare failures associated with single crowns, FPD,

and all ceramic, resin-bonded, and post and core

prostheses.

7.14.18 Diagnose and remove a failed prosthesis. (S)

7.15 Success and complications of ceramic prostheses

7.15.1 Present the clinical studies and failure percentages for

various types of cracks in a ceramic prosthesis.

7.15.2 Classify ceramic failures and discuss each type.

Module 8: Occlusion

This module provides a comprehensive understanding of the

different concepts about occlusion and the principles thereof,

including mandibular movement, angles, occlusal plane, and vertical

dimension of occlusion. Moreover, it highlights the factors affecting

the stability of occlusion and their role in successful treatment in the

long term, and also provides an understanding of the function of the

TMJ and the associated muscles and teeth, and how they work in

harmony. Further, it trains residents how to make jaw relation

records for the different restorative cases, starting from simple

restorations to full mouth rehabilitation, and how to diagnose and

manage the different occlusal problems that arise.

8.1. Anatomy of the stomatognathic system

8.1.1. Define the stomatognathic system.

8.1.2. List the structures of the stomatognathic system.

8.1.3. Recognize the functions of the stomatognathic system.

8.1.4. Discuss the abnormal functions of the stomatognathic

system:

mouth breathing

mouth habits: thumb sucking, lip biting, finger biting,

tongue thrust



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

abnormal development: macroglossia, short upper lip.

8.1.5. Explain the temporomandibular articulation.

8.2. Temporomandibular joint dysfunction

8.2.1. Discuss the function of the TMJ.

8.2.2. Define disorders of the TMJ.

8.2.3. Explain causes of TMJ dysfunction.

8.2.4. List signs and symptoms of TMJ dysfunction.

8.2.5. Discuss referral patterns for pain.

8.2.6. Perform a clinical examination for TMJ dysfunction. (S)

8.2.7. Interpret evaluations for jaw function. (S)

8.2.8. Diagnose TMJ dysfunction. (S)

8.2.9. Describe a plan for management of TMJ dysfunction.

8.2.10. Describe the impact of psychosocial issues on a patient

with persistent TMJ dysfunction.

8.2.11. Provide behavioral advice for management of TMJ

dysfunction. (S)

8.2.12. Construct appropriate occlusal appliances for the

diagnosis and treatment of TMJ dysfunction. (S)

8.2.13. Communicate and work with colleagues on the

multidisciplinary management of TMJ dysfunction. (S)

8.2.14. Monitor and evaluate the effectiveness of treatment

regimes.

8.3. Alignment and occlusion of dentation

8.3.1. Identify the factors and forces determining tooth

position.

8.3.2. Describe intra-arch and inter-arch tooth alignment.

8.3.3. Outline the buccolingual and mesiodistal occlusal

contact relationships.

8.3.4. Classify the common occlusal relationships of the

posterior and anterior teeth.

8.3.5. Identify occlusal contact during protrusive, iatrogenic

protrusive and retrusive mandibular movement.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.4. Fundamentals of occlusions

8.4.1. Define centric relation.

8.4.2. Explain maximum intercuspation occlusion.

8.4.3. Explain the different types of mandibular movement.

8.4.4. Explain the Bennett movement angle.

8.4.5. List the determinants of occlusion.

8.4.6. Explain incisal guidance (vertical and horizontal overlap

of anterior teeth).

8.4.7. Define occlusal plane, curve of Spee, curve of Wilson.

8.4.8. Discuss the causes and management of bruxism and

clenching.

Recognize the categories of occlusion: bilaterally

balanced, unilaterally balanced, and mutually protected

articulation.

8.4.9. Explain the types of occlusal interference.

8.5. Classification of occlusion:

8.5.1 Explain the concept of occlusion.

8.5.2 Identify the terminologies used to describe occlusion.

8.5.3 Classify the different types of occlusion.

8.5.4 Outline the factors affecting occlusion.

8.6. Criteria of optimum functional occlusion

8.6.1. Outline the history of occlusal study.

8.6.2. List the criteria for optimal functional occlusion.

8.6.3. Discuss the optimal orthopedically stable joint position.

8.6.4. Describe optimal functional tooth contact (direction of

forces placed on teeth, the amount of force placed on

teeth, postural considerations, and functional tooth

contact.

8.6.5. Apply the criteria of optimum functional occlusion in

clinical cases. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.7. Determinants of occlusal morphology

8.7.1. State the determinants of occlusal morphology.

8.7.2. Discuss and correlate anterior and posterior controlling

factors.

8.7.3. Illustrate the influence of controlling factors.

8.7.4. Explain the vertical determinants of occlusal morphology

considering:

Effect of condylar guidance on cusp height

Effect of anterior guidance on cusp height

Effect of the plane of occlusion on cusp height

Effect of the curve of Spee on cusp height

Effect of mandibular lateral translation movement on

cusp height.

8.7.5. Describe the horizontal determinants of occlusal

morphology.

8.7.6. Outline the relationship between anterior and posterior

controlling factors.

8.8. Articulators and facebows

8.8.1. Define the articulators and identify their uses in dental

practice.

8.8.2. Explain the theory of articulators.

8.8.3. List the types, advantages and disadvantages of

articulators.

8.8.4. Describe their function and limitations.

8.8.5. Explain their uses in jaw relationships and method of

adjustment.

8.8.6. Explain the role of articulators in duplicating mandibular

movement.

8.8.7. Classify articulators.

8.8.8. Explain the applications and limitations of articulators.

8.8.9. Identify the facebow, along with types and function. 8.8.10. Explain the function of the facebow and describe the

technique of its use in jaw relationships. 8.8.11. Explain the meaning and significance of Bennett shift

(immediate side shift and progressive side shift) and Bennett angle.

8.8.12. Differentiate between hinge axis and arbitrary hinge axis position.

8.8.13. Record the relationship between the jaws and the TMJ

using the facebow. (S)

8.8.14. Use articulators in different clinical cases. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.9. Diagnostic casts and interocclusal records

8.9.1. Describe the types of cast and their functions.

8.9.2. Describe the function and types of interocclusal records.

8.9.3. State the types of material used in jaw relationships.

8.9.4. Explain the factors influencing selection of an

interocclusal record.

Select and use interocclusal records in different cases.

(S)

8.10. Cephalometric analysis

8.10.1. Explain the purpose of cephalometry in diagnosis and

planning of treatment.

8.10.2. Recognize the main elements used in cephalometric

analysis

8.10.3. Outline the role of cephalometry in occlusal analysis.

8.11. Signs and symptoms of occlusal disease

8.11.1. Explain the criteria for optimal functional occlusion.

8.11.2. Define occlusal disease.

8.11.3. List the three stages involved in the occlusal

management system.

8.11.4. State the seven signs and symptoms of occlusal disease.

8.11.5. Describe the three golden rules of occlusion.

8.11.6. Label the 11 steps in clinical examination.

8.11.7. Identify the dentofacial esthetic diagnosis system.

8.11.8. Select the treatment modality for occlusal disease

depending on the etiology.

8.11.9. Illustrate the methods used to treat occlusal trauma.

8.11.10. Differentiate between a night guard and a therapeutic

splint.

8.11.11. List the types of therapeutic splints.

8.11.12. Explain when and how to integrate occlusal treatment in

clinical practice.

8.11.13. Describe the different maintenance procedures used for

patients with occlusal disease; night guard, patient

education, the periodontal model.

8.11.14. Treat different occlusal diseases using different

therapeutic procedures. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.12. Short dental arch

8.12.1. Describe functional dentition.

8.12.2. Analyze the strategies used in the management of

reduced dentition.

8.12.3. State the treatment options and alternatives for reduced

dentition.

8.12.4. Explain the basis of the short dental arch concept and

attitudes towards a short dental arch.

8.12.5. Justify the effect of a minimum number of occluding

pairs of teeth (short dental arch) on oral functionality

and masticatory efficiency.

8.12.6. List the possible advantages of a short dental arch.

8.12.7. Discuss the indications and contraindications for a short

dental arch.

8.12.8. Demonstrate the factors influencing a favorable

prognosis for a short dental arch.

8.12.9. Develop a comprehensive implant restoration treatment

plan for a short dental arch. (S)

8.12.10. Apply the appropriate treatment options for cases of

short dental arch. (S)

8.12.11. Review research in favor of a short dental arch.

8.13. Trauma from occlusion

8.13.1. Define occlusal trauma.

8.13.2. Classify occlusal trauma.

8.13.3. Diagnose occlusal trauma. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.14. Centric relation (determination and recording)

8.14.1. Define CR and adapted centric posture.

8.14.2. Discuss the location of the centers of rotation,

transverse horizontal axis.

8.14.3. Discuss important criteria related to CR and exclude

misconceptions.

8.14.4. Identify the condyle disc assembly.

8.14.5. Explain the split cast technique.

8.14.6. Outline the key points in determining CR, including pros

versus cons of each technique.

8.14.7. Describe load testing for verification of CR.

8.14.8. Explain the criteria for accuracy and reasons for error in

recording CR.

8.14.9. Describe the techniques for recording CR.

8.14.10. Describe the method of recording CR in edentulous

ridges.

8.14.11. Illustrate the clinical steps in determining and recording

CR and facebow transfers.

8.14.12. Determine CR using different materials in various clinical

situations. (S)

8.14.13. Apply the different techniques for recording CR. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.15. Interocclusal records

8.15.1. Identify the function of the jaw relationship record.

8.15.2. Explain the existing tripod interocclusal record according

to various clinical conditions and type of record.

8.15.3. Compare the types of interocclusal record, i.e., CR,

maximum intercuspation, and lateral interocclusal.

8.15.4. Describe the techniques for recording CR.

8.15.5. Justify the drawbacks of some of the CR recording

techniques.

8.15.6. Evaluate the materials used in making interocclusal

records and identify their indications and

contraindications.

8.15.7. Explain how to avoid errors and inaccuracies in jaw

relationships.

8.15.8. Describe the technique for recording jaw relationships in

patients with partially edentulous dentition.

8.15.9. Differentiate between articulators.

8.15.10. Select the appropriate type of articulator according to

the case. (S)

8.15.11. Explain the purpose of a facebow.

8.15.12. Illustrate the armamentarium and the step by step

procedure for making an interocclusal record and

mounting of casts on semi-adjustable articulators. (S)

8.15.13. Apply the different techniques for recording jaw

relationships. (S)

8.16. Mandibular movements and recording

8.16.1. List the factors regulating mandibular movements.

8.16.2. Identify the basic mandibular movements and positions.

8.16.3. Analyze the influence of condylar and incisal guidance

during mandibular movements.

8.16.4. Identify the finite helical axis.

.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.16.5. Explain Posselt’s envelope of motion:

Border movements in the sagittal plane.

Border movements in the frontal plane.

Border movement in the horizontal plane.

Effect of posture.

8.16.6. Outline the methods for studying mandibular

movements, e.g., direct clinical observation,

sophisticated electronic instrumentation, and

replication.

8.16.7. Explain mandibular border movement, three-

dimensional recording instrumentation, and

pantographic tracing.

8.16.8. State the factors influencing pantographic tracings of

mandibular border movements.

8.16.9. Describe the dynamic stereometry of the TMJ;

technique, condylar movements, and the condyle-fossa

distance.

8.16.10. Describe the graphic registration of lateral border

movements in a horizontal plane - Gothic arch or arrow

point tracing.

8.16.11. Justify the significance of understanding mandibular

movements.

8.17. Vertical dimension

8.17.1. Define the vertical jaw and horizontal jaw relationship.

8.17.2. Explain the significance of the vertical jaw relationship.

8.17.3. List the factors affecting this relationship.

8.17.4. Recognize the different types of vertical jaw relationship.

8.17.5. Determine the causes of loss of the VD.

8.17.6. Discuss oral and general health assessment of patients

with suspected loss of VD.

8.17.7. Identify the three components for evaluating VD and

discuss the relationship between them.

8.17.8. Describe the mechanical and physiologic methods of

determining VD.

8.17.9. Explain the effects of an increased vertical

relationship/decreased interocclusal distance.

8.17.10. Explain the effects of a decreased vertical

relationship/increased interocclusal distance.

8.17.11. Compare the different methods used for trial verification

of VD.

8.17.12. Apply the knowledge and concepts regarding VD to

clinical cases. (S)

8.17.13. Determine the VD clinically. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.18. Etiology, diagnosis, and treatment of posterior bite collapse

8.18.1. Explain the meaning of PBC as described by Amsterdam.

8.18.2. Recognize the different names for PBC, i.e., bite collapse,

collapse of occlusion, or posterior overclosure

8.18.3. Recognize the clinical signs of PBC as stated by

Amsterdam.

8.18.4. Discuss the causes of PBC.

8.18.5. Know the causes of tooth loss associated with PBC.

8.18.6. Discuss the compromising factors associated with tooth

loss.

8.18.7. List the occlusal changes associated with tooth loss.

8.18.8. Discuss the statement of Ramfjord and Ash regarding

PBC’s anterior maxillary flaring with loss of mandibular

first molars manifestation.

8.18.9. Discuss the findings of Stern and Brayer (loss of posterior

support and PBC coinciding with forward drift of the

mandible and increased anterior load).

8.18.10. Identify the compromising factors associated with

excessive bruxing.

8.18.11. Describe the method of diagnosing PBC associated with

tooth loss or bruxing.

8.18.12. Outline the stages involved in the treatment of PBC.

8.18.13. State the related signs used in the diagnosis of PBC.

8.18.14. Explain how to maintain occlusal stability.

8.18.15. Determine the prevalence of PBC.

8.18.16. Justify the role of excursive mandibular movement as a

factor contributing to PBC.

8.18.17. Diagnose PBC clinically. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.19. Anterior guidance and its Importance

8.19.1. Discuss the concept and function of anterior guidance.

8.19.2. Name the three factors considered in establishing the

occlusal contours of the posterior teeth.

8.19.3. Identify the types of anterior guidance.

8.19.4. Discuss the importance of anterior guidance over

condylar guidance.

8.19.5. Explain the significance of anterior guidance.

8.19.6. Recognize that next to CR, anterior guidance is the most

important determinant when performing oral

rehabilitation.

8.19.7. Discuss the major function of anterior guidance.

8.19.8. Explain the role of anterior guidance as a control on

occlusal posterior contours.

8.19.9. Discuss the effect of precisely establishing the correct

anterior guidance on the success or failure of occlusal

reconstruction hinges.

8.19.10. Compare and analyze canine guidance and group

function by a literature review.

8.19.11. Estimate the effect of anterior guidance on

electromyographic activity in the elevator muscles.

8.19.12. Explain the influence of pattern of tooth wear on the

treatment plan.

8.19.13. Discuss the four determinants of anterior form and

position (anatomic, physiologic, mechanical, and

esthetic).

8.19.14. Outline the criteria for the semi-adjustable articulator

used to restore anterior guidance.

8.19.15. Verify the relationship between anterior and condylar

guidance.

8.19.16. Differentiate between modification and re-

establishment of anterior guidance.

8.19.17. Explain the functionally generated path technique.

8.19.18. Identify convex or parabolic anterior guidance.

8.19.19. List the objectives of occlusal rehabilitation.

8.19.20. Describe the method for transferring occlusal anterior

guidance to the articulator.

8.19.21. Apply the principles of anterior guidance in clinical cases.

(S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.20. Occlusal stability

8.20.1. Define the concept of stable occlusion.

8.20.2. List the signs of stable and unstable occlusion.

8.20.3. Identify the requirement for occlusal stability.

8.20.4. Explain the treatment plan required for unstable

occlusion.

8.20.5. Apply the principles of occlusal stability in clinical cases.

(S)

8.21. Occlusal equilibration and selective teeth grinding

8.21.1. Explain the meaning and importance of occlusal

equilibration.

8.21.2. Identify the selective grinding concept and its

indications.

8.21.3. State the treatment goals for selective grinding.

8.21.4. Describe the technique for a selective grinding

procedure.

8.21.5. Perform selective grinding in clinical cases when

indicated. (S)

8.21.6. Treat cases of unstable occlusion. (S)

8.22. Bruxism

8.22.1. Differentiate between functional and parafunctional

mandibular movements.

8.22.2. Compare centric bruxism (clenching) and eccentric

bruxism.

8.22.3. Outline the types and etiology of bruxism.

8.22.4. Describe the treatment methods used for bruxism.

8.22.5. Verify the consequences of excessive bruxism.

8.22.6. Manage bruxism problems using different and

appropriate methods. (S)

8.23. Etiology and management of dental wear

8.23.1. Explain the meaning and types of dental wear.

8.23.2. Become familiar with the wear index classification.

8.23.3. Classify worn dentition according to location.

8.23.4. Verify the effect of wear on occlusion.

8.23.5. Discuss the diagnosis, prevention, and management of

dental wear problems.

8.23.6. State the types of severe wear occlusion.

8.23.7. Generate a treatment plan for severe wear occlusion. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.24. Overview of full mouth rehabilitation

8.24.1. Define full mouth rehabilitation and determine its

indications.

8.24.2. Discuss the various occlusal concepts and philosophies

pertaining to full mouth rehabilitation.

8.24.3. Describe the steps involved in the process of full mouth

rehabilitation.

8.24.4. Apply the steps of full mouth rehabilitation to clinical

cases. (S)

8.25. Clinical remounting

8.25.1. Explain the meaning and significance of clinical

remounting.

8.25.2. List the indications for clinical remounting.

8.25.3. Describe the steps of the clinical remounting technique.

8.26. Deep overbite

8.26.1. Differentiate between normal overbite and deep

overbite.

8.26.2. Classify the types of deep overbite and state their

etiology.

8.26.3. Compare stable and problematic deep overbite.

8.26.4. Estimate the need for treating deep overbite.

8.26.5. Explain the types of deep overbite problems.

8.26.6. Identify the methods used to correct deep overbite

problems.

8.26.7. Apply the steps for management of deep overbite to

clinical cases. (S)

8.27. Deep overjet

8.27.1. Explain the etiology of excess overjet.

8.27.2. Assess the effect of excess overjet on occlusion.

8.27.3. Realize the important considerations in treating an

extreme overjet problem.

8.27.4. Decide the appropriate treatment for extreme overjet

problems.

8.27.5. Apply the steps for management of deep overbite to

clinical cases. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.28. Anterior open bite

8.28.1. Recognize anterior and posterior open bite problems.

8.28.2. Discuss the types, etiology, prevalence, and treatment of

each type.

8.28.3. Apply the steps for management of anterior open bite to

clinical cases. (S)

8.29. Severe arch malrelationship

8.29.1. Categorize arch malrelationship.

8.29.2. Summarize the basic treatment concepts.

8.29.3. Outline the treatment objectives and options for

malrelationship problems.

8.30. Crowded anterior teeth

8.30.1. Analyze a case of crowded anterior teeth.

8.30.2. List the etiology of crowded anterior teeth.

8.30.3. Illustrate potential problems caused by crowded anterior

teeth.

8.30.4. Discuss the treatment methods used and the role of the

prosthodontist in correcting the problem.

8.31. Separated anterior teeth

8.31.1. Explain the meaning and causes of splayed anterior

teeth.

8.31.2. Describe the types and steps in treatment.

8.31.3. Revise the considerations to be taken before embarking

on any treatment.

8.32. Occlusal appliances

8.32.1. Define occlusal appliances and list their types.

8.32.2. Mention the indications and appropriate selection of

occlusal appliances, and describe their fabrication

technique.

8.33. Criteria for success of occlusal treatment

8.33.1. Outline the objectives of successful occlusal treatment.

8.33.2. Describe the testing process for successful occlusal

treatment.

8.33.3. Apply the criteria for success of occlusal treatment to

clinical cases. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

8.34. Postoperative care of patients undergoing occlusal therapy

8.34.1. State the objectives of postoperative care in occlusal

therapy.

8.34.2. Explain the indications for post-treatment occlusal

appliances.

8.34.3. Analyze the factors influencing the progress of

postoperative care.

8.34.4. Justify the importance of postoperative periodontal

maintenance.

8.34.5. Apply postoperative care in patients who have

undergone occlusal therapy. (S)

8.35. End to end occlusion

8.35.1. Compare anterior and posterior end to end occlusion.

8.35.2. Justify factors affecting selection of treatment for end to

end occlusion.

8.35.3. Describe the restorative methods used to treat end to

end occlusion.

8.35.4. Manage cases of end to end occlusion. (S)

8.36. Crossbite relationship

8.36.1. Differentiate between the different types of crossbite.

8.36.2. List the important principles in treating cases of

crossbite.

8.36.3. Describe the different methods used to treat crossbite

problems

8.36.4. Manage cases with different occlusal problems when

needed. (S)

Module 9: Dental implants

This module provides a basic knowledge of dental implants and the

skills necessary for diagnosis and planning treatment. Residents

discuss the rationale for dental implants and the principle of

osseointegration as well as the prosthetic components of implants,

including types of dental implant and the concepts of biomechanics,

occlusion of implant restoration, and an implant in the esthetic zone.

Finally, the resident will gain some experience on how to maintain a

dental implant.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

9.1. Historical overview of dental implantology, types of dental

implant, and the concept of osseointegration

9.1.1. Outline the history of implants and Dr. Branemark’s

breakthrough discovery of osseointegration.

