Practical Examination Handbook November 2014 -1- © Copyright 2012 Updated 1 Sept 2014 This work is copyright 2012. Copyright is held by the Australian Dental Council Ltd. It may not be reproduced for commercial use or sale. Reproduction requires a licence or written permission which may be obtained from: Australian Dental Council Ltd Po Box 13278 Law Courts Victoria 8010 Australia Tel +61 (0) 3 9657 1777 www.adc.org.au -2- Australian Dental Council Contents INTRODUCTION ................................................................................................... 5 VENUE ALLOCATIONS AND REQUIREMENTS ............................................... 5 REGISTRATION AND OTHER DENTAL BOARD OF AUSTRALIA REQUIREMENTS .................................................................................................. 6 CANDIDATE CONTACT INFORMATION ........................................................... 6 WITHDRAWING FROM AN EXAMINATION ...................................................... 6 CONTENT AND FORMAT .................................................................................... 7 EXAMINATION SCHEDULE ................................................................................ 7 EXAMINATION REGISTRATION ......................................................................... 8 EQUIPMENT, INSTRUMENTS AND SUPPLIES .................................................... 8 TRANSITIONAL WRITTEN EXAMINATION .......................................................... 8 EXAMINATION INSTRUCTIONS ......................................................................... 9 EXAMINATION CONDUCT POLICY ................................................................. 11 TIME EXTENSION POLICY................................................................................ 12 ADVERSE INCIDENT POLICY .......................................................................... 12 ASSESSMENT TASKS ....................................................................................... 13 ASSESSMENT CRITERIA .................................................................................... 14 Grade Derivation Grid ........................................................................................................ 14 Final Result Grade Derivation Grid .................................................................................. 14 ASSESSMENT CRITERIA .................................................................................... 15 Class III Composite Cavity Preparation ........................................................................... 15 Class II Amalgam Cavity Preparation ............................................................................... 16 Full Gold Crown Preparation............................................................................................. 17 Metal-ceramic Crown Preparation .................................................................................... 18 Endodontic Access Preparation ....................................................................................... 19 -3- Provisional Crown Restoration ......................................................................................... 20 Class II Composite Resin Restoration ............................................................................. 21 Class IV Composite Resin Restoration ............................................................................ 22 Class II Amalgam Restoration........................................................................................... 23 Radiographic exercise ............................................................. Error! Bookmark not defined. Rubber Dam Application ................................................................................................... 25 Record of Procedures ........................................................................................................ 26 Infection Control ................................................................................................................. 28 Clinical Communication .................................................................................................... 30 RESULTS.............................................................................................................. 31 VERIFICATION, REVIEW AND APPEAL ............................................................. 31 REPEATS ............................................................................................................. 31 -4- Introduction This information has been prepared for candidates of the Australian Dental Council (ADC) Practical Examination. The information booklet should be used in conjunction with the information on the ADC website. Under the provisions of the Health Practitioner Regulation National Law Act 2009 the Australian Dental Council (ADC) has been assigned the accreditation functions for the Dental Board of Australia. One of the key accreditation functions is the assessment of the knowledge, judgement, clinical skills and professional attributes of overseas qualified dentists who are seeking registration with the Dental Board of Australia to practise in Australia and whose qualifications are not otherwise approved for registration. ADC is the national assessment authority by the Department of