9.1.2. Discuss the scientific basis for osseointegration.

9.1.3. Describe the types of bone and bone reaction.

9.1.4. Distinguish the difference between healing related to

cortical bone and cancellous bone at the cellular level.

9.1.5. Identify the stages leading to integration.

9.1.6 Explain the biology of bony adaptation at the implant

surface.

9.2. Biomechanics, biomaterials and surface treatment of dental

implants

9.2.1. Discuss the biomechanical principles of implants.

9.2.2. Recognize the need for control of biomechanical loading

on dental implants (moments, stress, and strain).

9.2.3. Identify forces and their components (moments, force

transfer mechanisms, impact, and stress-strain

relationships) and their influence on clinical decision-

making and the treatment plan.

9.2.4. Explain the scientific rationale for the design of dental

implants.

9.2.5. List types of surface coating.

9.2.6. Apply the biomechanical principles in a treatment plan.

(S)

9.3. Occlusion of implant restoration

9.3.1. Differentiate between implant occlusion and natural

occlusion.

9.3.2. Discuss the basics and consequences of biomechanical

overload, bone mechanics, force directions, and various

occlusal schemes that contribute to the success of

implant restorations.

9.3.3. Explain the importance of controlling the position,

angulation, and occlusal force on the implant.

9.4. Patient selection for an implant and planning treatment

9.4.1. Review medical and dental history.

9.4.2. Recognize local, systemic, and behavioral risk factors.

9.4.3. State the steps in clinical and radiographic examination.

9.4.4. Explain the surgical and radiographic methods used to

insert stents.

9.4.5. Develop and apply treatment strategies. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

9.5. Evaluation of radiographic images in patients considering an

implant

9.5.1. List the necessary radiographic information needed.

9.5.2. Describe the types of radiographic images needed to

obtain the information required for implant planning.

9.5.3. Describe the importance and sequence of radiographic

monitoring for implant therapy.

9.5.4. Define image-guided surgery.

9.5.5. Interpret different radiographic images for single or

multiple implants. (S)

9.5.6. Identify the anatomic landmarks used to select the

correct position for the implant. (S)

9.6. Treatment planning for single-tooth implant restoration

9.6.1. Illustrate the alternative treatments available for single-

tooth replacement.

9.6.2. Discuss the contraindications and limitations of a single-

tooth implant.

9.6.3. Explain the orthodontic and occlusal considerations

related to posterior implant treatment.

9.7. Implant in the esthetic zone

9.7.1. Explain the general esthetic principles and related

guidelines.

9.7.2. Discuss esthetic considerations related to maxillary

anterior implant restoration.

9.7.3. Recognize the role of the biological width on esthetic

implant rehabilitation.

9.7.4. Analyze the clinical considerations that must be

addressed when placing an implant in the esthetic zone.

9.8. Screw-retained versus cement-retained implant restoration

9.8.1. State the indications for screw-retained prosthetic

restoration.

9.8.2. State the indications for cement-retained prosthetic

restoration.

9.8.3. Explain the advantages and disadvantages of screw-

retained and cement-retained prosthetic restoration.

9.8.4. Select and utilize screw-retained implant restoration. (S)

9.8.5. Select and utilize cemented-retained implant

restoration. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

9.9. Surgical aspects of implant dentistry

9.9.1. Describe the first surgical procedure.

9.9.2. Describe the second surgical procedure.

9.9.3. Explain the postoperative management.

9.9.4. State the complications that can occur after this surgery.

9.10. Prosthetic aspects

9.10.1. Explain the steps involved in a fixed implant prosthesis

for single-tooth replacement:

- in the esthetic zone

- for posterior teeth.

9.10.2. Explain the steps involved in a fixed implant prosthesis

for partially edentulous situations.

9.10.3. Differentiate between prefabricated and customized

healing abutments for soft tissue management.

9.10.4. State the different types or options for screw-retained

and cemented-retained abutments.

9.10.5. Discuss the types of implant temporization and

techniques used.

9.10.6. Compare the different options for making an impression

(closed versus open tray technique, and abutment

versus fixture level impressions)

9.10.7. Describe the procedures for bite registration, abutment

selection (plan sit), torqueing, and insertion.

9.10.8. Develop a treatment plan for complex implant cases.

9.10.9. Describe the process of full mouth rehabilitation using

dental implants.

9.10.10. Discuss the use of implants for growing patients.

9.10.11. Make a final impression with closed try (at the abutment and

fixture level). (S)

9.10.12. Make a final impression with open try at the fixture level. (S)

9.11. Immediate dental implant loading

9.11.1. State the rationale for immediate implant loading.

9.11.2. List the guidelines for immediate loading.

9.11.3. Determine factors that decrease the risk of immediate

occlusal loading.

9.11.4. Explain the advantages and disadvantages of non-

functional immediate loading.

9.11.5. Justify the risk of immediate occlusal loading.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

9.12. Implant-natural tooth connection

9.12.1. Evaluate the natural abutment appropriately.

9.12.2. Distinguish biomechanical differences in movement

between an implant and a natural tooth.

9.12.3. Recognize the difference in supporting mechanisms.

9.12.4. State the advantages and disadvantages of connecting a

tooth to an implant.

9.12.5. Justify the potential risk of connecting a tooth to an

implant.

9.12.6. Describe the connection method.

9.13. Complications and management of a prosthetic implant

9.13.1. Discuss the biological complications, i.e., incident rate,

etiology, and solutions.

9.13.2. Discuss the mechanical complications, i.e., incident rate,


9.13.3. Discuss the esthetic complications, i.e., incident rate,


9.13.4. Estimate and recognize complications of a prosthetic

implant in a case. (S)

9.14. Treatment planning for an implant-supported fixed partial

denture

9.14.1. Discuss the prosthetic options.

9.14.2. Classify the prosthetic movements.

9.14.3. State the advantages of an implant-supported FPD.

9.14.4. Describe the preloading and parameters affecting

preloading.

9.14.5. Identify a passive casting material and factors

influencing fabrication.

9.15. Maintenance of a dental implant

9.15.1. Recognize the periodontal aspects of a dental implant.

9.15.2. Define peri-implantitis.

9.15.3. Discuss the consequences of peri-implantitis.

9.15.4. Explain the hygiene protocol and instrumentation.

9.15.5. List the chemotherapeutic agents used.

9.15.6. Define the Implant Crown Aesthetic Index.

9.15.7. Examine implant cases and identify any complications.

(S)

9.15.8. Manage complications in implant cases. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

Module 10: Operative

This module provides essential clinical skills. It emphasizes the

practical aspects of tooth preparation and selection of appropriate

restoration methods. Residents discuss common restorative

problems and review their causes and solutions in scientific articles.

10.1 Clinical significance of dental anatomy, histology, physiology

and occlusion

10.1.1 Describe the specific anatomic features of each tooth

that help in diagnosis and treatment planning.

10.1.2 Illustrate the physiologic tooth forms and contours that

affect the supporting dental and paradental tissues.

10.1.3 Explain the biological principles and details of the

development, structure, and function of the hard and

soft tissues in the oral cavity.

10.2 Instruments and equipment for tooth preparation

10.2.1 Recognize the different types of instruments used in the

operative field; construction materials, parts, grasp

technique, and instrument motion.

10.2.2 Justify the use of different types of instruments

according to the clinical situation.

10.3 Amalgam restoration

10.3.1 Identify the indications for dental amalgam.

10.3.2 Correlate types of amalgam with their properties and

indications.

10.3.3 Indicate the criteria for successful amalgam restoration.

10.3.4 Restore posterior teeth using amalgam restoration. (S)

10.3.5 Finish and polish an amalgam restoration to create

appropriate anatomy and occlusion. (S)

10.4 Complex amalgam restorations

10.4.1 Formulate treatment strategies and determine the type

of restorative materials needed for a range of clinical

situations involving mutilated teeth.

10.4.2 Compare the various clinical treatment modalities for

badly mutilated teeth to ensure optimum postoperative

results.

10.4.3 Formulate a rationale for conservative treatment of

badly mutilated teeth with the emphasis on an

appropriate pulpal diagnosis and treatment protocol.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

10.5 Fundamental concepts of enamel and dentin adhesion

10.5.1 Compare the different types of adhesive available.

10.5.2 Select the correct type of adhesive system to be used in

a specific clinical situation.

Recognize the durability of bonding adhesives according

to different manipulative techniques.

10.5.3 Apply dental adhesive for composite restoration

following the standard protocol. (S)

10.6 Composite restoration

10.6.1 Explain the indications and contraindications of

composite restoration.

10.6.2 Correlate the material properties with indications and

contraindications.

10.6.3 Explain the conservative design for cavity preparation for

anterior and posterior composite restoration.

10.6.4 Discuss manipulation of layering techniques for anterior

composite restorations.

10.6.5 Discuss manipulation of the techniques for posterior


10.6.6 Describe finishing and polishing techniques.

10.6.7 Discuss special considerations in restoring crowded

teeth and their complications.

10.6.8 Restore anterior and posterior teeth with composite

restorations. (S)

10.6.9 Finish and polish a composite restoration using different

tools. (S)

10.7 Glass ionomers

10.7.1 Explain the indications and contraindications of glass

ionomers.

10.7.2 Discuss the steps in manipulation of glass ionomer

restoration.

10.7.3 Appraise the importance of water content in a glass

ionomer and the effect of contamination by moisture.

10.7.4 Restore teeth using a glass ionomer restoration

technique. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

10.8 Glass ionomers

10.8.1 Explain the indications and contraindications for a glass

ionomer.

10.8.2 Discuss the steps of manipulation of glass ionomer

restoration.

10.8.3 Appraise the importance of water content in a glass

ionomer and the effect of moisture contamination.

10.8.4 Restore teeth with a glass ionomer. (S)

10.9 Common restorative problems: restoration failures and

repair

10.9.1 Discuss reasons for failure of the different types of

dental restoration.

10.9.2 Explain the criteria for successful restoration.

10.9.3 Justify the appropriate management for each type of

failure.

10.9.4 Appraise the clinical criteria for evaluation of

restoration.

10.9.5 Frame precise, structured, and meaningful clinical

questions, and locate and apply the best available

evidence to answer these questions.

10.9.6 Manage a failed restoration. (S)

10.10 Controversial issues in operative dentistry

10.10.1 Identify and analyze controversial issues in operative

dentistry.

10.10.2 Identify the best available evidence for answering clinical

questions in operative dentistry.

Module 11: Esthetics (color, smile analysis, ceramic, CAD/CAM,

veneer, inlay, onlay, bleaching)

This module conveys the science and art of dental esthetics. It covers

the essential topics and materials needed to provide excellent

esthetics for the patient, including smile analysis, properties of the

color used, shade selection, and different types of restoration. The

resident is also exposed to new technology in smile analysis.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

11.1 Properties of light and color in dentistry

11.1.1. Discuss the components of daylight with different

wavelengths.

11.1.2. Define electromagnetic radiation.

11.1.3. List different light sources (illumination).

11.1.4. Define emission, transmission, and absorption of light.

11.1.5. Discuss primary, secondary, and complementary colors.

11.1.6. Discuss the dimensions of color with reference to hue,

value, and chroma.

11.1.7. Discuss the optical triad of fluorescence, opalescence,

and translucency.

11.1.8. Explain the phenomenon of metamerism.

11.1.9. Discuss the factors affecting shade matching.

11.1.10. List the recommended protocol for shade matching.

11.1.11. Apply the principles of light and color in clinical cases. (S)

11.1.12. Select the tooth shade using different shade guide

systems. (S)

11.2. Indirect tooth-colored restorations

11.2.1. Differentiate between composite and indirect ceramic

restorations.

11.2.2. Appraise different materials used for indirect tooth-

colored restorations.

11.2.3. Justify the use of different techniques according to the

clinical situation.

11.2.4. Master indirect tooth-colored restoration techniques. (S)

11.3. Conservative treatment for discolored teeth

11.3.1. Recognize types and characteristics of tooth

discoloration with reference to different etiologic

factors.

11.3.2. Describe the strategies applied in the management of

discolored teeth (bleaching, microabrasion,

macroabrasion).

11.3.3. Distinguish the types, composition, and mode of action

of tooth bleaching agents and techniques.

11.3.4. Identify the effects of bleaching agents on different

restorative agents.

11.3.5. List the alternative therapies available for tooth

bleaching.

11.3.6. Master the different techniques used to treat discolored

teeth. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

11.4. Esthetic considerations in diagnosis and treatment planning

11.4.1. Differentiate between esthetic and cosmetic

considerations, and recognize how to achieve high

esthetic quality.

11.4.2. List esthetic dental problems.

11.4.3. Differentiate the etiology as well as diagnostic and

treatment modalities for all diseases and lesions that

may affect the best esthetic outcome.

11.4.4. Perform a facial and smile analysis. (S)

11.4.5. Identify the esthetic treatment modalities available for

different esthetic and dental problems.

11.4.6. Interpret all treatment modalities for esthetic defects.

11.4.7. Recognize the indications, contraindications,

advantages, and disadvantages of different types of

direct and indirect esthetic veneer.

11.4.8. Prepare indicated teeth for composite and porcelain

veneers. (S)

11.4.9. Build up a composite veneer on indicated teeth. (S)

11.4.10. Cement porcelain veneers using different types of resin

cement. (S)

11.5 Sealer tooth discoloration and bleaching

11.5.1 Analyze measures to prevent tooth discoloration

secondary to endodontic treatment.

11.5.2 Select the bleaching agent and technique according to

the cause of discoloration.

11.5.3 Recognize the potential adverse effects of internal

bleaching and discuss means of prevention.

11.5.4 Identify the cause and nature of tooth discoloration.

11.5.5 Recognize factors that might influence leakage and how

to prevent them.

11.5.6 Differentiate between dentin and enamel discolorations.

11.5.7 Describe each step of the internal ‘’walking bleach’’

technique.

11.5.8 Describe how a bleaching agent can alter dentin.

11.5.9 Practice home and office bleaching with indicated cases.

(S)

Module 12: Periodontal-restorative interrelationship

This module provides a basic knowledge of the relationship between

periodontal tissues and types of restorative procedures that will have

an impact on the long-term success of a restoration.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

12.1 Introduction to periodontics

12.1.1. Identify components of the periodontal apparatus.

12.1.2. Describe the different periodontal biotypes.

12.1.3. Explain the local factors contributing to periodontal

disease:

-Anatomic

-Restorative

-Orthodontic

-Habitual.

12.1.4. Estimate the periodontal prognosis and the impact

thereon of individual risk factors.

12.1.5. Discuss the impact of individual risk factors on the

periodontal prognosis:

-Systemic

-Local.

12.1.6. Understand mucogingival therapy and periodontal plastic

surgery.

12.1.7. Define gingival recession and state its etiology.

12.1.8. Classify gingival recession.

12.1.9. List the indications and contraindications for surgical

treatment of gingival recession.

12.1.10. Distinguish the soft tissue grafting techniques.

12.1.11. Recognize the relationship between soft tissue recession

and orthodontics.

12.1.12. Classify ridge defects and explain gingival augmentation.

12.1.13. Define the biological width.

12.1.14. Correlate gingival dimensions (biologic width) with

restorative therapy.

12.1.15. Discuss crown lengthening in regard to:

-Classification

-Indications/contraindications

-Presurgical preparation and documentation.

12.1.16. Identify guided tissue regeneration

12.1.17. Define essential terminology

(osseoinduction/osseoconduction)

12.1.18. List main bone grafting materials and membranes

12.2. Factors affecting gingival esthetics

12.2.1. Identify the supracrestal connective tissue, the

junctional epithelium, and the sulcus.

12.2.2. List the anatomic components of the gingiva.

12.2.3. Describe the osseous crest and explain its importance.

12.2.4. Explain the role of the gingiva.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

12.2.5. Identify the periodontal biotype and bioform, including

types and significance.

12.2.6. Describe the gingival margin outline in smile analysis.

12.2.7. Explain the meaning of emergence profile and its

significance in gingival esthetics and health.

12.2.8. Explain the effect of tooth morphology on two aspects of

gingival undulation.

12.2.9. Clarify the impact of contact points on esthetics,

explaining the following concepts:

5 mm rule – Tarnow

Tooth shape and association with black triangles

Changes in IDP following extraction

Diastema and IDP

Gingiva biotype and IDP

Implant and IDP

Flat fixture platform versus scalloped fixture platform

12.2.10. Correlate tooth position and gingival progression in

three planes.

12.2.11. Define the gingival aesthetic line and gingival aesthetic

angle.

12.2.12. List the four classes of gingival aesthetic line.

12.2.13. Differentiate between an ideal, aesthetically acceptable,

and gummy smile.

12.2.14. Identify the different esthetic treatment modalities:

Gingivectomy

Crown lengthening

Cosmetic periodontal surgery

Grafts

Guided tissue regeneration

Orthodontic excursion/intrusion

Ridge augmentation

Orthognathic surgery.

12.2.15. Discuss the different types of esthetic periodontal

defects and the methods used for correction:

Violation of biological width

Gingival asymmetry

Esthetic/functional crown lengthening

Excessive gingival display

Excessive gingival pigmentation; gingival abrasion

technique



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

12.3. Effect of restorative treatment on gingival health

12.3.1. Biologic width

12.3.1.1. Explain the biologic width assessment method.

12.3.1.2. Justify the variation in biologic width.

12.3.1.3. Discuss consequences of biologic width violation.

12.3.1.4. Recognize the signs of biologic width violation.

12.3.1.5. Describe the procedures used to correct biologic width

violation (surgical and orthodontic).

12.3.2. Margin placement

12.3.2.1. List the types: supragingival, equigingival, subgingival.

12.3.2.2. State the reasons for extending margins subgingivally.

12.3.2.3. Explain the consequences of extending margins

subgingivally.

12.3.2.4. Discuss the margin placement guideline.

12.3.2.5. Identify the types of tissue retraction techniques.

12.3.3. Provisional restoration

12.3.3.1. Explain the effect of the different provisional materials

on gingival health.

12.3.3.2. Discuss critical areas in provisional restoration that

maintain the health and position of the gingiva (marginal

fit, contour, surface finish).

12.3.3.3. Verify the consequences of faulty provisional

restorations.

12.3.4. Marginal fit and crown contour

12.3.4.1. Describe the role of margin fit and open margins as

causative factors in the inflammatory response of the

gingiva.

12.3.4.2. Explain the effect of crown contour, including

emergence profile, height of contour, embrasures, and

overhang on gingival health.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

12.3.5. Subgingival debris and hypersensitivity

12.3.5.1. Illustrate the effect of subgingival debris following

restorative procedures on the periodontal ligament.

12.3.5.2. Discuss the hypersensitivity of the gingiva to dental

materials:

Non-precious alloys

Surface roughness and affinity for plaque

Class II amalgam restorations

Composite

Glass ionomer cement

Porcelain.

12.3.5.3. Identify recession factors:

Bone width (thick/thin)

Gingiva (thin or fibrotic, flat or scalloped form)

12.3.6. Interproximal embrasures

12.3.6.1. Explain how to manage interproximal embrasures

(natural tooth and implant).

12.3.6.2. Clarify the relationship between gingival embrasure

volume and papillary formation.

12.3.6.3. State the causes of open gingival embrasures.

12.3.6.4. Describe the methods used to alter gingival embrasures.

12.3.6.5. Manage the form of the gingival embrasure for patients

with gingival recession.

12.3.6.6. Explain the restorative correction techniques used for

open gingival embrasures.

12.4. Restoration of root-resected teeth

12.4.1. Identify the indications, contraindications, and

advantages of restoration of resected teeth.

12.4.2. Describe a special prosthetic design for resected teeth.

Module 13: Scientific research

This module communicates the principles of scientific research. It is

designed to improve many skills, including scientific thinking, team

work, and professional communication skills. Residents will have a

chance to conduct a research project and present their findings in a

written or oral format.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

13.1. 13.1 Introduction to scientific research

13.1.1. Define research.

13.1.2. Discuss its importance.

13.1.3. List the various types of research.

13.1.4. Explain the meaning of evidence-based dentistry.

13.1.5. List the steps for conducting research.

13.1.6. Identify skills needed to design and conduct research.

13.1.7. Recognize sources of information, articles, and data.

13.1.8. Open an account in PubMed. (S)

13.2. 13.2 Ethics in scientific research

13.2.1. Recognize research ethics (ethics training module: http://www.pre.ethics.gc.ca/eng/index/)

13.2.2. Present the principles of the Declaration of Helsinki (ethics)

13.2.3. Present the principles of the Belmont Report (ethics)

13.2.4. Select a research group and/or supervisor.

13.3. 13.3 Literature review

13.3.1. Describe the meaning of a literature review.

13.3.2. Discuss the importance of a literature review.

13.3.3. List the steps in conducting a literature review.

13.3.4. Apply methods for writing the introduction part of the manuscript.

13.3.5. Critique a literature review of published articles.

13.4. 13.4 Research problem and objectives 13.4.1 Define the research problem and purpose. 13.4.2 Explain the importance of the research problem. 13.4.3 Identify the purpose statements, research questions,

hypotheses, and objectives. 13.4.4 Formulate an hypothesis. 13.4.5 Formulate the research objective. 13.4.6 Discuss the process of developing a research question. 13.4.7 Apply methods of writing to the research objective. 13.4.8 Critique the research objectives of published articles.

13.5 Introduction to referencing 13.5.1 Define a reference and a citation. 13.5.2 List the different types of referencing style. 13.5.3 Recognize the meaning of plagiarism. 13.5.4 Write statements/paragraph with citations and

references. 13.5.5 Attend a hands-on EndNote workshop. (S)



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

13.6 Study design and research methodology 13.6.1 Describe the characteristics of quantitative, qualitative

and mixed methods research. 13.6.2 Explain a quantitative study design (research

methodology). 13.6.3 Describe descriptive and analytic studies. 13.6.4 Describe experimental research, quasi-experimental,

non-experimental quantitative research. 13.6.5 Discuss the steps involved in conducting experimental

research. 13.6.6 Explain the meaning and uses of correlational research. 13.6.7 Explain the meaning of causation and association

research. 13.6.8 Critique study designs in published articles.

13.7 Type of variables, confounding, modifiers, sampling technique, and data collection, Institutional Review Board (IRB)

13.7.1 List types of variables. 13.7.2 Define confounding and modifier variables. 13.7.3 List types of bias in research. 13.7.4 Discuss the process of quantitative data collection. 13.7.5 Explain sampling technique. 13.7.6 Explain how to obtain a study sample. 13.7.7 List the types of data collection tools (instruments to be

used to collect data). 13.7.8 Define the different methods of data collection (tests,

questionnaires, interviews, focus groups, observation). 13.7.9 Critique types of variables and sampling techniques in

published articles. 13.7.10 Discuss process of IRB approval for Research Project?

13.8 Questionnaires and standardized measurement 13.8.1 Discuss different types of questionnaire. 13.8.2 List the steps for construction of an instrument

(questionnaire). 13.8.3 Identify standardized measurement and assessment

techniques (e.g., scales, validity, and reliability). 13.8.4 Discuss methods for administering the tools for data

collection.

13.9 Qualitative study design 13.9.1 Identify qualitative study design (grounded theory

research, ethnographic research, narrative research). 13.9.2 Explain the process of qualitative data collection. 13.9.3 Discuss how to analyze and interpret qualitative data.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

13.10 Biostatistics 13.10.1 Identify the basics of biostatistics. 13.10.2 Explain how to interpret quantitative data. 13.10.3 Explain the data management process. 13.10.4 Discuss the process of quantitative data analysis. 13.10.5 Conduct a descriptive analysis. 13.10.6 Conduct an inferential analysis. 13.10.7 Describe how to analyze the data. 13.10.8 Describe how to report the results: tables, figures, and

presenting in text 13.10.9 Familiarity with use of the SPSS program (attend a

hands-on workshop). (S)

13.11 Research proposal 13.11.1 Describe the content of the research proposal. 13.11.2 Apply the above-mentioned methods of writing. (S)

13.12 Discussion 13.12.1 Identify the content of the discussion section. 13.12.2 Discuss the methods used to write the above discussion.

13.13 Conclusion, abstract, title, authorship, acknowledgements, publication, poster presentation

13.13.1 Identify the content of the conclusion. 13.13.2 Identify the content of the abstract. 13.13.3 List the types of title. 13.13.4 State how to arrange authorship. 13.13.5 Describe how to write acknowledgements. 13.13.6 Explain the process of publication. 13.13.7 Discuss how to design the poster.

13.14 Research grants 13.14.1 Explain the process of applying for a research grant. 13.14.2 Discuss the steps in critiquing research.

1.4 Perform appropriately timed clinical assessments with

recommendations that are presented in an organized

manner.

1.5 Carry out professional duties in the face of multiple

competing demands.

1.6 Recognize and respond to the complexity, uncertainty, and

ambiguity inherent in medical practice.

2 Perform a 2.1 Prioritize issues to be addressed in a patient encounter.



SN


able to)


Junior (R1&R2)

Senior (R3&R4)

patient centered-clinical assessment and establish a management plan

2.2 Elicit a history, perform a physical examination, select appropriate investigations, and interpret their results for the purpose of diagnosis and management, disease prevention, and health promotion.

2.3 Establish goals of care in collaboration with patients and their families, which may include slowing disease progression, treating symptoms, achieving a cure, improving function, and palliation.

2.4 Establish a patient-centered management plan.

3

Plan and perform procedures and therapies for the purpose of assessment and/or management

3.1 Determine the most appropriate procedures or therapies.

3.2 Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy.

3.3 Prioritize a procedure or therapy, taking into account clinical urgency and available resources.

3.4 Perform a procedure in a skilled and safe manner, adapting to unanticipated findings or changing clinical circumstances.

4

Establish plans for ongoing care and, when appropriate, timely consultation

4.1 Implement a patient-centered care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation.

5

Actively contribute, as an individual and as a member of a team providing care, to the continuous improvement of health care quality and patient safety

5.1 Recognize and respond to harm from health care delivery, including patient safety incidents.

5.2 Adopt strategies that promote patient safety and address human and system factors.



Communicator

Definition As communicators, SBRD residents form relationships with patients and their families that facilitate the gathering and sharing of essential information for effective dental health care.

SN

Key competencies

(Residents are able to)


Junior (R1&R2)

Senior (R3&R4)

1 Establish professional therapeutic relationships with patients and their families

1.1 Communicate using a patient-centered approach that encourages patients’ trust and autonomy, and is characterized by empathy, respect, and compassion.

1.1.1 Apply psychologic and behavioral principles in patient-centered communication.

1.1.2 Take time to talk and listen to dental patients to understand them better and improve the clinical relationship.

1.1.3 Provide direct and close contact with patients characterized by honesty and empathy to create a therapeutic alliance based on trust and respect.

1.2 Optimize the physical environment for the patient’s comfort, dignity, privacy, engagement, and safety.

1.2.1 Show concern about patient privacy and comfort. 1.2.2 Apply all the safety standards needed.

1.3 Recognize when the values, biases, or perspectives of patients, dentists, or other dental health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly.

1.4 Respond to a patient’s non-verbal behaviors to enhance communication.

1.4.1 Recognize and appropriately manage anxious or fearful dental patients.

1.4.2 Recognize and respect the dental patient’s need for privacy.

1.5 Manage disagreements and emotionally charged conversations.

1.5.1 Respect each patient’s perspectives, situation, concerns, and values and give alternative treatment plans.

1.5.2 Break bad news in an empathic manner.

1.6 Adapt to the unique needs and preferences of each patient and to his/her clinical condition and circumstances.

2 Elicit and synthesize accurate and relevant information, incorporating the

2.1 Use patient-centered interviewing skills to gather relevant biomedical, dental, and psychologic information.

2.1.1 Encourage and facilitate the dental patient to take the conversational lead, initiating topics in the area of their complaints, symptoms, experience, worries, values, and preferences.



SN

Key competencies

(Residents are able to)


Junior (R1&R2)

Senior (R3&R4)

perspectives of patients and their families

2.2 Provide a clear structure for and manage the flow of an entire patient encounter.

2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent.

2.3.1 Collect the relevant necessary information from the family, previous dentists, or other dental specialists, the patient’s physician (if related to a medical issue), and other professionals, with the patient’s permission.

2.3.2 Act professionally when screening for sensitive information

3 Share dental health care information and plans with patients and their families

3.1 Share information and explanations that are clear, accurate, and timely, while checking for patient and family understanding.

3.1.1 Use language that is easily comprehended and matches the patient’s requirements and expectations.

3.1.2 Utilize new technology to facilitate understanding of information and explaining dental treatment plans.

3.2 Disclose harmful patient safety incidents to patients and their families accurately and appropriately.

4 Engage patients and their families in developing plans that reflect the patient’s dental health care needs and goals

4.1 Facilitate discussion with patients and their families in a way that is respectful, non-judgmental, and culturally safe.

4.2 Assist patients and their families to identify, access, and make use of information and communication technologies to support their treatment plan, dental care, and manage their dental health.

4.3 Use communication skills and strategies that help patients and their families to make informed decisions regarding their dental health.

5 Document and share written and electronic information about the clinical encounter to optimize clinical decision-making, patient safety, confidentiality, and privacy

5.1 Document clinical encounters in an accurate, complete, timely, and accessible manner, in compliance with regulatory and legal requirements.

5.2 Communicate effectively using a written dental and medical health record, electronic dental and medical record, or other digital technology.

5.3 Share information with patients and others in a manner that respects patient privacy and confidentiality and enhances understanding.

Collaborator



Definition As collaborators, SBRD residents work effectively with other dental health care professionals to provide safe, high-quality, patient-centered care.

SN Key competencies (Residents are able

to)


Junior (R1&R2)

Senior (R3&R4)

1

Work effectively with dentists, physicians and other colleagues in the dental health care professions

1.1 Establish and maintain a positive relationship with dentists, physicians and other colleagues in the dental health care professions to support relationship-centered collaborative care.

1.1.1 Participate in intraprofessional (among dental colleagues) and interprofessional (among other dental and medical health care professionals) relationships and team work.

1.1.2 Work with other health care professionals and dental specialists to integrate care at the individual and community levels.

1.1.3 Apply the principles of team dynamics.

1.1.4 Engage in continuous intraprofessional and interprofessional development to enhance team performance.

1.2 Negotiate overlapping and shared responsibilities with dentists and other health care professionals during episodic and ongoing care.

1.2.1 Recognize one’s own professional role and responsibilities and those of others, including dental assistants, laboratory technicians, radiologists, hygienists, and other dental and medical specialties.

1.3 Engage in respectful shared decision-making with dentists and other colleagues in the dental health care professions.

2

Work with dentists, and other colleagues in the dental health care professions to promote understanding, manage differences, and resolve conflicts

2.1 Show respect toward collaborators.

2.1.1 Encourage the opinions and ideas of other interprofessional and intraprofessional dental health care team members.

2.1.2 Respect the roles and limitations of other professionals.

2.2 Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture.




to)


Junior (R1&R2)

Senior (R3&R4)

2.2.1 Value diversity among dental professionals.

2.2.2 Use constructive negotiation.

2.2.3 Describe strategies for conflict resolution in the team.

2.2.4 Give timely, sensitive, instructive feedback to others, and respond respectfully and professionally to feedback from others.

3

Hand over the care of dental patients to another dental health care professional when necessary to facilitate continuity of safe patient care

3.1 Determine when care should be transferred to another dentist or dental health care professional.

3.1.1 Recognize one’s own limitations and to know when to seek help from others.

3.2 Demonstrate handover of care, using both verbal and written communication, during a patient transition to a different dental health care professional, setting, or stage of care.

3.2.1 Write appropriate referral and consultation request forms.

Leader

Definition As leaders, SBRD residents engage with others to contribute to the vision of a high-quality dental health care system and take responsibility for the delivery of excellent patient care through their activities as clinicians, administrators, scholars, or teachers.


to)

Enabling competencies: (Residents are able to)

Junior (R1&R2)

Senior (R3&R4)

1

Contribute to improved delivery of dental health care in teams, organizations, and systems

1.1 Apply the science of quality improvement to contribute to improving systems of patient care.

1.2 Contribute to a culture that promotes patient safety.

1.3 Analyze patient safety incidents to enhance systems of care.




to)

Enabling competencies: (Residents are able to)

Junior (R1&R2)

Senior (R3&R4)

1.4 Use health informatics to improve the quality of patient care and optimize patient safety.

2 Engage in the stewardship of dental care resources

2.1 Allocate dental care resources for optimal patient care.

2.2 Apply evidence and management processes to achieve cost-appropriate care.

3 Demonstrate leadership in professional practice

3.1 Demonstrate leadership skills to enhance dental care.

3.2 Facilitate change in dental health care to enhance services and outcomes.

4

Manage career planning, finances, and human resources in a dental practice

4.1 Set priorities and manage time to integrate practice and personal life.

4.2 Manage a career and a practice.

4.3 Implement processes to ensure Improvement

in personal practice.

Health Advocate

Definition As health advocates, SBRD residents contribute their expertise and influence as they work within communities or patient populations to improve dental health. They work with those they serve to determine and understand needs, speak on behalf of others when required, and support the mobilization of resources to effect change.

SN Key competencies Residents are able

to:

Enabling competencies Residents are able to:

Junior (R1&R2)

Senior (R3&R4)

1

Respond to an individual patient’s dental health needs by advocating for the patient within and beyond the clinical environment

1.1 Work with patients to address determinants of dental health that affect them and their access to necessary dental health services or resources.

1.2 Work with patients and their families to increase opportunities to adopt healthy dental behaviors.

1.3 Incorporate prevention, promotion, and surveillance of oral health into interactions with individual patients.



SN Key competencies Residents are able

to:

Enabling competencies Residents are able to:

Junior (R1&R2)

Senior (R3&R4)

2

Respond to the needs of the communities or populations served by advocating for system-level change in a socially accountable manner

2.1 Work with a community or population to identify the determinants of oral health that affect its members.

2.2 Improve clinical practice by applying a process of continuous quality improvement to prevention, promotion, and surveillance of oral health.

2.3 Contribute to the process of improving oral health in the community or population served.

Scholar

Definition As scholars, SBRD residents demonstrate a lifelong commitment to excellence in practice through continuous learning and by teaching others, evaluating evidence, and contributing to scholarship.


to)


Junior (R1&R2)

Senior (R3&R4)

1

LIFELONG LEARNING Engage in continuous enhancement of professional activities through ongoing learning

1.1 Develop, implement, monitor, and revise a personal learning plan to enhance professional practice.

1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing personal performance using various internal and external data sources.

1.3 Engage in collaborative learning to improve personal practice and contribute to collective improvements in practice in an ongoing way.

1.3.1 Learn from and make use of the expertise of other dentists or dental health care professionals.

2

TEACHER Teach students, residents, the public, and other health care professionals

2.1 Recognize the influence of role modeling and the impact of the formal, informal, and hidden curriculum on learners.

2.1.1 Participate in teaching with dental students, interns, residents, or colleagues.

2.2 Promote a safe learning environment.

2.3 Ensure patient safety is maintained when learners are involved.




to)


Junior (R1&R2)

Senior (R3&R4)

2.4 Plan and deliver a learning activity.

2.5 Provide feedback to enhance learning and performance.

2.6 Assess and evaluate learners, teachers, and programs in an educationally appropriate manner.

3

EVIDENCE-INFORMED DECISION-MAKING Integrate best available evidence into practice

3.1 Recognize uncertainty in clinical practice and knowledge gaps in clinical and other professional encounters, and generate focused questions that address them.

3.2 Identify, select, and navigate pre-appraised resources.

3.3 Critically evaluate the integrity, reliability, and applicability of health-related research and literature.

3.4 Integrate evidence into decision-making in clinical practice.

4

RESEARCH Contribute to the creation and dissemination of knowledge and practices applicable to health

4.1 Demonstrate an understanding of the scientific principles of research and scholarly inquiry and the role of research evidence in health care.

4.2 Identify ethical principles for research and incorporate them into obtaining informed consent, considering potential harms and benefits, and considering vulnerable populations.

4.3 Contribute to the work of a research program.

4.4 Pose questions amenable to scholarly inquiry and select appropriate methods to address them.

4.5 Summarize and communicate to professional and lay audiences, including patients and their families, the findings of relevant research and scholarly inquiry.



Professional

Definition As professionals, SBRD residents are committed to the dental health and well-being of individual patients and society through ethical practice, high personal standards of behavior, accountability to the profession and society, dentist-led regulation, and maintenance of personal oral health.

SN Key competencies

Residents are able to: Enabling competencies Residents are able to:

Junior (R1 and

R2)

Senior (R3 and

R4)

1

COMMITMENT TO PATIENTS Demonstrate a commitment to patients by applying best practices and adhering to high ethical standards

1.1 Exhibit appropriate professional behavior and relationships in all aspects of practice, demonstrating honesty, integrity, humility, commitment, compassion, respect, altruism, respect for diversity, and maintenance of confidentiality.

1.1.1 Put patients’ interests before their own or those of any colleague, organization or business.

1.1.2 Manage information about patients as confidential and use it for the purposes for which it is given.

1.1.3 Keep information secure at all times.

1.1.4 In special cases, it may be justified to make confidential patient information known without consent if it is in the public interest or the patient’s interest.

1.1.5 Maintain appropriate boundaries in relationships with patients and without abusing those relationships.

1.2 Demonstrate a commitment to excellence in all aspects of practice.

1.3 Recognize and respond to ethical issues encountered in practice.

1.3.1 Reject politely any payment, gift, hospitality, request to make or accept any referral that may affect professional judgment.

1.3.2 Treat patients politely and with respect, in recognition of their dignity and rights as individuals.

1.3.3 Recognize and promote the patient’s responsibility for making decisions about oral and dental treatment.



1.3.4 Treat patients fairly and in line with the law.

1.4 Recognize and manage conflicts of interest.

1.5 Display professional behavior in the use of technology-enabled communication.

2

COMMITMENT TO SOCIETY Demonstrate a commitment to society by recognizing and responding to societal expectations in oral health care

2.1 Demonstrate accountability to patients, society, and the profession by responding to societal expectations of dentists.

2.2 Demonstrate a commitment to patient safety and quality improvement.

3

COMMITMENT TO PROFESSION Demonstrate a commitment to the profession by adhering to standards and participating in dentist-led regulation

3.1 Fulfill and adhere to the professional and ethical codes, standards of practice, and laws governing dental practice.

3.1.1 Recognize laws and regulations that affect a dentist’s work, premises, equipment and business, and follow them

3.2 Recognize and respond to unprofessional and unethical behaviors in dentists and other colleagues in the health care professions.

3.2.1 Treat all team members and other colleagues fairly and in line with the law without discrimination.

3.3 Participate in peer assessment and setting of standards.

3.3.1 Share knowledge and skills effectively with other team members and colleagues in the interests of patients.

4 COMMITMENT TO SELF Demonstrate a commitment to dental health and well-being to foster optimal patient care.

4.1 Display self-awareness and manage influences on personal well-being and professional performance.

4.2 Manage personal and professional demands for a sustainable practice throughout life.

4.4 Promote a culture that recognizes, supports, and responds effectively to colleagues in need.

(S) Clinical skills; Practicing skill independently; Practicing skill under supervision; Skill is not required



Integration of disciplines

To simplify the distribution of the learning objectives included in the different restorative disciplines, the committee reorganized them into integrated modules that will ensure that the resident covers all the learning objectives of the restorative specialties. A well planned curriculum will ultimately result in a good learning experience for the residents, where the relationship between modules and learning activities makes sense and the modules can build upon one another along the learning continuum. These modules are classified according to subject theme as:

Module 1: Basic science

Module 2: Case history, examination, diagnosis and treatment strategies

Module 3: Cariology

Module 4: Oral and facial pain and pain control

Module 5: Dental and clinical materials

Module 6: Endodontics

Module 7: Fixed partial dentures

Module 8: Occlusion

Module 9: Dental implants

Module 10: Operative

Module 11: Esthetic considerations

Module 12: Periodontal-restorative interrelationship

Milestones and continuum of learning

Milestones are a new feature of CanMEDS 2015 (part of the CBD project) and reflect the abilities expected of a health professional at a certain stage of expertise. These milestones represent a continuum of learning and training. This continuum focuses on residency and continuing professional development after graduation. The CBD continuum approach breaks down specialist education into a series of integrated stages (see diagram), whereby residents in the program develop competencies at different stages during their residency and throughout practice. These stages are: Transition to discipline stage This is a new preparatory stage emphasizing the clinical knowledge and skills of the resident before entering the clinic. Foundation of discipline This stage covers scientific research and basic core science before moving on to more advanced discipline-specific competencies. Core of discipline This is the main stage, in which the resident covers the core competencies that make up the majority of the discipline. This starts with the basic specialty and progresses to become more advanced and complex during the transition from junior to senior residency.



Continuing professional development After graduation, dentists progress in competence to attain expertise during continuing professional development (learning in practice).



Clinically, residents in the training program will be exposed to different cases from different training centers. Therefore, their responsibility in the clinic will increase and progress across the duration of the training period, starting with clinical examination and making the correct diagnosis through to devising a treatment plan and appropriate management. Junior residents have the responsibility for examination, collecting full patient records and data, making the right diagnosis, and writing a treatment plan. Moreover, junior residents perform dental procedures in the clinic and provide high-quality treatment for their patients. The earlier procedures are performed under the supervision of an assigned specialist and consultant. Senior residents have greater responsibility for management of advanced cases, in addition to teaching junior residents under minimum supervision by a specialist and consultant. The following table shows the expected continuum of learning that should be achieved in each level of progression.

Procedures Junior level Senior level Consultant

Medical expert: Comprehensive dental treatment includes:

Clinical examination

Diagnosis

Treatment plan

Restorative procedures

Recall and follow-up.

Residents show limited knowledge, skills, and broad competencies. Residents work in a dental clinic with close supervision. Their attitude is under development.