Immigration and Border Protection to assess professional skills for migration purposes. The ADC assessment and examination procedure consists of the following steps: 1. Initial Assessment of Professional Qualifications in Dentistry 2. Written Examination 3. Practical Examination The format of the ADC examination process has been approved for the purposes of registration in Australia. The ADC cannot vary the format of the examination, or grant exemptions from the requirements of the examinations. Venue Allocations and Requirements The Practical Examination is held over two days at various venues in Australia. They are held twice per year, in June and November. Candidates applying to sit the Practical Examination must have a valid Written Examination and English language test result at the closing date of the relevant examination. The Written Examination is valid for three years (3) years from the date that results are notified to candidates via the online Candidate Portal or the letter of notification of results. English language test results are valid for two (2) years from the date of the OET or IELTS examination. Candidates can apply to sit either the June or the November Practical Examination. Candidates will select the venue that they wish to sit the examination using the online portal on the ADC website (www.adc.org.au), and then must submit an application form and the relevant examination fee within two (2) weeks, in order to confirm their booking. The ADC reserves the right to remove a candidate’s provisional booking if they repeatedly make a provisional booking but fail to submit an application form and payment. After successful submission of an application form and payment, candidates will receive confirmation of their allocation to the examination, and also receive an information pack relevant to their particular venue. The venues in which the ADC examinations are held are usually clinics within dental hospitals or university dental schools. Each venue has its own requirements that must be met by ADC candidates. -5- Registration and other Dental Board of Australia Requirements As the examination format does not involve the treatment of patients, candidates are no longer required to provide evidence of immune status but will be required to have ascertained this before being registered. The ADC and the DBA will share candidate information where it is necessary for the proper functioning of the examination. This may include: candidate contact details, names of candidates listed for particular examination sessions, information relating to professional indemnity insurance, names of candidates with limited registration for examination purposes. Following the examinations, the ADC provides the DBA with the name and details of candidates who have successfully completed the Practical Examination and been awarded the ADC Certificate (General Dentist). Candidate Contact Information Candidates must notify the ADC of any change in mailing address immediately in writing. Information may not be reissued to candidates who fail to advise the ADC or employ a suitable mail redirection service from their previous address. Timetables and urgent information may be communicated to candidates via their nominated email address. Candidates must ensure the email address they provide is reliable and checked regularly. Candidates who use free webmail services (Gmail, Yahoo, Hotmail, etc) should properly maintain their mailboxes. The ADC will not accept responsibility for nonreceipt of correctly addressed emails. Withdrawing from an Examination Candidates withdrawing from an examination should contact the ADC in writing. An intention to withdraw can be sent by email if the date of the examination is imminent and a withdrawal letter, together with any supporting documentation, has been posted to the ADC. Withdrawal notification will not be accepted by telephone. The ADC’s response will be made to the candidate in writing. Candidates will forfeit 20% of their examination fees if their withdrawal from an examination is received before the closing date for that examination session. Those candidates whose withdrawal is received after the closing date for the examination series will forfeit 50% of their examination fees. Candidates who withdraw within four weeks of the examination date will forfeit the whole fee unless their withdrawal is due to acceptable medical grounds, supported by a medical certificate – in which case they forfeit 40% of the fee. Failure to undertake the examination because of an inability to obtain necessary visas or to arrange travel, etc will be considered a withdrawal and fees will be forfeited. -6- Content and Format During the two day Practical Examination, participants will be evaluated on their performance of dental procedures on simulated patients (manikins) in a clinical setting. Each day participants will be issued a: 1. Typodont model mounted in a manikin on a dental chair. The typodont will be labelled with the participant’s ID number. 2. Selected teeth for practice preparations. 3. Detailed list of required procedures for that day specifying tooth numbers and surfaces. 