Residents show knowledge and experience as specialists in restorative dentistry. Residents work in dental clinics without close supervision. Residents perform dental procedures as expected of a specialist in restorative dentistry. Their attitude develops as expected of a specialist in restorative dentistry.

Dentists in this stage maintain achieved competences, and continue their professional development to attain and update more skills within their scope of practice.

Communicator

Residents can actively listen and respond to a patient inquiry. Residents use appropriate non-verbal body language communication to demonstrate attentiveness, interest, and responsiveness to patients and their families.

Residents use appropriate non-verbal behaviors to enhance communication with patients. Residents provide information on diagnosis and prognosis in a clear, compassionate, respectful, and objective manner. Residents facilitate discussions with patients and their families in a respectful and safe environment.

Dentists demonstrate advanced non-verbal communication skills in difficult situations.

Dentists teach others how to use non-verbal communication to enhance dentist-patient rapport.

Dentists are role models for their colleagues.




Collaborator

Residents respect the established rules of their team.

Residents receive and appropriately respond to input from other health care professionals.

Residents differentiate between task and relationship issues among health care professionals.

Residents work effectively with dentists and other colleagues in the health care professions. Residents establish and maintain positive and healthy relationships with dentists and other colleagues in the health care professions.

Dentists contribute to policy discussions related to collaborative care. Dentists teach, assess, and utilize a model of collaborative care. Dentists use e-Health tools to enhance collaboration in health care.

Leader Residents describe the process for reporting adverse events and medical errors. Residents determine cost discrepancies between best practice and their current practice.

Residents analyze adverse events and medical errors to enhance systems of care. Residents develop plans to change areas of wasteful practice within their discipline. Residents evaluate a problem, set priorities, execute the plan, and analyze the results.

Dentists contribute to the improvement of health care delivery in teams, organizations, and systems Dentists design processes that balance standardization and variability to reduce medical errors and ensure patient safety in the delivery of health care. Dentists provide mentorship and guidance to help others develop leadership and motivational skills.

Health advocate

Residents respond to an individual patient’s health needs by advocating for the patient within and beyond the dental clinical environment. Residents analyze a given patient’s needs for health services or resources related to the scope of their discipline.

Residents apply the principles of behavior modification during conversations with patients to improve oral health. Residents participate in a process to improve oral health in the community.

Dentists collaborate with organizations and surveillance programs to identify needs at the population level.

Dentists plan or lead the implementation of a program to improve the oral health of the community.




Residents select appropriate patient education resources related to their discipline.

Scholar Residents review and update earlier learning plan(s) with input from others.

Residents demonstrate basic skills in teaching others.

Residents demonstrate an understanding of the importance of scientific research and analyze its limitations and applicability.

Residents create a learning plan, incorporating all the CanMEDS domains.

Residents discuss a learning plan and strategy for ongoing self-monitoring with a mentor and faculty advisor.

Residents conduct scientific research.

Dentists develop a plan to enhance competence across all CanMEDS domains for practice and update it as needed.

Dentists plan systematic approaches to assessment of learners and evaluation of programs.

Dentists conduct and publish scientific research in scientific journals.

Professional Residents manage tensions between societal and dentists’ expectations.

Residents demonstrate an ability to regulate tension, emotions, thoughts, and behaviors while maintaining their capacity to perform professional tasks.

Residents demonstrate a commitment to patients by applying best practices and adhering to high ethical standards.

Residents demonstrate a commitment to patients by applying best practices and adhering to high ethical standards.

Dentists exhibit appropriate professional behaviors.

Dentists exhibit honesty, integrity, dedication, compassion, respect, altruism.

Dentist serves as a role model and teaches learners and colleagues professionalism.

Top ten conditions in the specialty

1) Dental caries2) Reversible pulpits and irreversible pulpitis3) Necrotic pulp4) Apical abscess5) Missing teeth6) Tooth discoloration7) Tooth sensitivity



8) Tooth fracture9) Restoration failure10) Malalignment of occlusion

Top ten causes of a visit to accident and emergency

1) Dental pain2) Dental trauma3) Intra-oral swelling4) Extra-oral swelling5) Porcelain fracture or chipping6) Lost, unstable, fallen down crown 7) Loss of healing abutment/fixture of implant 8) A fallen restoration9) Postoperative sensitivity 10) Tooth mobility

Top ten procedures performed

1) Amalgam restoration2) Composite restoration3) Root canal treatment4) Temporary restoration5) Porcelain fused-to-metal crown6) Post and core 7) Fixed partial denture8) Bleaching9) Indirect tooth-colored restoration10) Dental implants

Common complications or malpractice

1) Root canal perforation2) File separation in the canal3) Open margin 4) Flare-up 5) Overhang6) Spacing between crowns7) No osseous integration for implant8) Broken restoration9) Tooth discoloration (due to intrinsic and extrinsic factors) 10) Occlusal interference



Procedural requirements upon completion of residency according to level of

training:

Procedure Code Requirement

4 years

Minimum requirements/year Remarks

R1 R2 R3 R4

I. TREATMENT PLAN AND DIAGNOSIS

Approved treatment plan according to SBRD guidelines

TX-1 20 3 8 14 20 Per patient

Diet analysis TX-2 20 3 8 14 20 Per patient

Smile analysis TX-5 20 3 8 14 20 Per patient

II. CARIOLOGY

Caries control TX-3 20 3 8 14 20 Per patient

Caries assessment TX-4 20 3 8 14 20 Per patient

III. OPERATIVE

Amalgam Amalgam class I O-6 50 10 20 35 50

Amalgam class II O-7 50 10 20 35 50

Amalgam buildup

O-8 25 3 10 18 25

Composite Anterior (Cl III, IV, V)

O-9 100 20 45 70 100

Posterior (Cl I, II, V, VI)

O-10 100 20 45 70 100

Anterior composite buildup

O-11 15 1 4 9 15

Anterior diastema closure

O-12 5 - 1 3 5

Posterior composite buildup

O-13 20 3 6 13 20

Glass ionomers (resin-modified)

O-14 30 5 10 20 30

Pit and fissure sealants O-15 25 3 10 18 25

Preventive resin restoration O-16 30 5 10 20 30

Metal (inlay/onlay) O-18 2 - 1 - 2



IV. ESTHETIC

In-office bleaching O-1 15 1 4 9 15 Assessed per arch with a minimum of four teeth per arch

Home bleaching O-2 15 1 4 9 15 Per arch

Non-vital bleaching O-3 10 1 3 6 10 Per tooth

Microabrasion O-4 10 1 3 6 10 Per tooth

Enameloplasty/reshaping O-5 10 1 3 6 10 Per tooth

Ceramic (inlay/onlay) O-17 20 3 8 13 20

Veneers Direct - composite

O-19 10 1 3 6 10

Indirect - ceramic

O-20 40 5 15 30 40

All ceramic crowns P-5 60 8 24 40 60

V. ENDODONTIC

Anterior RCT E-1 50 6 18 34 50 At least five retreatments

Retreatment E-2

Premolar RCT E-3 50 6 18 34 50 At least five retreatments

Retreatment E-4

Molar RCT E-5 50 6 18 34 50 At least five retreatments

Retreatment E-6

V. FIXED PARTIAL DENTURE

Porcelain fused-to-metal crowns

P-4 45 6 16 30 45

Non-surgical management of TMJ dysfunction

P-7 3 - 1 2 3

IV. RESTORATION OF ENDODONTICALLY TREATED TEETH

Prefabricated post and core - metal

P-1 25 5 10 17 25 Core should not be included in operative requirements

Esthetic post and composite core

P-2 25 5 10 17 25 Core should not be included in operative requirements

Cast post and core P-3 20 3 8 13 20

VI. IMPLANT

Implant fixture P-6 15 - 3 8 15 Prosthesis not included

VII. RECALL

6 months, completed R-1 A1 – 20 1 6 12 20 Per patient



comprehensive case recall A2 – 15 A3 – 12

- -

2 -

7 3

15 12

1 year, and above completed comprehensive case recall

R-2 A1 – 12 A2 – 9 A3 – 6

- - -

3 - -

8 4 -

12 9 6

Per patient

6 months, CRA recall R-3 A1 – 20 A2 – 15 A3 – 12

1 - -

6 2 -

12 7 3

20 15 12

Per patient

1 year and above, CRA recall R-4 A1 – 12 A2 – 9 A3 – 6

- - -

3 - -

8 4 -

12 9 6

Per patient

6 months, endodontic recall R-5 A1 – 60 A2 – 40 A3 - 30

10 - -

25 10 -

40 25 15

60 40 30

Per tooth

1 year and above, endodontic recall

R-6 A1 – 40 A2 – 30 A3 - 20

- - -

8 - -

24 15 -

40 30 20

Per tooth

COMPREHENSIVE CASES CC A1 – 20 CC

A2 – 15 CC

A3 – 12 CC

3

-

-

8

4

-

14

9

6

20

15

12

A1 applicants who were enrolled in R1 are required to complete 20 CC (maximum 8 simple cases and minimum 2 complex) A2 MSD and AEGD applicants who were enrolled in R2 are required to complete 15 CC (maximum 6 simple cases and minimum 2 complex). A3 MSD applicants who were enrolled in R3 are required to complete 12 CC (maximum 4 simple cases and minimum 2 complex)

Completed case – simple (SI and SII)

CC-S Refer to appendices for code complexity

Completed case – moderate (MI and MII)

CC-M

Refer to appendices for code complexity

Completed case – complex (CI and CII)

CC-C Refer to appendices for code complexity

TEACHING AND ACADEMIC ACTIVITIES



General principles

Teaching and learning are based on strategies that encourage self-directed learning, development of a high level of intellectual ability, and integration of knowledge and skills. Multiple and effective instructional methods will be offered to help residents achieve their learning objectives in most areas.

Every week, at least 6 hours of formal teaching time should be reserved. Formal teaching time is planned in advance with an assigned tutor, time slots, and a venue. Formal teaching time excludes clinical training.

The core educational program includes the following formal teaching and learning activities:

Universal topics

Core speciality topics o Basic science course o Preclinical course (basic speciality topics and practical training) o Advanced specialty topics

Trainee-selected topics

Research and evidence-based topics

Educational methods and professional development topics.

The core educational program will be supplemented by other practice-based and work-based learning such as: 1) Clinic-based learning 2) Comprehensive case presentations 3) Treatment plan sessions/case-based learning 4) Literature review in RD or Journal Club 5) Self-direct learning 6) Community services 7) Elective modules (special interest module) 8) Supplementary courses and workshops.

Every 4 weeks, at least one hour should be assigned to activities such as meeting with mentors (refer to mentor guidelines), review of portfolio, or mini-clinical evaluation exercise.

Core educational program

Universal topics

Introduction and rationale Universal topics are high-value, interdisciplinary topics of the utmost importance to the trainee. The reason for delivering the topics centrally is to ensure that each trainee receives high-quality teaching and develops essential core knowledge. These topics are common to all dental specialties.



Description Topics included here must meet one or more of the following criteria:

Impactful: topics that are common or life-threatening

Interdisciplinary: topics that are difficult to teach in a single discipline

Orphan: topics that are poorly represented in the undergraduate curriculum

Practical: topics that trainees will encounter in clinical practice.

These topics will be developed and delivered centrally by the commission through an e-learning platform. A set of preliminary learning outcomes for each topic will be developed. Content experts, in collaboration with the central team, may modify the learning outcomes.

These topics will be didactic in nature and will focus on practical aspects of care. These topics have more content than a workshop and other planned face-to-face interactive sessions. The suggested duration of each topic is one-and-half hours.

Teaching methods E- learning

Assessment

On-line formative assessment at the end of each learning unit.

Combined summative assessment in the form of context-rich MCQ after completion of all topics.

Alternatively, these topics can be assessed in a summative manner along with specialty examination.

Module Universal topic

R1 - Hospital acquired infections - Occupation hazards for health care workers

R2 - Safe drug prescribing - Recognition and management of diabetic emergencies

R3 - Antibiotic stewardship - Abbreviations

R4 - Prescribing drugs in the elderly

- Side effects of chemotherapy and radiation therapy

Core specialty topic

Basic science course

Introduction and rationale Basic science courses are advanced didactic courses in basic biomedical and biodental science, designed to cover in more depth certain topics that were taught during undergraduate education. The aim of this course is to provide residents with the level of knowledge of the basic sciences required to ensure that they are competent in their dental specialty.



Description This course consists of intensive didactic lectures or seminars covering topics in anatomy, embryology, oral biology, oral pathology, oral microbiology, pharmacology, oral medicine, radiology, and biomaterials at the postgraduate level. It is delivered to the residents for ten weeks (two days per week) in the beginning of the residency year. Teaching methods

Didactic lectures or seminars. Assessment

End of year examination in an MCQ format.

Attendance

Course contents

Topic Objective

Head and neck anatomy To provide residents with advanced knowledge of the structure and blood supply of the head and neck, tongue, oropharynx, teeth and masticatory muscles, and the TMJ

Craniofacial development and growth

To provide residents with knowledge of embryology and development of the face.

Oral biology To provide residents with advanced knowledge of oral pathology, especially the microstructure and biology of the oral tissues.

Oral pathology To advance residents’ knowledge about oral pathology and the etiology and pathogenesis of oral and para-oral disease to a level beyond undergraduate study.

Oral microbiology To provide residents with advanced knowledge on the composition of oral flora and factors influencing its structure.

Dental radiology To provide residents with education in radiation physics, radiation biology, hazards and protection, advanced imaging techniques, and diagnostic oral radiology.

Pharmacology

To enhance residents’ knowledge of pharmacologic agents, especially those commonly used in treating oral and systemic diseases. Residents must gain experience in prescribing medication for patients under their care and must be fully knowledgeable of the indications, contraindications, and potential adverse reactions of all medications used.

Dental biomaterials To provide residents with the knowledge necessary to select appropriately and manipulate the various dental material systems used in the oral cavity.



Preclinical course (basic specialty topics and practical training)

Introduction and rationale This course is one of the basic preparatory components of the SBRD curriculum. The main focus is on developing the residents’ skills and knowledge of the basic principles they need to be proficient in caring for patients in the field of restorative dentistry. The basic knowledge and psychomotor skills gained in this course will also provide residents with increased ability and confidence to acquire additional advanced knowledge and technical skills in the different disciplines of restorative dentistry. General objectives By the end of this course, the residents are expected to: 1) Revise the basic principles and current concepts in restorative dentistry. 2) Develop a basic knowledge about the principles, technical steps, indications, and

contraindications of the different procedures and the materials involved in the operative, fixed prosthodontics, and endodontic disciplines.

3) Gain knowledge about dental morphology and occlusion. 4) Explain and apply the appropriate sequence of clinical investigations. 5) Use the necessary investigations required to make a clinical diagnosis and develop a suitable

treatment strategy. 6) Explain the basic principles of dynamic diagnosis and management of caries. 7) Recognize the basic periodontal concepts, diseases, and procedures determining the success

of restorative dental practice. 8) Identify the main concepts of esthetics and color in dentistry. 9) Identify all the types of dental materials used in laboratory procedures. 10) Explain the main laboratory procedures, be able to communicate effectively with laboratory

technicians, and give correct instructions to the laboratory during future clinical work. 11) Understand the terminology, types, procedures, and steps involved in making dental implants. 12) Maximize psychomotor skills in the different operative, fixed prosthodontics, and endodontic

procedures and be ready to implement them clinically. 13) Demonstrate appropriate time management during laboratory work. 14) Demonstrate appropriate patient record-keeping before commencing clinical procedures. 15) Be trained to recognize personal mistakes, and how to avoid and correct them. 16) Communicate professionally with supervisors, colleagues, and other laboratory staff. 17) Be able to correlate the physical, chemical and biological properties of restorative materials

with teeth and surrounding soft tissues with regard to the different procedures. Course description This course is delivered to residents over 12 weeks (3 days per week) at the start of the residency year. It is composed of two integrated sections. The first section introduces residents to basic knowledge in the different restorative disciplines by covering the basic specialty topics. The content of this section will be delivered in the form of lectures, resident presentations, and group discussion. The second section focuses on developing the psychomotor skills required by residents during their clinical work, in addition to practicing some diagnostic and laboratory procedures. It is designed to provide hands-on training in the clinical and laboratory procedures essential for the SBRD program.



This will be in the form of assigned exercises representing the different operative, endodontic, and fixed prosthodontic procedures and materials. Reading assignments will be required of the residents before the session, and supplementary short lectures or discussions will precede the laboratory work. Educational strategy and teaching methods The preclinical course is based on teaching strategies that encourage interactive, student-centered approaches, team work, and self-directed learning. The hands-on training sessions will apply the principles of psychomotor teaching to ensure development of the three phases of psychomotor skill; cognitive, development and automated. Various instructional techniques will be used, including:

Interactive lectures

Resident activity (presentations, assignments)

Group discussion

Demonstrations using different aids

Close laboratory supervision

Training during free time. Assessment

Evaluation of resident activities (cognitive)

Weekly quizzes (cognitive)

Continuous assessment of assigned projects (psychomotor skills) Evaluation The evaluation will be based on:

An end of course evaluation form

Discussions with residents and faculty for their comments on the course.



Content and learning objectives

Topics Learning objectives (Residents should be able to)

CanMEDS roles

Examination and diagnosis History-taking Clinical examination Radiographic

interpretation -Development of treatment strategies and plans -Writing referral and consultation letters

Lectures and presentations 1. List the steps and skills needed to conduct a

patient interview and for medical and dental history-taking.

2. Explain factors in the dental, medical, and social history likely to be relevant to the presenting condition and its previous management.

3. Describe the relevant biology, anatomy, and physiology of normal and abnormal intra-oral and extra-oral structures and tissues.

4. List the steps for examination of the patient and their:

- Oral mucosa and related structures - Periodontium - Dental hard tissues

and make the appropriate diagnoses. 5. Discuss the systemic factors likely to have a

bearing on the above. 6. Identify all types of dental and medical tests

and investigations needed for the diagnosis. 7. Consolidate all data from the history,

symptoms, examination, and tests to form a final diagnosis.

8. Explain the phases and sequences of writing a treatment strategy in conjunction with the patient and producing a plan according to their needs and preferences, including any future need for revision or modification.

9. Explain the importance and procedure involved in using evidence-based dentistry concepts while writing a treatment plan.

10. Identify emergency conditions that require immediate treatment.

11. Recognize components of a consultation and referral letter.

Hands-on and group discussion session 1. Use and interpret correctly all appropriate

investigations (e.g., radiographic, vitality, hematologic and microbiologic tests, and appropriately articulated study casts) to diagnose oral problems.

2. Write down the diagnosis for selected clinical cases (selected clinical photographs and radiographic films).

3. Write a treatment plan for selected cases. 4. Write consultation letters for selected cases. 5. Write referral letters for selected cases.

Medical expert

Communicator Collaborator Leader Scholar Professional




CanMEDS roles

Basic principles and procedures for FPD - Introduction to FPD - Impression materials - Casts - Facebows - Articulators - Interocclusal records,

bite registration materials, and techniques

- Diagnostic casts

Lectures and presentations 1. Recognize the scope and importance of fixed

prosthodontic treatment. 2. List types of impression material used. 3. Explain the principles and techniques used for

making an impression. 4. State the types of bite registration material. 5. Describe the methods used for bite

registration. 6. List all types of materials used in laboratory

work. 7. Discuss the importance and uses of diagnostic

casts. 8. Explain the laboratory procedures for

construction of a cast. 9. Discuss the purpose of using a facebow. 10. Classify the articulators used in dentistry. 11. Name the parts of the articulators. 12. Describe the procedure for mounting

diagnostic casts.

Hands-on training session 1. Make maxillary and mandibular impressions for

residents. 2. Take the bite registration using different

materials. 3. Use the facebow on residents. 4. Pour upper and lower impressions using dental

stone. 5. Check casts for accuracy and trim them. 6. Transfer the relationship of a patient’s

maxillary arch and TMJ to an articulator by using a facebow.

7. Mount diagnostic casts on semi-adjustable articulators.

8. Adjust the setting of the articulator.

Medical expert

Collaborator Leader Scholar Professional

Basic principles and procedures for FPD - Principles of occlusion - Occlusal analysis - Diagnostic wax-up

Lectures and presentations 1. Explain the main principles of occlusion. 2. Discuss the importance of and procedure used

for occlusal analysis. 3. Discuss importance and uses of diagnostic wax-

up.

Hands-on training session

1. Mount extracted teeth on alginate impressions.

2. Pour alginate impressions with extracted teeth.

3. Analyze occlusion of the previously mounted casts.

Medical expert





CanMEDS roles

4. Perform diagnostic wax-up. (Laboratory staff will demonstrate these procedures)

5. Adjust wax-up for selected cases.

Basic principles and procedures of endodontics - Introduction to

endodontics, diagnosis and treatment planning

- Diagnostic tools and techniques used in endodontics

- Pulp anatomy - Access opening

Lectures and presentations 1. Explain the scope of endodontics in dentistry. 2. Classify pulpal and periapical pathosis. 3. Organize diagnostic steps in a sequential

manner. 4. Describe the tools and techniques used in

diagnosis. 5. Identify factors that will affect the treatment

plan. 6. Describe the anatomic regions of pulp. 7. Describe common shapes of roots in cross-

section and common canal configurations in these roots.

8. Explain the process of access opening.

Hands-on training session 1. Prepare access opening for anterior/single

canal and posterior/multi canal teeth. 2. Perform and interpret vitality tests.

Medical expert


Basic principles and procedures of endodontics - Biological and

mechanical objectives of cleaning and shaping

- Endodontic instruments

- Isolation - Working length

determination - Instrumentation

(hands and rotary)

Lectures and presentations 1. Describe the objectives of both cleaning and

shaping. 2. Describe the design (longitudinal, cross-

sectional, and tip configuration) of the common canal preparation instruments and their mode of use.

3. Explain the differences between stainless steel and NiTi instruments.

4. Explain the basis for sizing and taper (standardization) of hand-operated instruments.

5. Describe the correct use of instruments to prevent breakage within the canal.

6. Describe the action and use of engine-driven (Gates Glidden drills and Peeso reamers) and rotary instruments.

7. Differentiate between hand and rotary techniques (including advantages and disadvantages)

8. Describe the importance of rubber dam isolation during endodontic procedures.

9. Describe the apical anatomy. 10. List the methods for measuring working length. 11. Explain how to determine the appropriate size

of the master apical file.

Medical

expert Collaborator Leader Scholar Professional




CanMEDS roles

12. Describe the techniques used for standardized and flaring preparations.

13. State the properties of the “ideal” root canal irrigants.

14. Describe the needles and techniques that provide the maximal irrigant effect.

15. Discuss the main types, properties and role of intraconal and interappointment medicaments.


1. Apply a rubber dam on a selected tooth. 2. Determine the working length of

anterior/single canal and posterior/multi canal teeth.

3. Enlarge the canal orifice using a Gates Glidden drill.

4. Perform mechanical and chemical debridement for 2/upper and 2/lower anterior/single canal and 2/upper and 2/lower posterior/multi canal teeth.

Basic principles and procedures of endodontics - Obturation - Coronal seals

Lectures and presentations 1. Analyze the importance of both apical and

coronal seals. 2. List the criteria for the ideal obturating

material. 3. Differentiate between lateral and vertical

compaction. 4. Describe the lateral and vertical compaction

technique. 5. List the other techniques used for obturation. 6. Describe the steps and tests for master cone

fitting. 7. List the criteria for the ideal sealer. 8. List the most common sealers used. 9. Explain the importance and technique for

removing excess sealer and obturating material from the pulp chamber.

10. Name the most common core materials and their advantages and disadvantages.

11. Outline the postoperative risks to the unrestored tooth.

12. Discuss the clinical and radiographic criteria for evaluating the quality of obturation.

13. Describe signs of successful and unsuccessful RCT.


1. Mix root canal sealer (AH26 cement). 2. Obturate 2/upper anterior/single and 2/lower

posterior/multiple canal teeth using the lateral compaction method.

Medical expert





CanMEDS roles

3. Obturate 2/upper anterior/single and 2/lower posterior/multiple canal teeth using the vertical compaction technique.

4. Remove excess sealer and gutta percha from the chamber.

Workshop - Rotary systems - Obturation systems

Sponsored hands-on (rotary and obturation systems)

Basic principles and procedures of FPD - Restoration of

endodontically treated teeth

- Types of posts and cores

Lectures and presentations 1. Recognize the restorative options following

RCT. 2. State the factors influencing the choice of

technique used in restoring endodontically treated teeth.

3. Discuss the types of core material. 4. Lists the steps and instruments used in

preparation of a post space. 5. Discuss the types of post (advantages,

disadvantages, and indications). 6. Describe the common mistakes that can be

made during preparation of a post space. 7. Know the types of cement used with a post. 8. Explain the method used to mix dental cement.


1. Perform an initial crown preparation. 2. Build up a core with composite and without a

post. 3. Prepare a post space using Peeso reamer drills

and a ParaPost system. 4. Cement different posts with different cements. 5. Build up the core with different restorations. 6. Build up a post and core directly on the tooth

using resin (Duralay or Pattern Resin GC) 7. Make impression for the post space to

construct a cast post and core indirectly.

Medical expert





CanMEDS roles

Cariology I - Dynamics of dental

caries - Diagnosis of caries

Lectures and presentations 1. Explain the dynamics of caries. 2. Discuss the concept of balance and imbalance

with regard to dental caries. 3. Explain the factors affecting the dental caries

process. 4. Introduce the concepts of critical pH,

saturation, demineralization and remineralization.

5. Justify the appearance of incipient lesions. 6. Demonstrate the optimum method for

diagnosis of caries. 7. Describe the different clinical presentations of

caries. 8. Explain the principles of the International

Caries Detection and Assessment System. 9. Revise the concepts of sensitivity and

specificity.

Hands-on training session 1. Online training on the International Caries

Detection and Assessment System.

Medical expert


Cariology II - Caries risk assessment

and the CAMBRA system, Part 1

- Caries risk assessment and the CAMBRA system, Part 2

Lectures and presentations 1. Explain the role of oral bacteria and biofilm in

dental caries. 2. Explain the effect of fluoride and formation of

fluorapatite. 3. Explain the role of diet in development of

caries. 4. Explain the role of saliva in dental caries. 5. Summarize the different salivary tests

available. 6. Contrast the different models used to estimate

the risk of caries, e.g., CAMBRA. 7. Explain the principles of CAMBRA. 8. Develop preventive and management

strategies based on the risk of caries.

Hands-on training session 1. Perform saliva sampling and analysis. 2. Perform a CRA using Cariogram, CAMBRA and

other systems.

Medical expert





CanMEDS roles

Basic principles and procedures of operative and esthetics - Introduction to

operative and esthetic dentistry

- Factors affecting operative treatment plan

- Amalgam, composite and glass ionomer restorations

- Instruments used in operative practice

- Dental adhesives

Lectures and presentations 1. Recognize the importance and scope of

operative restorative dentistry. 2. State the main factors that can affect the

choice of material and technique to be used. 3. List the types, advantages, indications and

contraindications of amalgam, composite and glass ionomer restorations.

4. Explain the basic principles of amalgam and composite preparations and restorations.

5. Describe the process of polymerization for composites and methods to reduce polymerization shrinkage and stress.

6. Describe the technique of matrix application, incremental placement, and finishing and polishing for composite resins.

7. Recognize the types of adhesive systems. Hands-on training session

1. Prepare Class II, Class IV and Class V composite resin restorations.

2. Apply matrix band and wedge. 3. Restore cavities with composite restorations. 4. Build up a Class IV composite restoration using

the multi layering technique. 5. Perform a finishing and polishing procedure for


Medical expert


Basic principles and procedures in operative and esthetics - Main principles in

esthetic, colors and shade selection

- Conservative treatments for discolored teeth

- Inlays and onlays - Esthetic veneers

Lectures and presentation 1. Define esthetics and recognize the basic artistic

elements that need to be considered to ensure optimal esthetic results.

2. State the scientific basis of color. 3. Explain the steps in the color replication

process (shade selection and duplication). 4. Explain the methods used in the main shade

guide systems. 5. Recognize the different types and causes of

tooth discoloration. 6. Describe the strategies applied in the

management of discolored teeth (bleaching, microabrasion and macroabrasion).

7. Describe the techniques, indications, and contraindications for restoration of ceramic inlays and onlays.

8. Describe the types, techniques, indications, and contraindications for preparation and restoration of esthetic veneers, both direct and indirect.

9. Describe the techniques used for fabrication of provisional restorations.

Medical expert





CanMEDS roles

Hands-on training session 1. Use the different types of shade guide systems. 2. Perform inlay cavity preparation. 3. Perform onlay cavity preparation. 4. Cement onlay porcelain with resin cement. 5. Prepare a tooth for esthetic veneer utilizing a

butt joint design. 6. Prepare a tooth for esthetic veneer utilizing a

feathered incisal edge design. 7. Prepare a tooth for esthetic veneer utilizing a

palatal chamfer design. 8. Fabricate provisional restorations for

preparation of the veneer. 9. Restore tooth using a composite esthetic

veneer. 10. Cement porcelain veneer with resin cement.

Basic principles and procedures of FPD - Basic principles of

treatment planning for teeth

- Restorations and replacement

- Principles of tooth preparation

- Provisional restorations

Lectures and presentations 1. Acquire basic concepts for diagnosis and

treatment planning to restore and replace teeth and short edentulous spans.

2. Discuss the main principles of crown and bridge preparation.

3. List the types of provisional restoration. 4. Describe the techniques for constructing

provisional restorations.

Hands-on training session 1. Perform single crown preparations with

different margin designs (mounted teeth). 2. Perform teeth preparation for FPD (mounted

teeth). 3. Fabricate an appropriate provisional

restoration.

Medical expert


Periodontal consideration - Basic concepts in

Periodontics - Components of

gingiva - Periodontal disease

classification - Periodontal

examination - Periodontic indices - Biological width - Introduction to

management

Lectures and presentations 1. Recognize the basic concepts used in

periodontics. 2. List the parts of the gingiva. 3. Differentiate between normal and diseased

gingiva. 4. Identify the main classification of periodontal

diseases. 5. List the steps of clinical examination and

assessment methods to arrive at a periodontal diagnosis (probing depth, bleeding index, clinical attachment level, radiographic evidence of bone loss, and the presence or absence of signs and symptoms in the patient).

6. Explain the meaning and importance of biological width.

Medical

expert Collaborator Leader Scholar Professional




CanMEDS roles

- Introduction to periodontal surgery

7. Name the main periodontal treatment modalities used.

8. Identify the different periodontal surgical therapies and their indications.

9. Discuss the healing period after surgical crown lengthening.

Hands-on training session 1. Perform complete periodontal examinations on

residents. 2. Observe surgical crown lengthening and

gingivectomy using an electrosurgery machine (video).

3. Assess the need for periodontal treatment or surgery (from selected clinical pictures and radiographs).

Basic principles and procedures for FPD - Tissue management - Final impression

making - Interocclusal record - Working cast and die - Pindex system - Die preparation

Lectures and presentations 1. Discuss indications for tissue management. 2. Describe the different methods of gingival

tissue displacement and hemostasis. 3. Discuss the requirements of an ideal final

impression. 4. Discuss the requirements of an ideal working

cast. 5. Describe the different materials and

techniques used for a die system. 6. List the steps of the Pindex system and die

preparation.

Hands-on training session 1. Make standard final impression. 2. Pour final impression. 3. Construct proficient working casts with

removable dies. 4. Perform die trimming and determine the finish

line with red-blue pencil.

Medical expert





CanMEDS roles

Basic principles and procedures for FPD - Wax patterns - Investing, casting,

finishing and polishing of cast restorations

- Dental alloy - Dental porcelain

Lectures and presentations 1. Explain the steps of wax pattern fabrication. 2. Explain the laboratory procedures for

construction of cast restorations. 3. Identify all types of dental laboratory

materials. 4. Describe the different types of ceramics used. 5. Describe the different types of metal alloy used

in a porcelain-fused-to-metal prosthesis.


Attend a demonstration by laboratory production staff on wax-up, investing, casting, and finishing and polishing cast restorations.

Medical expert


Basic principles and procedures for FPD - Framework designs

for metal ceramic restoration

- Metal-ceramic restorations

- All-ceramic restorations

Lectures and presentations 1- Recognize the importance and procedure of

framework designs for metal ceramic restoration.

2- State the laboratory steps for fabricating metal-ceramic restorations.

3- State the laboratory steps for fabricating all-ceramic restorations.

Hands-on training session - Attend a demonstration by laboratory

production staff.

Medical expert


Basic principles and procedures for FPD - Metal and porcelain

try-in - Characterization and

glazing - cementation

Lectures and presentations 1. Explain the steps of clinical try-in for crowns. 2. State the advantages, disadvantages, and steps

of stain application. 3. List the types of luting agents used for

cementation. 4. Explain the correct technique for cementation.


1- Apply the try-in steps for metal and porcelain crowns (demonstration)

2- Use the staining kit for color modification and characterization (demonstration)

3- Cement porcelain-fused-to-metal crown with zinc phosphate (video)

4- Cement all-ceramic crown with resin cement (video)

Medical expert





CanMEDS roles

Introduction to Dental implants I

Lectures and presentations 1. Describe the history and types of dental

implants. 2. Identify implant terminology. 3. Explain the process for reaching an appropriate

treatment plan. 4. Describe the components of a dental implant. 5. Describe the steps for the surgical component

of the implant. 6. Recognize the healing period for the surgical

component. 7. Identify the prosthetic components of the

implant. 8. Name the types of implant systems. 9. State the types of crown (cemented and

screwed types), along with their indications, contraindications, advantages, and disadvantages.

10. Describe the different techniques for taking an impression.

11. Explain the meaning and techniques of torqueing.


1. Watch the surgical component of an implant (video).

2. Watch the prosthodontics component of an implant (video).

3. Make a final impression for an implant using the open tray technique.

4. Make a final impression for an implant using the closed tray technique.

5. Perform torqueing on the screwed-type crown. 6. Perform torqueing on the abutment.

Medical expert


Dental implants II Workshop

Specialty topics (weekly scientific activities)

Introduction and rationale The weekly scientific activity course (delivering the advanced specialty topics) is a part of the didactic courses required by the SBRD program. The main focus is on acquiring the advanced knowledge to be integrated with the clinical skills and attitudes acquired in the clinical training part of this program and to develop the competencies needed for a successful professional practice in the field of restorative dentistry.



The educational objectives of this course are:

To cover the recommended reading list on advanced topics for each restorative discipline (operative dentistry, endodontics, fixed prosthodontics, and dental implants).

To help residents acquire experience in researching and critical analysis of scientific papers.

To improve the resident’s presentation and discussion skills.

To prepare for examination.

To develop independence, self-confidence, and creativity. Course description The topics in this course are delivered during the residency program for one day each week. They provide residents with advanced knowledge about the different restorative disciplines that challenge the residents dependent on their level of training. It is composed of three parts (weekly scientific activity wheels). The first part includes the topics that should be covered during R1 residency, the second part includes the topics that should be covered during R2 residency, and the third part includes the topics that should be covered during R3 and R4 residency. The weekly scientific activity day consists of a morning and an afternoon session. In each session, a different topic will be delivered and various educational activities will be undertaken according to the tutor’s choice. Discussion of pros and cons, residents’ activity or interactive lectures, and a literature review will be undertaken during each session. Weekly scientific activity wheels representing the different modules delivered at each level

Teaching strategies and methods The weekly scientific activity course is based on educational strategies that encourage interactive, student-centered approaches in an attempt to develop skills in team work, self-directed learning, lifelong learning, and a high level of intellect.



Each tutor will be responsible for selecting and organizing the educational method that best fits the reviewed topic. These methods can be: • Residents presentations or seminars • Problem-based learning • Interactive lectures • Case-based learning • Review of the literature (seminars or discussion) • Guest speakers • Discussion of pros and cons • Residents assignments • Cooperative learning (‘buzz groups’) • Workshops Content of each module

Module Content

Examination, diagnosis and treatment plan strategies

1. Patient assessment, examination, diagnosis, and treatment planning strategy

2. Diagnosis, differential diagnosis, and management of emergencies

Cariology 1. Dental caries: etiology, clinical characteristics, and risk assessment

2. Caries diagnosis and detection methods

3. Caries prevention and management 4. Non-carious tooth loss

Oral and facial pain and pain control

1. Mechanisms of odontogenic and non-odontogenic pain

2. Local anesthesia in endodontics

3. Endodontic pharmacology

Dental and clinical materials

1. Dental amalgam 2. Composites 3. Light-curing units 4. Glass-ionomers 5. Hybrid ionomers 6. Intermediate restorative materials 7. Fluoride, gels, rinses, and varnishes 8. Pit and fissure sealants 9. Bonding and bonding agents 10. Dental cements – liners and bases 11. Ceramics

12. Impression materials 13. Gypsum products 14. Casting investments 15. Dental waxes 16. Dental casting alloys and soldering 17. Casting procedures, casting defects, and

lost-wax technique 18. Abrasive and polishing materials 19. Amalgam toxicity 20. Emerging techniques and materials



Module Content

Endodontics 1. Tooth morphology and access cavity preparation

2. Working length determination 3. Cleaning and shaping of root canal

system 4. Obturation 5. Single visit-multi visit RCT 6. Irrigation and intracanal medication 7. Endodontic mishaps 8. Microbiology and treatment of

endodontic infection 9. Pathobiology of the peri-apex 10. Rotary instruments 11. Tooth resorption 12. Management of painful tooth

emergencies 13. Vital pulp therapy 14. Mineral trioxide

aggregate/perforation

15. Non-surgical retreatment 16. New technology 17. Treatment of mature and immature

teeth 18. Regenerative endodontics 19. Periradicular surgery 20. Pulpal reaction to caries and dental

procedures 21. Pulp reaction to tooth preparation 22. Pulp reaction to cements and adhesives 23. Pediatric endodontics 24. Endodontics and periodontal

interrelationships 25. Effect of age and systemic health on

endodontics

Fixed partial dentures

1. Anatomy of the stomatognathic system

2. TMJ dysfunction 3. Treatment planning for single and

multiple missing teeth 4. Topics in treatment planning I 5. Resin-bonded FPD 6. Cantilever FPD 7. Topics in treatment planning II 8. Pier abutments 9. Prosthetic therapy of periodontally

diseased dentition 10. Longevity of tooth restoration 11. Principles of tooth preparation 12. Fluid control, soft tissue management,

and impression techniques

13. Investing, casting, and soldering techniques

14. Pontics and edentulous ridge 15. Restorative contours 16. Restoration of endodontically treated

teeth 17. Types of posts and cores 18. Provisional restorations 19. Try-in, adjustment, polishing, and

cementation technique 20. All ceramic restorations 21. Common types of failures of crowns and

FPD (causes and management) 22. Success and complications of all ceramic

prostheses 23. Dental update



Module Content

Occlusion 1. Clinical significance of dental anatomy, histology, physiology and occlusion

2. Fundamentals of occlusion 3. Alignment and occlusion of the

dentition 4. Determinant of occlusal morphology 5. Criteria of optimum functional

occlusion 6. Articulators and their use 7. Cephalometric analysis 8. Diagnostic wax-up 9. Casts, facebows and interocclusal

records 10. Classification of occlusion 11. The occlusal plane 12. Signs and symptoms of occlusal

disease 13. Short dental arch 14. PBC (etiology, diagnosis, and

treatment) 15. Anterior guidance and its importance 16. Group function versus canine

guidance (literature review) 17. Occlusal stability 18. Occlusal equilibration and selective

tooth grinding 19. CR (determination and recording) 20. Interocclusal records (advanced cases)

21. Mandibular movement and recording 22. Vertical dimension 23. Bruxism 24. Dental wear (etiology and management) 25. Overview of full mouth rehabilitation 26. Clinical remounting 27. Occlusal appliances 28. Criteria for success of occlusal

treatment 29. Postoperative care of occlusal therapy

patients 30. Treating different occlusal problems 31. End to end occlusions 32. Separated anterior teeth 33. Crossbite relationship 34. Deep overbite 35. Deep overjet 36. Anterior open bite 37. Severe arch malrelationship 38. Crowded anterior teeth

Dental implants

1. Historical overview of dental implantology, types of dental implant, and concept of osseointegration

2. Biomechanics, biomaterials and surface treatment of dental implants

3. Occlusion of implant restoration 4. Implant patient selection and

treatment planning 5. Radiographic image analysis and

evaluation of an implant patient 6. Treatment planning for single-tooth

implant restoration 7. Implant in esthetic zone 8. Screw-retained versus cemented

implant restoration

9. Surgical aspects of implant dentistry 10. Prosthetic aspects I 11. Prosthetic aspects II 12. Immediate dental implant loading 13. Implant-natural tooth connection 14. Implant prosthetic complication and

management 15. Treatment planning for an implant-

supported FPD 16. Maintenance of a dental implant



Module Content

Operative 1. Instrument and equipment for tooth preparation

2. Amalgam restoration 3. Complex and pin-retained amalgam

restorations 4. Composite restoration 5. Glass ionomer restorations 6. Fundamental concepts of enamel and

dentin adhesion I and II

7. Restorative treatment of special cases 8. Common restorative problems: causes

and solutions 9. Restoration failures and repair 10. Tooth surface loss: diagnosis and

management 11. Controversial issues in operative

dentistry I and II

Esthetic 1. Esthetic considerations in diagnosis and planning of treatment

2. Smile analysis 3. Color and shade selection

4. Properties of light and color in dentistry 5. Conservative treatment for discolored

teeth 6. Indirect tooth-colored restorations

Periodontal-restorative interrelationship

1. Components of the periodontal apparatus

2. Periodontal biotype 3. Clinical periodontal examination and

data collection 4. Different procedures involved in

clinical periodontal examination and data collection

5. Diagnosis and classification of periodontal diseases

6. Essential periodontal indices (plaque, bleeding, gingival)

7. Local factors contributing to periodontal disease

8. Periodontal prognosis and the impact of individual risk factors

9. Mucogingival therapy and periodontal plastic surgery

10. Gingival recession 11. Ridge defect classification and gingival

augmentation

12. Biologic width 13. Crown lengthening 14. Guided tissue regeneration 15. Essential terminology

(osseoinduction/osseoconduction) 16. Bone grafting material and membranes 17. Periodontic-prosthodontic topics I 18. Crown lengthening (biological width,

ferrule effect) 19. Preparation considerations essential for

gingival health 20. Factors affecting gingival esthetics 21. Effect of prosthodontic treatment on

gingival health

Assessment

Evaluation of resident’s activities (presentations, literature review, contribution to discussion)

Quizzes

Attendance

End of year examination (MCQ). Evaluation Evaluation will be based on:

End of course evaluation form

Discussion sessions with residents and faculty for comments on the course.