4. Scheduled time to perform the Rubber Dam, Communication and/or Radiology tasks. Examination Schedule The following is an indicative schedule for the Practical Examination. More detailed information will be provided to candidates who enrol for the examination. TRANSITIONAL WRITTEN EXAM (Friday before the Practical Examination) For those candidates who have passed the Written (Preliminary) Examination prior to 2014, and for all Public Sector Dental Workforce Candidates. Validation of registration 9:00 a.m. - 9:30 a.m. Transitional exam 10:00 a.m. - 12:00 noon ORIENTATION (Friday before the Saturday examinations commence) Orientation lecture 2:00 p.m. – 3:00 p.m. Validation of registration 7:30 a.m. - 8:00 a.m. Orientation and instructions 8:00 a.m. - 8:30 a.m. Set up 8:30 a.m. - 9:00 a.m. Clinical procedures on simulated patients 9:00 a.m. - 4:30 p.m. Validation of registration 7:30 a.m. - 8:00 a.m. Set up 8:00 a.m. – 8:30 a.m. Clinical procedures on simulated patients 8:30 a.m. - 4:00 p.m. DAY 1 DAY 2 -7- Examination Registration During the validation of registration participants will be issued an Identification (ID) badge. To receive the ID badge, participants will be required to show current government photo identification (i.e. a current passport or driver’s licence) for comparison to the ID badge. The participant’s name on the government photo identification must match the name used by the participant to register with the ADC for the Practical Examination. Participants who do not provide government photo identification will not be admitted into the examination. Participants must have their ID badge visible at all times and must submit them as directed at the end of the Assessment. Participants who fail to submit their ID badge may receive a fail grade for all requirements in the Assessment. Equipment, Instruments and Supplies Standard equipment and materials will be provided for these exercises. Candidates will not be permitted to supply their own instruments or handpieces. Detailed instrument information will be provided to candidates as part of their venue pack. Please note that dental burs will not be provided. Candidates are required to bring all relevant burs to the exam. The dental clinic at the Assessment Centre will NOT be accessible prior to the Assessment. Candidates are advised to bring a small clock or watch to the examination. Candidates will not be permitted to use phones, laptop computers, tablets or other devices to monitor the time. Transitional Written Examination In the transition period to the new examination format, candidates who have completed the old Preliminary Written Examination will be required to sit the Transitional Written Examination as part of the Practical Examination process. This will be a two hour multiple choice examination paper consisting of scenario-based and stand-alone questions. The Transitional Written Examination will be held on the Friday immediately prior to the weekend practical examination. All Public Sector Dental Workforce Scheme Candidates will be required to sit the Transitional Written Examination. Candidates who pass the Transitional Written Examination but fail the Practical Examination will not be required to re-sit the Transitional Written Examination. -8- Examination Instructions 1. At the beginning of each day, the list of tasks for the day will be distributed. There will be three timetabled assessment tasks – Rubber Dam, Radiographs and Communication. Candidates will be allocated 30 minutes for the Rubber Dam task on one day, and will be allocated 15 minutes each for the Radiograph task and the Communication task on the other day. Candidates may perform the other requirements for the day in any order. 2. Participants are not permitted to remove teeth from typodonts, nor are they permitted to remove typodonts from the manikins. 3. Participants are not permitted to have extra typodont teeth in the assessment area. 4. If there are problems with any of the teeth, typodonts or manikins, candidates should bring this to the attention of the examination convenor as soon as possible, to rectify if necessary. 5. If a candidate experiences an adverse incident during the examination, it is their responsibility to bring it to the attention of one of the invigilators immediately. The invigilator can then complete an Adverse Incident form. The ADC will not be able to take into consideration any adverse incidents that are reported to the ADC after the examination. 6. Participants must wear eye protection, masks, gowns and gloves whilst undertaking any simulated clinical activity. The venue will supply gowns, masks and gloves, but participants must provide their own eye protection. 7. Participants may use magnification aids and may take breaks whenever needed. 8. There will be a mandated 45 minute lunch break scheduled for each day. 9. Participants who start or complete a procedure other than an identified requirement on an identified tooth or practice tooth will receive a fail grade for that requirement. 10. Participants are responsible for their own supplies. The ADC and the Assessment Centre will not be held responsible for personal supplies left unattended. 11. Participants are financially responsible for any damage caused to any supplied equipment. 