Trainee-selected topics

Introduction and rationale These practically relevant topics are selected by senior residents themselves. The aim is to provide an opportunity for senior residents to develop personally and professionally by choosing, arranging and performing an educational activity of his/her own choice in any field of restorative dentistry. Course description During their last residency year, senior residents can select topics to be presented to the juniors, graduates or other professionals in any format they choose, including lectures, case presentations, or workshops. These topics are to be presented within the core education program according to the following guidelines:

Trainees will be given the choice to develop a list of topics alone

Trainees can choose any topic relevant to their needs

All topics must be planned and cannot be random

All topics must be approved by the local education committee. Assessment

Peer assessment

Portfolio

Assessment by supervisors and consultants.

Research

Introduction and rationale Research is a systematic process of collecting and analyzing information to increase understanding of the phenomenon under study (Leedy and Ormond, 2010). In the SBRD program, this process is helpful in generating, integrating and applying knowledge gleaned from research in clinical practice. Conducting scientific research will improve residents’ skills, including their critical thinking, problem-solving and decision-making skills. Furthermore, it creates an innovation-oriented culture and encourages professional communication skills in residents. Moreover, residents will have the opportunity to gain more knowledge and experience through a direct relationship with expert research supervisors. Course description This course will provide SBRD residents with the basic skills needed to approach a scientific research project and complete it successfully. Moreover, it will provide them with an overview of the application of research methodology in dentistry. Therefore, this course will cover topics such as:

The research process

Study design

Basics of biostatistics

Manuscript writing

Research presentation.



The content of this course will be delivered at the beginning of R2 utilizing a student-centered concept. Residents will participate in presenting scientific information by asking, discussing, critiquing and justifying scientific issues based on scientific evidence. One specialist member will attend as a guest to contribute, guide the discussion, and add valuable comments. A hands-on workshop will be held during this course to facilitate understanding of the research process. General objectives At the end of the SBRD program, residents will be able to: 1) Identify the basics of scientific research. 2) Explain the meaning and application of evidence-based dentistry. 3) Use relevant information sources (PubMed, journals, textbooks, websites, and library). 4) Recognize literature that has relevance to clinical practice. 5) Recognize the ethical principles of scientific research. 6) Explain study designs. 7) Conduct scientific research (e.g., proposal defense, research presentation, and poster

presentation). 8) Recognize the basics of biostatistics. 9) Present scientific research, topics, and articles with good verbal communication. 10) Write a scientific research manuscript that will improve the resident’s scientific writing skills. 11) Explain the process of publication. 12) Appraise published articles.

Topics Objectives (Residents will be able to)

Teaching methods CanMEDS Framework roles

Introduction to scientific research

1. Define research. 2. Discuss its importance. 3. List the types of research. 4. Explain the meaning and principles

of evidence-based dentistry. 5. List the steps of conducting

research. 6. Identify skills needed to design and

conduct research. 7. Recognize sources of information,

articles, and data. 8. Open account in PubMed

(workshop).

Lecture. Group discussion. Workshop.


Ethics in scientific research

1. Recognize research ethics (Ethics Training Module: http://www.pre.ethics.gc.ca/eng/index/)

2. Present principles of the Declaration of Helsinki (ethics)

3. Present principles of the Belmont Report (ethics)

4. Select research group and/or supervisor.

Assignment (resident needs to submit certificate of ethics by answering questions in the training module (website: Panel on Research Ethics).

Residents will present principles of the Declaration of Helsinki and Belmont Report in





front of each other.

Literature review 1. Describe the meaning of a literature review.

2. Discuss the importance of a literature review.

3. List the steps in conducting a literature review.

4. Apply methods of writing to the introduction section of the manuscript.

5. Critique literature review of published articles.

Lecture. Group discussion. Residents will review and

critique the introduction section of a selected article in a group.

Residents will write the introduction section for a literature review of a selected topic (workshop).


Research problem and objectives

1. Define research problem and purpose.

2. Explain the importance of the research problem.

3. Identify purpose statements, research questions, hypotheses and objectives

4. Formulate an hypothesis. 5. Formulate a research objective. 6. Discuss the process of developing a

research question. 7. Apply objective methods of writing

research. 8. Critique research objectives of

published articles.


critique the introduction section and objectives of the selected article in a group.

Residents will write the research objectives for the selected topic (workshop).






Introduction to referencing

1. Define a reference and a citation. 2. List the different types of

referencing styles. 3. Understand the meaning of

plagiarism. 4. Write statements/paragraph with

citations and references. 5. Attend an EndNote hands-on

workshop.


identify type of references for a selected article in a group.

Residents will attend an EndNote hands-on workshop.

Residents will write statements or a paragraph with citations and references using the EndNote program.

Residents will write statements or a paragraph with different referencing styles.


Study design/research methodology

1. Describe the characteristics of quantitative, qualitative, and mixed methods research.

2. Explain quantitative study design (research methodology).

3. Describe descriptive studies and analytical studies.

4. Describe experimental research, quasi-experimental and non-experimental quantitative research.

5. Discuss the steps in conducting experimental research.

6. Explain the meaning and uses of correlational research.

7. Explain the meaning of causation and association research.

8. Critique study designs of published articles.


critique the methods section of a selected article.

Residents will identify the type of study design used in a selected article.






Types of variables, confounding modifiers, IRB, sampling techniques, data collection

1. List types of variables. 2. Define confounding and modifier

variables. 3. List types of bias found in research. 4. Discuss the process of quantitative

data collection. 5. Explain sampling technique. 6. Explain how to obtain a sample. 7. List the types of data collection tools

(instrument that will be used to collect data).

8. Define the different methods of data collection (tests, questionnaires, interviews, focus groups, observation).

9. Critique types of variables and sampling techniques used in published articles.


critique the methods section of a selected article.

Residents will identify types of variables in a selected article.

Residents will identify the sampling technique used in a selected article.


Questionnaires, standardized measurement

1. Discuss types questionnaires. 2. List steps of construction of an

instrument (questionnaire). 3. Identify standardized measurement

and assessment (including scales of measurement, validity, and reliability).

4. Discuss methods used to administer tools for data collection.


critique questionnaires mentioned in a selected article in a group.

Residents will construct a questionnaire.

Residents will select a research topic to be conducted during the program.


Qualitative study design

1. Identify qualitative study design (grounded theory research, ethnographic research, narrative research).

2. Explain the process of qualitative data collection.

3. Discuss how to analyze and interpret qualitative data.

Lecture. Group discussion Resident will review and

critique a qualitative study design in a selected article in a group.

Identify type of qualitative study design in a selected article.






Biostatistics I 1. Identify the basics of biostatistics. 2. Explain how to interpret

quantitative data. 3. Explain the data management

process. 4. Discuss the process of quantitative

data analysis. 5. Conduct descriptive analysis. 6. Conduct inferential analysis.


critique the statistical section of the selected article in a group.

Residents will discuss descriptive and inferential analysis of data.


Biostatistics II 1. Describe how to analyze data. 2. Describe how to present tables,

figures, and results. 3. Attend a hands-on SPSS workshop.


critique the statistical section of a selected article in a group.

Residents will discuss descriptive and inferential analysis of data.

Residents will enter research data in the SPSS program and analyze it.

Residents will arrange data in tables and figures.


Research proposal 1. Describe the contents of a research proposal.

2. Apply learned writing methods when writing the proposal.

Lecture. Group discussion. Residents will complete a

mini proposal form in a group.

Residents will present their mini proposal.


Discussion 1. Identify the content of the discussion section.

2. Discuss the methods used to write the discussion section.


critique the discussion section of a selected article.






Conclusion -Abstract -Title -Authorship Acknowledgements -Publication -Poster

1. Identify the contents of the conclusion.

2. Identify the contents of the abstract. 3. Know the types of titles. 4. State how to present authorship. 5. Describe how to write

acknowledgements. 6. Explain the process of publication. 7. Discuss how to design a poster

presentation.


critique the conclusion, abstract, and title of a selected article in a group.

Design a poster using the PowerPoint program.

Discuss the publication process for a target journal.


Research grants 1. Explain the process of applying for a research grant.

2. Discuss the steps of critiquing research.


critique some selected articles in a group.

Residents will use a check list to critique the selected articles.


Proposal defense presentation

1. Submission of initial draft results at end of R2.

2. Submission of initial draft of discussion in the middle of R3.

3. Submission of manuscript at end of R3.

4. Submission of poster at beginning of R4.

5. Research presentation at beginning of R4.



Educational methods and professional development topics

Introduction and rationale The SBRD curriculum has adopted a clear mission and vision that supports excellence in medical education and employs new educational strategies and instructional methods. This necessitates appropriate development of both SBRD program faculty and residents for better understanding and applying of the adopted concepts, principles and required skills of learning, teaching, managing, communicating and professional development. Course description This course will introduce SBRD residents to the new approaches and concepts in medical education and provide them with the skills in teaching, learning, communication, leadership, team work, and self-direct learning needed during their training years and their future professional education and development. The content of this course will be delivered in the form of lectures and workshops during the first and second years of residency. Teaching strategies and methods The medical educational methods and professional development courses are based on educational strategies that will emphasize interactive student-centered approaches to encourage self-directed learning, lifelong learning, problem-solving, and a high level of intellect. Many teaching methods will be used, including:

Interactive lectures

Workshops

Guest speakers

Resident activities and assignments. Assessment

Attendance and contribution

Residents’ presentations and assignments

Online examination. Evaluation The evaluation will be based on:

An end of cycle evaluation form

Final tests

Discussion sessions with residents and faculty for comments on the course.



Course content

Lecture/Workshop Content CanMEDS competencies

1. New approaches, concepts, and strategies in medical education

- Challenges and reasons for changes in medical education.

- Outcome/competency-based education. - Problem-based learning. - Case-based learning. - Practice-based learning. - Community-based education. - Patient-centered education. - Student-centered learning. - E-learning. - Evidence-based medicine. - Active learning. - Problem-solving and critical thinking.

Medical expert Collaborator Scholar Professional

2.Principles of adult learning and learning styles

- Definition of andragogy. - Principles of adult learning. - Differences between pedagogy and

andragogy. - Applying principles of adult learning to

training. - Different styles of learning.

Scholar Leader

3.Teaching methods - Principles of teaching. - Innovative and traditional methods of

teaching. - Advantages and disadvantages of the

different teaching methods.

Scholar Professional

4.Educational objectives - Definition and rationale. - Taxonomy of educational objectives. - How to write educational objectives.

Scholar

5.Problem-based learning - Definition and rationale. - Steps of practice-based learning. - Roles of group members.

Scholar Leader

6.Self-directed learning - Definition and rationale. - Principles of SDL. - Steps of SDL. - Advantages of SDL. - Perception of SDL.

Collaborator Scholar Professional

7.Group dynamics and team work - Definition of group dynamics and behavior that affects the group process.

- Stage of group development. - Functions and ground rules in group work. - Nature of team work. - Steps for creating an effective team. - Importance of team work in education and

health care.

Collaborator Professional




8.Assessment and new methods of assessment

- Definition of assessment. - Summative and formative assessments. - Extended matching items versus MCQ. - Objective structured clinical and practical

examinations. - Portfolio. - Work-based assessments.

Scholar

9.Feedback and self-reflection - Definition of feedback and self-reflection. - Importance and effect of feedback and self-

reflection on learning outcomes.

Scholar Collaborator Professional

10.Presentation skills - Rationale for and basic components of an oral presentation.

- Steps for preparing and creating effective presentations.

- Manage the presentation environment. - Use visual aids and support materials. - Understand and overcome fear and anxiety of

public speaking and gaining confidence and control.

- Balancing verbal and non-verbal messages to engage listeners.

- Maximizing vocal delivery. - Body language tips and technique. - Interacting with and handling questions from

the audience.

Collaborator Scholar Professional

11.Study and learning skills - Process of studying. - Importance of study skills. - Effective learning/study skills.

Scholar

12.Writing skills - Importance and types of writing. - Strategies to improve writing. - Essential steps and process for writing

assignments. - Definition of plagiarism. - Strategies that minimize potential for

plagiarism.

Scholar

13.Leadership skills

- Concept of leadership and importance of leadership skills.

- Differences between a leader and a manager. - Skills of an effective leader. - Techniques for dealing with conflict. - Aspects of leadership in health care.

Collaborator Professional Leader

14.Communication skills and professionalism

- Meaning and relevance of communication skills in health sciences education and training.

- Importance of effective communication skills in practice.

- Communication skills in the context of health sciences education.

Collaborator Communicator Professional

http://www.businessballs.com/presentation.htm#prepare-create-presentations

http://www.businessballs.com/presentation.htm#prepare-create-presentations

http://www.businessballs.com/presentation.htm#public-speaking-fear

http://www.businessballs.com/presentation.htm#public-speaking-fear




- Definition and elements of professionalism. - Competencies needed for dentists as

communicators and professionals according to the CanMEDS competency framework.

15.Workshop design

- Definition and importance of workshops. - Workshops as an educational and

developmental tool. - Essential steps for designing an effective

workshop.

Collaborator Leader Professional

16.Time management - Definition and advantages of time management.

- Steps and skills needed to manage time. - Implementation of time management in

practice.

Professional Medical expert

17.Faculty development

- Definition and principles of faculty development and their rationale.

- Effects of faculty development interventions on knowledge, attitudes, and skills of health care professionals and the institutions in which they work


18.Program evaluation

- Definition and principles of program evaluation.

- Purpose of program evaluation in education. - Evaluation according to Bloom’s taxonomy of

educational objectives. - Relevance of evaluation to the learning

process.

Scholar Leader

19.Dental practice management

- Business management, including third party payment and professional practice development.

- Management of auxiliaries and other office personnel.

- Maintenance and management of patient records.

- Book-keeping/accounting. - Office design and arrangement and placement

of equipment. - New technology in practice.

Leader Professional Communicator Collaborator

Practice and work-based learning

Clinical-based learning

In the context of providing comprehensive restorative dental care, the program includes advanced clinical training in operative dentistry, endodontics, fixed prosthodontics, and implantology, with the emphasis on diagnostic science and soft tissue management. There will be a sufficient number and variety of cases in all three disciplines to ensure an appropriate training ground for each resident.



Residents will be assigned patients who present increasingly difficult problems and will be given increasingly greater clinical responsibility as they progress in their advanced training. The resident is expected to upgrade and increase his/her knowledge, skill, and ability in the management of a wide range of complex dental problems and acquire a specialist’s perspective. Assessment methods used include: CBD, multi-source feedback or 360, DOPS, a mini clinical evaluation exercise, and a clinical supervisor’s report.

Activity Objective (Residents will be trained to)

CanMEDS competencies

Clinical-based learning

- Elicit a detailed medical and dental history using patient-centered interviewing skills.

- Carry out a thorough and appropriate assessment and examination of oral and extra-oral structures of a patient and make appropriate diagnoses.

- Complete a thorough examination of any existing restoration, RCT, prostheses, implants and related tissues and structures, evaluating the biological and esthetic quality of each.

- Conduct a periodontal examination, charting, and diagnosis. - Use and interpret correctly all appropriate investigations. - Use evidence-based decision-making. - Use all clinical examination, history, and investigation findings to develop

alternative and effective treatment strategies. - Develop communication skills by deciding the treatment strategy in

conjunction with the patient and producing a plan according to their needs and preferences.

- Work with other health professionals to develop an effective treatment plan and provide high-quality, safe and patient-centered care.

- Write consultation and referral letters. - Advise patients on preventive methods. - Manage emergencies and traumatic injuries. - Carry out non-surgical RCT and retreatment cases for all teeth using

different techniques. - Master skills of all restorative procedures (endodontic, operative, and

prosthodontic) - Provide restorative, conservative and esthetic treatment using different

materials and techniques - Provide an appropriate periodontal restorative treatment plan and

management. - Provide all types of fixed prosthodontic therapy using the appropriate

techniques, materials, and technologies available for all types of fixed dental prostheses and restorations.

- Diagnose and manage significant occlusal conditions and disorders. - Diagnose oral parafunction and other factors in the development of

dysfunction of mandibular movements and the TMJ, and provide behavioral advice for management of these problems.

- Diagnose, generate an appropriate treatment plan, and provide the best treatment methods for the different occlusal problems.

- Construct appropriate occlusal appliances for the treatment of these problems.

- Provide full mouth rehabilitation treatment following all recommended steps.

- Provide dental implant therapy in multiple clinical circumstances.

Medical expert Communicator Collaborator Scholar Health advocate Professional





- Liaise appropriately with dental technicians with respect to necessary laboratory requirements.

- Use conscious sedation techniques in conjunction with appropriate specialists.

- Recognize the importance of working with a team of health professionals in patient management.

- Apply ethical and humanistic principles in clinical care. - Supervise junior residents or undergraduate students (for seniors). - Improve collaboration skills by receiving instructions and feedback from

supervisor or colleagues.

Presentation of advanced cases

Formal patient case conferences will be held annually for discussion of diagnostic problems, treatment planning, case presentation, review, and follow-up. All R2, R3, and R4 residents should present a comprehensive case managed in their clinic once a year. Attendance and contribution of the other residents to discussion are mandatory. Each resident will be assessed by at least three consultants who will complete a special assessment form.



Presentation of advanced cases

- Present a comprehensive case with a detailed history, examination, and description of the investigation tools used.

- Recognize social, systemic, and oral factors that influence the treatment plan and prognosis.

- Present the consultation reports and outline their influence on the treatment strategy.

- Formulate an appropriate differential diagnosis and alternative treatment plans.

- Incorporate evidence into the treatment plan, techniques, and selection of materials.

- Follow the ideal sequence in patient management. - Document comprehensive cases following the

recommended format. - Present follow-up of a patient’s case. - Expose other residents to different cases and treatment

modalities. - Improve presentation skills by regularly seeking feedback

on presentation.

Medical expert Scholar



Treatment plan sessions or case-based learning

All treatment plans for comprehensive and special cases should be presented and discussed locally in the training center and in the presence of the clinical supervisors and other residents. Case-based teaching sessions are conducted as an alternative interactive teaching method. Faculty-based, complex problem cases are written to stimulate discussion and collaborative analysis.



Treatment plan sessions - Develop competence in short presentations on comprehensive cases.

- Formulate a correct diagnosis based on history, clinical examination, investigations, and consultation.

- Develop the best treatment strategy after discussing the case with supervisors.

- Expose the other residents to dental cases with different problems and treatment strategies.


Case-based learning - Develop skills in analytical thinking and reflective judgment by reading and discussing complex, real-life scenarios.

- Formulate a correct diagnosis based on history and investigations.

- Develop the best treatment strategy after discussing the case.

- Residents are encouraged to interact with each other in team projects.

- Explore educational sources beyond the required textbook.

Medical expert Scholar Leader Collaborative

Literature review in RD and Journal Club

Classical and current dental literature on different topics in restorative dentistry will be prepared and discussed in the form of a seminar by residents in the presence of training staff. Residents will be evaluated weekly by the tutor at the end of the session.


CanMEDS

competencies

Literature review in RD and Journal Club

- Present the summarized assigned or selected articles to other residents and consultants.

- Review literature related to restorative dentistry to improve decision-making and patient care.

- Acquire knowledge about the different types of studies and methodologies.

- Critically appraise the published articles. - Keep up to date with the literature. - Recognize classical and current published articles and case

reports impacting on the practice of restorative dentistry. - Identify areas of controversy in areas of restorative

dentistry disciplines.

Scholar Medical expert Health

advocate



Self-directed learning

Self-directed learning is an educational experience that is planned and organized by the resident with or without the help of others. It is used to further learning in a particular area or to meet a learning objective. This kind of learning can take place in multiple ways throughout the residency program.



Self-directed learning - Take responsibility for personal learning above and beyond responding to instruction.

- Develop independence, confidence, and awareness of available resources.

- Predict personal learning needs and objectives. - Develop searching and reading skills using relevant journals

and books. - Develop an interest in further learning beyond the essential

core curriculum. - Develop lifelong learning skills. - Encourage critical thinking skills. - Maintain a personal portfolio.

Medical expert


Community service

Residents have the opportunity to learn by community service in groups. The most important aspect of this service is helping patients to improve their oral health. The aim of these activities is to assist residents in identifying and meeting dental health and social needs in the community. This service can be done in several ways: volunteering at hospitals or nursing homes; providing dental health education programs in schools; or participating in programs run by dental or medical societies.