12. During the Assessment, participants must demonstrate competency in performing procedures in a clinical environment. Although there are no criteria for evaluating the posture of a participant, procedures must be performed in anatomically acceptable positions. Invigilators will direct participants to correct unacceptable positions. Any participant who continues to work with the manikin in an unacceptable position may be dismissed from the Assessment. Examples of unacceptable positions include: the manikin’s head positioned so that a patient would be uncomfortable the manikin’s neck extended so that a patient would be uncomfortable the participant inappropriately leaning on or contacting the patient’s torso or head. -9- 13. The typodont models used for the restorative exercises are the ADC Models from One Dental. A variety of teeth may be used, some of which are plain Ivorine, and others with simulated enamel/dentine. Some of the simulated enamel/dentine teeth may also have simulated caries. Plain Ivorine: These teeth are of uniform colour and consistency. Simulated enamel: The simulated enamel is white in colour and is made of composite resin that is harder than the simulated dentine and simulated caries. The teeth have been manufactured so that procedures may be performed using normal pressure with a dental bur and, if desired, finishing can be done using normal pressure with sharp hand instruments. Simulated dentine: The simulated dentine is yellow in colour and is softer than the simulated enamel Simulated caries: Currently we are using two forms of teeth that have simulated caries present. Some have simulated caries placed by the manufacturers and some are pre-prepared and filled with Cavit to simulate caries. For those enamel/dentine teeth with simulated caries the manufacturing process ensures that the caries depth is standardized for each tooth used. The simulated caries in dentine is grey in colour and is softer than the simulated enamel but of similar hardness to the simulated dentine. In anterior teeth, there is also a cavitation (hole) in the simulated enamel on the proximal surface(s). This cavitation extends through the simulated enamel into the simulated dentine and must be included as part of the preparation. The manufacturing process for teeth with simulated caries ensures that caries depth is standardized for each tooth used as part of the Assessment. As a result of the manufacturing process, there may be a small cement-filled space between the simulated enamel and the simulated dentin which may appear grey in colour. This is not simulated caries. Simulated pulp chamber and canals: The simulated dental pulp chamber and canals are hollow spaces lined with red colouring. Please Note: The use of metal hand instruments in cavity preparations will leave a grey stain. 14. The FDI two digit tooth numbering system (below) is used for all Assessments. FDI NUMBERING SYSTEM PERMANENT DENTITION 18 48 17 47 16 46 15 45 14 44 13 43 12 42 11 41 21 31 22 32 23 33 24 34 RIGHT 25 35 LEFT PRIMARY DENTITION 55 85 54 84 53 83 52 82 51 81 61 71 RIGHT 62 72 63 73 64 74 LEFT - 10 - 65 75 26 36 27 37 28 38 Examination Conduct Policy Candidates will be required to provide a signed statement at the examination registration indicating that they have read and understood the following Examination Conduct Policy, and agree to abide by the following conditions of the examination: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Participants must be punctual for both days of the examination. Participants arriving late for an examination WILL NOT be given any extra time to complete the examination. The dental clinic at the Examination Centre WILL NOT be accessible prior to the examination. Space at the Examination Centre is provided ONLY for participants. Family and friends will not be admitted. Standard equipment and materials will be provided for the examination exercises. Candidates will be able to supply their own dental materials, but WILL NOT be able to supply their own instruments or handpieces. Please note that dental burs will not be provided. Candidates are required to bring all necessary burs to the examination. At the beginning of each day, the list of tasks to be completed for the day will be distributed. The application of the rubber dam, communication and the radiography exercises will be timetabled for each individual candidate. Participants may perform the remaining requirements for the day in any order. Food and/or drink (including water) are not allowed in the examination room unless special consideration for medical reasons has been granted by the ADC office. A written request to the ADC office must include a medical certificate signed by a doctor indicating the accommodation measures required. Candidates MUST NOT bring any electronic devices (including but not limited to mobile phones, personal computers and tablet devices, cameras and other recording devices) into the examination room. Candidates MUST NOT bring this handbook, dental textbooks or other written material into the examination room. Candidates are not permitted to remove teeth from typodonts, nor are they permitted to remove typodonts from the manikins. Candidates are not permitted to have extra typodont teeth in the examination area. Candidates must wear eye protection, masks and gloves as if they were treating patients (not using simulation). Candidates must manage excess amalgam appropriately and ensure that their work areas are left clean. Candidates may use magnification aids and may take breaks whenever needed. Candidates who start or complete a procedure other than an identified requirement on an identified tooth or practice tooth will receive a fail grade for that task. Candidates are financially responsible for any damage caused to any supplied equipment. The ability of participants to read, interpret and comply with instructions and other written material is part of the examination. Examination supervisors and invigilators will not answer questions involving content. Participants must stop working and leave the examination room at the indicated ending time. Participants who refuse to leave the examination room at the indicated ending time will be given a fail grade for all requirements that day. - 11 - 19. 