Activity Objective

(Residents will be trained to)

CanMEDS

competencies

Community service - Participate in local organizations that benefit the community as a whole.

- Demonstrate respect for all people regardless of culture and socioeconomic background.

- Develop experience in volunteering activities. - Encourage residents to interact with each other in a

community project. - Become active members of the community when they have

their own practices. - Assess the needs of a community.

Medical expert Communicator Collaborator Health advocate Professional Leader



Elective (special interest) module

Towards the end of training in the program and once the majority of learning objectives are achieved, senior SBRD residents may choose to undertake special interest modules, with the approval of the Regional Local Committee and SBRD Scientific Committee. These elective modules have included:

Attachment to an overseas institution recognized within the specialty as providing superior additional experience within the sphere of interest of the trainee.

National attachment to an institution recognized within the specialty as providing superior additional experience within the sphere of interest of the trainee.

Locum part-time trainee opportunities within or outside the training unit with the approval of the SBRD Scientific Committee.

Activity Objective


CanMEDS

competencies

Elective (special interest) module

- Select modules they expect to find interesting and encouraging intrinsic motivation and a deeper approach to learning.

- Gain additional experience within the sphere of interest of the trainee from units and staff locally or abroad.

Medical expert Communicator Collaborator Professional

Supplementary courses and workshops

Frequent seminars, workshops, and demonstrations of dental procedures will be conducted throughout the program. This includes hands-on training in new dental materials, new dental technology, and modern clinical procedures, and improving clinical skills.

Activity Objective


CanMEDS

competencies

Supplementary courses, workshops, and guest speaker lectures

- Keep up to date with the latest advances in restorative dentistry materials and techniques.

- Identify and practice modern clinical procedures. - Benefit from the experience and knowledge of local and

international speakers. - Acquire knowledge and skills in advanced areas of

restorative dentistry.


ASSESSMENT


ASSESSMENT

Assessment in dental education programs is changing. Recognition is increasing, so planning assessments need to focus on assessment programs or systems rather than on individual tools, and these systems must focus on multiple methods and sampling strategies to ensure that the full range of relevant competencies are evaluated as robustly as possible. To promote learning, assessment should be educational and informative, and residents should learn from tests and receive feedback on which to build their knowledge and skills. Pragmatically, assessment is the most appropriate engine by which to harness the curriculum. Additionally, with an increasing focus on the performance of dentists and on public demand for assurance that dentists are competent, assessment also needs to have a summative function. Final tests of clinical competence, which allow a decision to be made about whether a dentist is fit to practice or not, are in demand. Purpose The purposes of assessment during the training program are as follows:

To support learning

To encourage professional growth

To monitor progression

To judge and certify competency

To evaluate the quality of the training program. General principles:

Judgment should be based on holistic profiling of a trainee rather than individual traits or instruments

Assessment should be continuous in nature

The resident and faculty must meet to review the resident’s performance

Assessment should be strongly linked to the curriculum and content of the course. The assessment plan of the SBRD program is formulated in accordance with the Saudi Commission’s training and examination rules and regulations. This includes the following:

Annual promotion assessment

This assessment is conducted towards the end of each training year throughout the program, and includes the following:

End of year in-training evaluation

This evaluation report is prepared for each resident at the end of each year based on the quarterly ITER, oral presentation on a regional treatment plan, academic assignments and oral clinical examination, in addition to completion of a minimum 8–10 cases with a certain complexity code, and completing other clinical requirements. These clinical requirements should be documented by an electronic tracking system on an annual basis. Evaluations will be based on achieving the minimum requirements of the procedures and clinical skills.

ASSESSMENT


Formative continuous evaluation

This evaluation should fulfill the CanMEDS competencies based on the in-training evaluation, including medical expert, communicator, and clinical procedure skills performance. The resident’s performance will be evaluated by the program director and joint staff (at least two) for the following competencies: 1) Performance of the trainee during daily work for each discipline. 2) Performance and participation in academic activities. 3) Performance in a 10–20-minute direct observation assessment of trainee-patient interaction.

Trainers are encouraged to perform at least two assessments per academic training year, preferably one every 6 months. Trainers should provide timely and specific feedback to the trainee after each assessment of a patient treatment plan.

4) Performance of diagnostic and therapeutic procedural skills by the trainee (DOPS and daily direct clinical supervision). Timely and specific feedback for the trainee after each procedure is mandatory.

5) Assessment tools to be used are DOPS, Mini-CEX, Multi- Source feedback, Case-based Discussion

ratings.

6) The evaluation form for CanMEDS-based competencies at the end of a rotation must be completed every 3 months during the training year, and signed by at least two consultants. The program director will discuss the evaluation with the resident as necessary; thereafter, the resident should sign the form. The evaluation form will be submitted to the local Training Committee of the SCFHS within one week following the end of each 3 months.

7) The clinical requirement should be documented by an electronic tracking system (e-logbook when applicable) on an annual basis. Evaluation will be based on achievement of the minimum requirements of the procedures and clinical skills as determined by the program.

Regional treatment plan oral presentation (CBD): summative evaluation

The resident will be evaluated based on an oral presentation as part of the his/her annual promotion assessment where he/she describes a case, including history-taking, diagnostic tools used, diagnosis in each discipline, and how he/she can formulate an integrated treatment plan and identify alternative plans. A completed case is not mandatory, so the resident can present a case in progress.

Oral clinical examination/OSCE/SOE: summative evaluation

This evaluation is based on presenting a completed case toward the end of the year. A committee will assess the management of the case from the operative, endodontic, and prosthodontic perspectives. or in a structured oral examination format or objective structured clinical examination format. R4 residents will not be involved in this examination.

End of year written examination

The end of year examination will be limited to R1, R2, and R3. The number of examination items, eligibility, and passing score will be in accordance with the Commission’s training and examination rules and regulations. A resident will not need to take this end of year examination if he/she obtained a passing grade in the Part I examination during R1. Examination details and blueprints are published on the commission website: www.scfhs.org.sa


ASSESSMENT


Final in-training evaluation report

In addition to approval of completion of all clinical cases (20 minimum) and clinical requirements (resident’s logbook) by the local committee, the resident’s performance will be evaluated by the program director and joint staff (at least two supervisors), and approved by the chairman of the local committee accordingly. Moreover, R4 residents must get more than 70% during the final year (minimum three quarterly evaluations), in order to be eligible for the final written examination.

Principles of restorative dentistry examination (Saudi Board Examination: Part I)

This is conducted in the form of a written examination with an MCQ format and is held at least once a year. The number of examination items, eligibility, and passing score will be in accordance with the Commission’s training and examination rules and regulations. Examination details and blueprints are published on the commission website: www.scfhs.org.sa

Final restorative dentistry board examination (Saudi Board Examination: Part 2)

The final Saudi Board examination comprises two parts:

Written examination

This examination assesses the theoretical knowledge base (including recent advances) and problem-solving capabilities of candidates in the specialty of restorative dentistry. It is delivered in an MCQ format and held at least once a year. The number of examination items, eligibility, and passing score will be in accordance with the Commission’s training and examination rules and regulations. Examination details and blueprints are published on the commission website: www.scfhs.org.sa

Clinical/Oral examination

This examination assesses a broad range of high-level clinical skills, including gathering of data, diagnosis, patient management, and communication and counseling skills. The examination is held at least once a year. The examination eligibility and passing score will be in accordance with the Commission’s training and examination rules and regulations. Examination details and blueprints are published on the commission website: www.scfhs.org.sa




ASSESSMENT


Certification

Certificate of completion of training will only be issued upon the resident’s successful completion of all program requirements. Candidates passing all components of the final specialty examination will be awarded the Saudi Board in Restorative Dentistry certificate.

Assessment tools

A combination of tools for assessment of learning and assessment for learning that balances between the summative and formative, and are reliable, valid, and authentic will be used (refer to appendices for assessment forms). Miller’s Pyramid – 1990

Assessment tool Competency assessed

Knows/Knows how

MCQ and extended matching items

- Knows and knows how (Miller’s pyramid). - High cognitive function (clinical reasoning, problem-solving, knowledge,

integration of basic and clinical science). - Assesses medical expert competency.

Written assignment - Knows and knows how (Miller’s pyramid). - High cognitive function (clinical reasoning, problem-solving, knowledge,

integration of basic and clinical science). - Assesses medical expert and scholar competencies.

Shows how

Objective structured clinical examination

- Shows how (Miller’s pyramid). - Test clinical skill performance and competence in skills such as communication,

clinical examination, history, dental procedures, manipulation techniques, radiographic image evaluation, and interpretation of investigations.

- Assesses medical expert and communicator CanMEDS competencies.

http://en.wikipedia.org/wiki/Communication

http://en.wikipedia.org/wiki/Clinical_examination

ASSESSMENT


Clinical oral examination - Shows how (Miller’s pyramid). - Test clinical skill performance and competence in skills such as clinical

examination, history, dental procedures, manipulation techniques, counseling, radiographic image evaluation, and interpretation of investigation tools.

- Assesses medical expert, health advocate and scholar CanMEDS competencies.

Does (work place-based assessment)

Mini-clinical evaluation exercise

- Does stage (Miller’s pyramid). - History-taking or medical interviewing skills, physical examination skills, clinical

judgment, professionalism or humanistic qualities, organization/efficiency, counseling skills, collaboration and communication skills.

- Assesses medical expert, communicator, collaborator and professional CanMEDS competencies.

Direct observation of procedural skills

- Does stage (Miller’s pyramid). - Assesses the procedural skills essential for providing good clinical care, focusing

on especially important and technically demanding procedures - Assesses medical expert CanMEDS competency.

Multiple source feedback (360 assessment method)

- Does stage (Miller’s pyramid). - Patient care, professionalism, collaboration and communication skills and

practice-based learning. - Assesses communicator, collaborator, professional, teacher and leader

CanMEDS competencies.

Case-based discussion - Focuses on clinical knowledge, record-keeping, history-taking, clinical findings and interpretations, searching the evidence base, diagnosis, treatment plans, consultations, management and follow-up.

- Assesses medical expert and scholar CanMEDS competencies.

Portfolios and logbook - Does stage (Miller’s pyramid). - Clinical performance and technical skills can be assessed using the portfolio

approach. - Portfolios may be best used for assessment of competencies that are difficult to

evaluate using other techniques, e.g., communication, risk management, problem-solving, response to feedback, decision-making, response to ethical and professional dilemmas, patient advocacy, scholarship, information, and change in management skills.

- Assesses medical expert, communicator, collaborator, professional, health advocate, scholar and leader CanMEDS competencies.

Scholarly projects - Planning and conducting research and presentations. - Assesses scholar and medical knowledge CanMEDS competencies.

Clinical supervisor’s report (in training assessment)

- Does stage (Miller’s pyramid). - Specialty in training assessment in which the key standards of clinical

performance, technical skills, and all other competencies are defined. Residents are requested to meet all the standards.

- Assesses collaborator, communicator, scholar, health advocate, leader, and professional CanMEDS competencies.



ASSESSMENT


Trainee support (mentorship)

Each trainee must have an assigned supervisor.

A clinical supervisor must not have more than three trainees at any given point of time.

Assigned supervisors must follow the trainee for at least one year.

Portfolio and logbook

The portfolio will be an integral component of training.

Each trainee will be required to maintain a logbook.

An educational supervisor should be in charge of maintaining and reviewing the portfolio and provide continuous feedback to the trainee.

The portfolio should include the following: o Curriculum vitae o Professional development plan o Records of educational training events o Reports from educational supervisors o Logbook o Reflection o Other, e.g., patient feedback and clinical audits.

REFERENCES


REFERENCES

1) Kern DE, Thomas PA, Hughes MT. Curriculum Development for Medical Education: A Six-Step Approach. Baltimore, MD, USA: Johns Hopkins University Press; 2009.

2) Dent J, Harden RM. A Practical Guide for Medical Teachers. 3rd ed. Amsterdam, The Netherlands: Elsevier; 2009.

3) Saudi Commission for Health Specialties. Post Graduate Resident Training Curriculum Template. Riyadh, Saudi Arabia: Saudi Commission for Health Specialties;

4) CanMEDS [cited March 1, 2015]. Available from: http://www.royalcollege.ca/portal/page/portal/rc/public.

5) The Draft CanMEDS 2015. Physician Competency Framework Series IV. Frank JR, Snell L, Sherbino J, editors. Ottawa, Canada: Royal College of Physicians and Surgeons of Canada; 2015.

6) The Draft CanMEDS 2015. Milestones Guide. Ottawa, Canada: Royal College of Physicians and Surgeons of Canada; September 2014.

7) CanMEDS 2015. Physician Competency Framework. Ottawa, Canada: Royal College of Physicians and Surgeons of Canada; October 2015.

8) AMEE Guides 2015 [cited March 4, 2015]. Available from: https://www.amee.org/publications.

9) Wallen RJ, Fraenkel NE. How to Design and Evaluate Research in Education. 6th ed. New York City, NY, USA: McGraw-Hill Education Companies; 2006.

10) Creswell JW. Educational Research: Planning, Conducting, and Evaluating Quantitative and Qualitative Research. 4th ed. New York City, NY, USA: Pearson College Division; 2012.

11) Saudi Commission for Health Specialties. Introduction to Clinical Research for Residents. Riyadh, Saudi Arabia: Saudi Commission for Health Specialties; 2014.

12) Saudi Commission for Health Specialties. General Exam Rules and Regulations. Vol. 14.0. Riyadh, Saudi Arabia: Saudi Commission for Health Specialties; 2014.

13) Miller GE. The assessment of clinical skills competence performance. Acad Med. 1990;65(9):63-7.

14) Saudi Commission for Health Specialties. The Saudi Specialty Certificate in Restorative Dentistry Program. 2nd ed. Riyadh, Saudi Arabia: Saudi Commission for Health Specialties; 2008.

15) General Dental Council. Protecting patients, regulating the dental team. [Cited September 5, 2015]. Available from: www.gdc-uk.org.

16) The Royal College of Surgeons of England. Restorative Dentistry Index of Treatment Need Complexity Assessment, England: Clinical Effectiveness Committee, The Royal College of Surgeons of England.

17) American Dental Association. Caries Risk Assessment Form (Age >6). American Dental Association, editor. Chicago, IL, USA;: American Dental Association; 2011.

18) American Society of Anesthesiologists. ASA Physical Status Classification System. American Society of Anesthesiologists: Schaumburg, IL, USA; October 15, 2014.

http://www.royalcollege.ca/portal/page/portal/rc/public

https://www.amee.org/publications

http://www.gdc-uk.org/

APPENDICES


APPENDICES Appendix I

Academic schedule (example)

R1

Oct/Nov/Dec

Preparatory courses Orientation Basic science Preclinical training

Jan/Feb/March/April/May/June/July/Aug/ Sep

Date AM PM

Sunday Treatment plan/CBD

Clinical training Clinical training

Monday Clinical training Clinical training

Tuesday Clinical training SDL

Wednesday Weekly scientific activities Interactive lectures/residents’ presentations/literature review/guest

speaker/workshops/pros and cons

Thursday Clinical training/supplementary or professional development courses lectures and workshops/community service

Clinical training/supplementary or professional development lectures and workshops/community service

R2

Oct/Nov/Dec

Research block

Jan/Feb/March/April/May/June/July /Aug/Sep

Date AM PM

Sunday Treatment plan/CBD

Clinical training Clinical training



Wednesday Weekly scientific activities

Interactive lectures/residents’ presentations/literature review/guest speaker/workshops/pros and cons

Thursday

Clinical training/supplementary or professional development courses lectures and workshops/community service

Clinical training/supplementary or professional development courses lectures and workshops/community service

R3/R4

Oct/Nov/Dec/ Jan/Feb/March/April/May/June/July/Aug/ Sep

Date AM PM

Elective module Sunday Treatment

plan/CBD Clinical training Clinical training


APPENDICES



Wednesday Weekly scientific activities Interactive lectures/residents’ presentations/literature

review/guest speaker/workshops/pros and cons/trainee selected topics

Thursday Clinical training/supplementary

lectures or workshops/community service

Clinical training/supplementary

lectures or workshops/community

service

Appendix II

Clinical Guidelines In SBRD Rota 1) All assigned comprehensive clinical cases should fulfill SBRD clinical case criteria (Appendix III

[A]). 2) Each comprehensive case is evaluated for subcriteria in: patient assessment, CRA,

periodontics, operative dentistry, endodontics, and prosthodontics (Appendix III [B–G]). 3) All assigned comprehensive clinical cases should involve skills from the three disciplines:

operative dentistry, endodontics, and fixed prosthodontics. 4) There should be full documentation of each case preoperatively, including accurate medical

and dental records, during the course of treatment and postoperatively, with clinical slides, mounted diagnostic casts, and full-mouth X-ray or orthopantomogram. Follow SBRD treatment plan protocol with regard to documentation. (Appendix IV)

5) A definitive treatment plan must be approved by the consultant-in-charge and a copy documented inside the patient’s file.

6) Each patient receiving full mouth rehabilitation should sign a consent form prior to initiating treatment, and indicate their approval of the treatment plan.

7) Residents should only consult assigned SBRD instructors in specified centers. 8) If the resident needs consultation in one or more dental specialties and there is no available

consultant at the particular training center, arrangements should be made by the Regional Training Supervision Committee to provide the necessary consultation.

9) The resident must present his/her clinical cases during the weekly case presentations and treatment planning sessions in the training center in the presence of the consultants and other residents.

10) Information on a clinical case should be presented on a typed report sheet and include the following:

Patient information (including name, sex, education, place of work, and marital status).

Chief complaint.

Dental and medical history.

Clinical examination, extra-oral and intra-oral.

Diagnostic report, e.g., X-ray, pulp viability test, laboratory test.

Diagnosis.

Proposed treatment plan.

APPENDICES


11) Resident must have his/her personal intra-oral camera to take the appropriate clinical slide documentation needed for the program.

12) Resident should have his/her personal laptop. 13) Finalized comprehensive SBRD cases ready for evaluation by the Regional Case Evaluation

Committee should have:

A special plastic file to contain the number of cases in sequence.

Hard and soft copy of case presentations.

Clinical images (preoperative, during the course of treatment, and postoperative).

X-rays taken during the preoperative and postoperative phases with dates clearly marked.

The Regional Case Evaluation Committee will prepare a report regarding eligibility for promotion for the Central Residency Committee for final evaluation and approval.

All residents will obtain an overall report on cases. 14) The resident must complete the minimum number of comprehensive cases to be eligible for

promotion and completion of the program.

Year A1 A2 A3

SBRD R1 3 - -

SBRD R2 8 4 -

SBRD R3 14 9 6

SBRD R4 20 15 12

15) Residents should complete the necessary number of single requirements per year to be

eligible for promotion and completion of the program. 16) To be eligible for graduation, all residents are required to complete the minimum number of

cases with the following RDITN complexity and score:

Item A1 A2 A3

Simple: SI and SII 8 6 4

Moderate: MI and MII 10 7 6

Complex: CI and CII 2 2 2

Minimal complexity score 24 18.5 16

17) Cases treated in SBRD clinics should follow the allotted protocol, Phases I–VI (Appendix VI). 18) Trainees should fill out SBRD assessment form for each comprehensive case. 19) Only assigned SBRD instructors with a specified code are permitted to participate in clinical

training, evaluation and sign the SBRD clinical evaluation forms following all dental procedures. All clinical evaluation forms must be collected at the Regional Training Supervisory Committee Office and then subsequently submitted to the Central Residency Training Committee.

20) Each resident should fill out the annual SBRD logbook on a daily basis, followed by the signature and stamp of the assigned clinical instructor. Any evaluation form, logbook entry, forms, or treatment plan lacking a consultant-in-charge stamp code will not be accepted by the Regional Training Supervisory Committee.

APPENDICES


Appendix III

A. Restorative Dentistry Index Of Treatment Need (RDITN)

RDITN SIMPLE (3–4 units)

Simple I (SI) IF: 1- Assessment of all subcriteria (medical, caries

risk, periodontic, operative, endodontic, prosthodontic) are classified as simple.

2- Assessment of three or fewer subcriteria (medical, caries risk, periodontal, operative, prosthodontic, endodontic) are classified as complex.

Simple II (SII) IF:

1- Assessment of four or more subcriteria (medical, caries risk, periodontal, operative, endodontic, prosthodontic) are classified as complex.

RDITN MODERATE (5–9 units)

Moderate I (MI) IF: 1- Assessment of all subcriteria (medical, caries

risk, periodontal, operative, endodontic, prosthodontic) are classified as simple.

2- Assessment of three or fewer subcriteria (medical, caries risk, periodontal, operative, endodontic, prosthodontic) are classified as complex.

Moderate II (MII) IF:

1- Assessment of four or more subcriteria (medical, caries risk, periodontal, operative, endodontic, prosthodontic) are classified as complex.

RDITN COMPLEX (10 or more units)

Complex I (CI) IF: 1- Assessment of all subcriteria (medical, caries

risk, periodontal, operative, endodontic, prosthodontic) are classified as simple.

2- Assessment of three or fewer subcriteria (medical, caries risk, periodontal, operative, endodontic, prosthodontic) are classified as complex.

3- MI or MII cases with 7–9 units and ≤10 occluding pairs (short dental arch).

Complex II (CII) IF:

A. Assessment of four or more subcriteria (medical, caries risk, periodontal, operative, endodontic, prosthodontic) are classified as complex.

APPENDICES


B. RDITN/medical assessment Physical status classification system (ASA, 2014)

ASA 1 A normal healthy patient

ASA 2 A patient with mild systemic disease without substantive functional limitations

ASA 3 A patient with severe systemic disease with substantive functional limitations

ASA 4 A patient with severe systemic disease that is a constant threat to life

ASA 5 A moribund patient who is not expected to survive without the operation

ASA 6 A patient declared brain-dead and whose organs are being removed for donor purposes

Simple medical history Complex medical history

ASA 1–2 ASA 3–5 Medical history that significantly affects clinical management and outcome/need for premedication.

APPENDICES


RDITN/Caries Assessment

CARIES RISK ASSESSMENT

Patient name

Age

Date

Low risk Moderate risk High risk

Contributing conditions Check or circle the conditions that apply

I Fluoride exposure (through drinking water, supplements, professional applications, toothpaste)

Yes

No

II Sugary foods or drinks (including juice, carbonated or non-carbonated soft drinks, energy drinks, medicinal syrups)

Primarily at meal times

Frequent or prolonged between meal exposures/day

III Caries experience of mother, caregiver and/or other siblings (for patients aged 6–14 years)

No carious lesions in last 24 months

Carious lesions in last 7

23 months Carious lesions in last 6 months

IV Dental home: established patient of record, receiving regular dental care in a dental office

Yes No

General health conditions Check or circle the conditions that apply

I Special health care needs (developmental, physical, medical or mental disabilities that prevent or limit performance of adequate oral health care by themselves or caregivers)

No

Yes (over age 14)

Yes (ages 6-14)

II Chemo/radiation therapy No

Yes

III Eating disorders No

Yes

IV Medications that reduce salivary flow No

Yes

V Drug/alcohol abuse No

Yes

Clinical conditions Check or circle the conditions that apply

I Cavitated or non-cavitated (incipient) carious lesions or restorations (visually or radiographically evident)

No new carious lesions or restorations in last 36 months

1 or 2 new carious lesions or restorations in last 36 months

3 or more carious lesions or restorations in last 36 months

II Teeth missing due to caries in past 36 months No

Yes

III Visible plaque No

Yes

APPENDICES


IV Unusual tooth morphology that compromises oral hygiene

No

Yes

V Interproximal restorations - 1 or more No

Yes

VI Exposed root surfaces present No

Yes

VII Restorations with overhangs and/or open margins; open contacts with food impaction

No

Yes

VIII Dental/orthodontic appliances (fixed or removable) No

Yes

IX Severe dry mouth (xerostoma) No

Yes

Circle or check the boxes of the conditions that apply.

Low risk: only conditions in “low risk” column present.

Moderate risk: only conditions in “low” and/or “moderate risk” columns present.

High risk: one or more conditions in the “high risk” column present.

Simple CRA criteria Complex CRA criteria

1- Low caries risk score 2- Moderate caries risk score

1- High caries risk score

B. RDITN/Periodontal Assessment Criteria

Basic periodontal examination

0 No bleeding or pocketing detected

1 Bleeding on probing - no pocketing exceeding 3.5 mm

2 Plaque retentive factors present - no pocketing exceeding 3.5 mm

3 Pockets 3.5 mm to 5.5 mm in depth (color-coded area partially visible)

4 Pockets > 5.5 mm in depth

APPENDICES


Simple and complex periodontal assessment

Simple periodontal assessment Complex periodontal assessment

1. BPE 1–3 in all sextants 1. BPE score of 4 in any sextant. 2. BPE score of 3 or 4 or in patients under 35 years

of age. 3. Smoking 10+ cigarettes a day. 4. A concurrent medical factor that is directly

affecting the periodontal tissue. 5. Root morphology that adversely affects

prognosis. 6. Rapid periodontal breakdown >2 mm

attachment loss in one year. 7. A high percentage of bleeding on probing in

relation to a low plaque index. 8. A history of treatment for periodontal disease. 9. A family history of early tooth loss due to

periodontal disease. 10. Observe bone loss on sequential radiographs.

C. RDITN/Operative Assessment Criteria

SIMPLE OPERATIVE CRITERIA COMPLEX OPERATIVE CRITERIA

1- Direct restorations (regardless of number) 2- Pit and fissure sealants (regardless of

number) 3- Enameloplasty/Reshaping 4- Direct veneers (regardless of number) 5- Intracoronal restoration inlays/onlays (≤2) 6- In-home bleaching, office bleaching,

microabrasion 7- Diastema closure (direct restoration) 8- Intracoronal bleaching (≤2) 9- Indirect veneers (≤4)

1- Indirect veneers (≥5) 2- Intracoronal restoration inlays/onlays (≥3) 3- Intracoronal bleaching (≥3)

Once a single complex component is present in the definitive treatment plan, the RDITN operative assessment is categorized as “complex".

APPENDICES


D. RDITN/Endodontic Assessment Criteria

SIMPLE ENDODONTIC CRITERIA COMPLEX ENDODONTIC CRITERIA

1. Single/multiple root canals with curvature ≤40° to the root axis that are considered negotiable from radiographic or clinical evidence through their entire length.

1. Single/multiple root canals with curvature >40° to root axis that may or may not be considered negotiable from radiographic or clinical evidence through their entire length.

2. No root canal obstruction or damaged access.

2. Incomplete root development

3. Require incision and drainage 3. Teeth with iatrogenic damage or pathologic resorption

4. Teeth with difficult root morphology

5. Retreatment

6. Periradicular surgery

All teeth requiring RCT should be evaluated and classified as either Simple “S” or Complex “C” according classification criteria.

≥50% of RCT teeth have been diagnosed as “Complex”; the RCT classification will be assessed as “Complex”.

If the tooth has been extirpated and/or instrumented but not obturated, then it should be categorized according to clinical and radiographic findings in accordance with the RCT Classification Index.

APPENDICES


E. RDITN/Prosthodontic Assessment Criteria

SIMPLE PROSTHODONTIC CRITERIA COMPLEX PROSTHODONTIC CRITERIA

1. Abutments contained in posterior in simple

cases (3–4 units)

2. 1–2 implant fixtures in moderate cases (5–9

units)

3. 1–3 implant fixtures in complex cases (≥10

units)

4. Class I, Class II Division 1 and 2, Class III

molar/canine relationship

5. Class I skeletal relationship

6. No occlusal preprosthetic therapy is

required

7. Occlusion requires localized adjunctive

therapy (e.g., enameloplasty on premature

occlusal contacts)

8. Moderate cases (5–9 units) with abutments

not exceeding 2 sextants

9. Minor soft tissue procedures

10. Minor hard tissue procedures

11. Simple orthodontic therapy (spacing,

extrusion, intrusion, uprighting)

12. Simple implant placement, no

augmentation required

1. Abutments that include anterior in simple

cases (3–4 units)

2. Implant fixtures regardless of number for

simple cases (3–4 units)

3. 3 or more implants in moderate cases (5–9

units)

4. 4 or more implant fixtures in complex cases

(≥10 units)

5. Class II and III skeletal relationship

6. Entire occlusion must be re-established but

without any changes in the occlusal VD

7. Entire occlusion must be re-established

including any changes in the occlusal VD

8. Moderate cases (5–9 units) with abutments in

3 or more sextants

9. Complex cases (≥10 units) with an entire arch

restored by implant-supported prosthesis

10. Symptoms of TMJ dysfunction

11. Parafunction

12. Moderate cases (only in cases with 7–9 units)

and 10 occluding pairs (short dental arch)

13. Complex implant placement, augmentation

required

14. Hard tissue augmentation required

15. Surgical correction of dentofacial deformities

(congenital or acquired)

16. Full arch orthodontic therapy

17. Orthognathic surgery

All criteria should be evaluated and classified as either Simple “S” or Complex “C”.

If any of the complex criteria are found, the “prosthodontic classification" will be judged as “Complex”.

APPENDICES


Appendix IV

CASE APPROVAL FORM

Resident’s name: __________________________________________________________________ Resident’s no.: ____________________________________________________________________ Date: ______________________________ Case no.: ____________________________________

A. Appropriate documentation Fully Performed Partially Performed Not Performed

1. Medical and dental history

2. Chief complaint

3. Dental charting

4. Extra-oral examination: Face, lymph nodes, TMJ, muscles

5. Intra-oral examination: Teeth, mouth opening, periodontium, mucosa, tongue

6. Clinical test for suspected teeth: thermal percussion, palpation, bite

7. Preoperative

orthopantomogram

8. Preoperative 20 cm

9. Intra-oral pictures, 5 views

before treatment

10. Mounted diagnostic casts

11. Diagnostic wax-up

12. Diagnosis

13. Treatment plan

Not performed

APPENDICES


14. Postoperative

orthopantomogram

15. Postoperative 20 cm

16. Picture during treatment

17. Intra-oral pictures: 5 views

after treatment

Assessed by: _______________________________________________________________________ Signature: ____________________________________________ Case fits SBARD requirement Yes No Case: Accepted Rejected

Appendix VI

CASE REPORT EVALUATION FORM

Name: Resident year:

Ex

cellen

t (5

)

Very

goo

d (

4)

Av

era

ge (

3)

Belo

w a

vera

ge (

2)

Poo

r (1

)

Poo

r (1

)

No

n-a

pp

lica

ble

(0

)

Training center: R1 R2

R3 R4

Region:

□ Central □ Eastern □ Western

POINTS OF EVALUATION

1 Abstract

2 Clinical case documentation:

Appropriate documentation of critical informative data: patient

gender, age, medical/dental history, chief complaint,

medications prescribed, previous procedures, or any appliances

constructed.

All critical diagnostic tests, examinations, or procedures have

been recorded.

3 Appropriate treatment plan

4 Successful in declaring the various treatment options

(alternative treatment plans)

5 Quality of treatment rendered

APPENDICES


6 Supports treatment plan with pertinent literature

7 Quality of presentation

Slide quality (with regard to type of fonts, no conflicting

backgrounds, and an absence of grammatical errors).

Organization in delivering an informative presentation.

Effective use of figures and/or tables if required.

High-quality photographs and radiographs.

Detailed documentation of treatment steps.

8 Knowledge

9 Professionalism during presentation

Conduct and demeanor during presentation, including behavior

in discussion and response to criticism

10 Time management

Comments

……………………………………………………………………………………………………………

……………………………………………………………………………………………………………

……………………………………………………………………………………………………………

……………………………………………………………………………………………………………

Evaluator information:

Consultant name: _______________________________________________________________ Signature: ___________________________________ Date/time: __________________________

Total score

_________________ × 20=____ %

No. of evaluation items

APPENDICES


Appendix VII

Resident’s Presentation Rating Form

Trainee name: Level: Date of presentation: Topic: Please use the following scale to evaluate the presentation:

Very weak Weak Acceptable Good Very Good Not applicable

1 2 3 4 5 N/A

Medical expert 1 2 3 4 5 N/A

- Demonstrated thorough knowledge of the topic - Presented at the appropriate level and with adequate

details

- Well-prepared, knew content and answered questions Comments (optional)

Communicator - Provided objectives and an outline - Presentation was clear and organized - Used effective methods and presentation style - Established good rapport with the audience Comments (optional)

Collaborator - Invited comments from learners and led discussions - Worked with supervisor/team effectively in preparing

the session

Comments (optional)

Health advocate - Managed time effectively - Addressed preventive aspects of care Comments (optional)

Scholar - Posed appropriate learning questions - Accessed and interpreted the relevant literature

APPENDICES


Comments (optional)

Professional - Maintained patient confidentiality if clinical material

was used

- Identified and managed relevant conflicts of interest - Supported conclusions with relevant convincing

evidence

Comments (optional)

Overall performance Did not meet

expectations Short of expectations

Met expectations

Exceeded expectations

Far exceeded expectations

Comments:

Evaluator name:_____________________________________________________________________ Evaluator signature: _________________________________________________________________

APPENDICES


Appendix VIII

Mini-Clinical Evaluation Exercise Rating Form

Trainee name SCFSH #

Residency

level

Date

Brief summary of case:

CASE NEW FOLLOW-UP

COMPLEXITY LOW MODERATE HIGH

FOCUS DATA GATHERING THERAPY OTHERS

DIAGNOSIS COUNSELING

SCORE FOR STAGE OF TRAINING

Criteria Unsatisfactory Satisfactory Superior

1 2 3 4 5 6 7 8 9

Posture History-taking Physical examination skills

Communication skills

Critical judgment Humanistic quality/professionalism

Organization and efficiency

Overall clinical care

Suggestions for development:

Evaluator’s Name: ___________________________________________________________________ Signature: _________________________________________________________________________

APPENDICES


Description of Criteria

DESCRIPTION OF CRITERIA

Posture Sitting posture on the chair/operative position and gaining

access/positioning the patient

History-taking Facilitates patient’s narrative; uses appropriate questions to obtain accurate, adequate information effectively; responds to verbal and nonverbal cues appropriately

Physical examination skills Follows an efficient, logical sequence; examinations are

appropriate for clinical problems provides patients with

explanations; is sensitive to patients’ comfort and modesty

Communication skills Explores patients’ perspectives; jargon-free speech; open and honest; empathetic; agreement on management plans and therapies with patients

Critical judgment Forms appropriate diagnoses and suitable management plans; orders selectively and performs appropriately diagnostic studies; considers risks and benefits

Humanistic

quality/professionalism

Shows respect, compassion, and empathy; establishes trust; attends to patient’s comfort and needs; respects confidentiality; behaves in an ethical manner; is aware of legal

frameworks and his or her own limitations

Organization and efficiency Prioritizes; is timely and succinct; summarizes

Appendix IX

Case-Based Discussion Rating Form

Trainee name SCFSH #

Residency level Date

Brief summary of case:

CASE NEW FOLLOW-UP

COMPLEXITY LOW MODERATE HIGH

FOCUS DATA GATHERING THERAPY OTHERS

DIAGNOSIS COUNSELING

APPENDICES


Assessment

SCORE FOR STAGE OF TRAINING

CRITERIA UNSATISFACTORY SATISFACTORY SUPERIOR

1 2 3 4 5 6 7 8 9

Clinical case documentation

• Appropriate documentation of critical

informative data: patient gender, age,

medical/dental history, chief complaint,

medications prescribed, previous

procedures or any appliances constructed.

• All critical diagnostic tests

Appropriate treatment plan

Consultations and referrals

Successful in stating the various treatment

options (alternative treatment plans)

Supports treatment plan with pertinent literature

Knowledge

Professionalism

Leadership/managerial skills

Overall performance

Suggestions for development:

Evaluator’s Name: ___________________________________________________________________

Evaluator’s Signature: ________________________________________________________________

APPENDICES


Appendix X

In-Training Evaluation Report

Trainee name SCFSH# Training center

Level of training Rotation dates

Competencies

Meeting

Rarely Inconsistently Generally Exceeds N/A

Medical expert Score Weight %

Appropriate basic knowledge

Subtotal:

__/100 50

Accurate history and physical examination

Appropriate clinical decisions

Appropriate emergency management

Appropriate indication for procedures

Performance before, during and after procedures

Clinical skills proficiency

Communicator

Appropriate interaction with patient/family/others

Subtotal:

__/100 15

Accurate documentation

Appropriate planning

Clear presentation

Collaborator

Appropriate interaction with health professionals

Subtotal:

__/100 5 Appropriate consultations

Appropriate management of conflict

APPENDICES


Leader/Manager

Appropriate use of information technology

Subtotal:

__/100 10

Appropriate understanding of resources

Appropriate time management

Follows policies and procedures

Maximizes benefits to patients

Health advocate

Appropriate response to patients’ health needs

Subtotal: __/100

5 Appropriate promotion and participation in patient safety

Scholar

Participates in appropriate medical education activities

Subtotal: __/100

10

Implements an ongoing plan for self-education

Analyzes and integrates medical information

Teaches others

Completion of the electronic logbook

Professional

Appropriate professional attitude

Subtotal:

__/100 5

Understands medical and legal obligations

Punctual

Maintains ethics and moral standards

Accepts advices

Participates in professional organizations

APPENDICES


Total Score:

/100

100

Comment on the strengths and weaknesses of the candidate. Make direct reference to the objectives and give

specific examples wherever possible.

Evaluation methods Mini-CEX5

DOPS6

OSCE7

MCQ 8 Others (specify):

Residency training committee approval Meeting No. Date

Program director’s name: Date Signature

Trainee name: Date Signature

* Rarely ≤30%; inconsistently >30–60%; generally >60–90%; exceeds >90%

Appendix XI

Treatment Plan Phases

PHASE I PHASE II PHASE III PHASE1V PHASE V PHASE VI

PREVENTIVE PHASE ENDODONTIC PHASE OPERATIVE PHASE

PRE-PROSTHODONTIC SURGICAL PHASE

PROSTHODONTIC PHASE

RECALL AND MAINTENANCE

This consists of two parts: emergency management and stabilization

Emergency: To manage any dental emergency to control patient’s symptoms

1. Medical history 2. Acute infection management,acute pain management, esthetic emergencies

Stabilization: Objectives – to control disease process, educate the patient, and establish patient-doctor relationship

A. Diagnosis and risk assessment 1. Diagnosis - Medical history

- Dental history - Diet history - Radiographic evaluation - Soft/hard tissue evaluation - Dental consultations (periodontic orthodontic, surgery)

- Other necessary diagnostics(pulp vitality tests, cephalometricanalysis, smile analysis,

Objectives – eliminate infection, eliminate secondary periodontal involvement, reassessment of restorability of teeth, assessment of appropriate treatment modality per case and outcome.

A. Establish a definitive endodontic treatment plan

B. Management of vital pulp (prevention of pulp damage, reversible or irreversible)

C. Management of traumatic injuries

D. Root canal therapy of all non-vital dentition and restore with a provisional restoration

E. Assessment and preparation of endodontic cases requiring surgery

Objectives – eliminate caries, restore function, restore esthetics, maintain healthy periodontium, and restore dentition to a maintainable level A. Establish a

definite operative treatment plan

B. Restore all carious teeth with permanent restorations

C. Bleaching performed prior to placement of definitive restorations

D. Assessment and preparation of teeth

A. Cases that require extensive prosthodontic management- alteration of vertical dimension/plane of occlusion or esthetic considerations require additional pre-treatment steps:

- Final evaluation of occlusion, mounted diagnostic casts

- Occlusal analysis

- Diagnostic wax-up

- Fabrication of provisionals, templates and surgical stents

B. Restoration of endodontically treated teeth, post and cores

A. Fabrication and delivery of definitive prosthesis:

- Crowns/fixed partial dentures

- Implant-supported prosthesis

- Occlusal appliance

B. Fabrication of restorations postponed to Phase V such as: porcelain veneers or onlays constructed to correct anterior guidance, or alter the occlusal plane

Establish recall and maintenance plan according to the Caries Risk Assessment and complexity of treatment received

APPENDICES


mounted diagnostic casts, charting) - Fill SBARD treatment plan forms - 2. Risk assessment

- General health - Patient expectations - Diet analysis (Tufts diet evaluation) and recommendations

- CRA - Periodontal assessment - Parafunction and/or habits

a. Tentative treatment plan

Inform the patient that implementation of the plan depends on the outcome of the stabilization phase

b. Periodontal initial preparation- Oral hygiene instructions – prescriptions and instructions foruse of hygiene aids in accordance with CRA category

- i.e., toothbrush, flossing, chlorhexidine - SCRP/prophy - Extraction of non-restorable and/or periodontal involved teeth

- If needed, placement of a transitional partial/complete denture. Placement of a provisional fixed restoration and permanent alteration of teeth should be avoided until patient compliance or commitment has been demonstrated.

Re-evaluation # 1: Evaluate outcomes of periodontal initial preparation and patient compliance Caries control

- Extraction of non-restorable carious teeth - Excavation of extensive caries and placement of provisional restorations - In case of pulp exposure proceed by doing a pulpectomy restored with a provisional restoration Re-evaluation # 2: Evaluate outcome of initial preparation and patient compliance

requiring periodontal treatment (insufficient tooth structure or smile analysis)

E. Veneers or intracoronal restoration in a complex therapy requiring altering the occlusion can be postponed to Phase V

C. Refine provisional restorations and establish a final functional occlusal scheme D. Surgical plan: periodontal surgery/prosthetic surgery/endodontic surgery/implant placement as needed E. Orthodontics if needed Re-evaluation #3

Evaluate oralhygiene andpatient compliance

Evaluate hard and soft tissuehealth

Evaluation offunction, speech,esthetics ofprovisionalrestorations

· Acquire competence and confidence in the various restorative clinical disciplines (operative...

Documents

Transcript of · Acquire competence and confidence in the various restorative clinical disciplines (operative...