20. 21. Participants who do not abide by the above Regulations will be given a fail grade for all requirements that day. A participant who considers themself disadvantaged by an adverse event beyond the participant’s control, occurring either immediately before or during the examination must inform the supervisor or invigilator immediately and may ask that the ADC void the results of the examination. Post examination advice of an adverse event will not be accepted. I have received and read the ADC Practical Examination Handbook Time Extension Policy If a candidate experiences problems with equipment, it is acceptable for them to ask a member of staff for assistance. If there is a problem with equipment that the ADC or Examination Venue has provided, and the candidate loses more than 30 minutes of assessment time, they can ask to complete a Time Extension form to request an extension. It is important to note that the examination already has an extra 30 minutes of time built-in to the Assessment, and generally delays of less than 30 minutes will not be granted a time extension. Candidates may be moved to another bay in order to solve problems with non-functioning equipment. Candidates will not be granted a time extension for problems that arise with anything that they have supplied for the examination. Adverse Incident Policy If a candidate experiences an adverse incident during the examination, it is their responsibility to bring it to the attention of one of the examiners immediately. The invigilator can then complete an Adverse Incident form. The ADC will not be able to take into consideration any adverse incidents that are reported to the ADC after the examination. Adverse incidents include situations that are beyond the control of the candidate that are likely to affect their performance in the examination, for example chair malfunction or a broken typodont. Personal illness and minor incidents that are readily rectified (i.e. a loose tooth that is tightened before work commences) would not usually warrant the completion of an Adverse Incident form. - 12 - Assessment Tasks Participants will be required to perform 12 tasks from the following list. The tasks will be set for each examination by the ADC. In addition to the 12 tasks, Infection Control will be assessed throughout the examination. 1. Class II amalgam preparation. 2. Class III composite resin preparation. 3. Full gold crown preparation. 4. Metal-ceramic (porcelain fused to metal) crown preparation. 5. Endodontic access preparation on a molar tooth. Teeth with simulated enamel, dentine and pulp will be provided for the Endodontic Access Preparation 6. Fabricate a provisional crown restoration for a pre-prepared* metal-ceramic (porcelain fused to metal) crown preparation on Day 2 of the Assessment. The original unprepared tooth will be in the typodont used on Day 1 of the Assessment. 7. Restore a pre-prepared* tooth with a direct Class II composite resin restoration. 8. Restore a pre-prepared* tooth with a direct Class IV composite resin restoration. 9. Restore a pre-prepared* tooth with a Class II amalgam restoration. 10. Taking nominated radiographs in a manikin. 11. Apply a rubber dam. 12. Record keeping. 13. Clinical communication. * § ǂ A pre-prepared tooth is supplied for those tasks requiring restorations. The rubber dam, communication and infection control tasks are assessed ‘on-site’. The assessment of the other tasks from all examination facilities is attended at a central site after the examination. - 13 - Assessment Criteria Participants will receive a score for each task as determined by using the evaluation criteria for the requirement and the “Grade Derivation Grid”. The final result for each participant will be determined using the “Final Result” Grade Derivation Grid. Grade Derivation Grid Each task is evaluated in one (1) or three (3) criteria categories. The components within each category are assessed, and the category receives the lowest grade allocated within that category. 1. Tasks with one criterion category (Infection Control, Record Keeping, Rubber Dam) The grade assigned for these requirements will be determined as described in the evaluation criteria. 2. Tasks with three criteria categories The grade assigned for these requirements will be determined by the grades assigned in the criteria categories. Overall Grade Criteria A 2 A and no C or D is assigned in any criteria category. B No more than 1 C and no D is assigned in any criteria category. C 2 C’S and no D are assigned in any criteria category. D 1 D assigned in any criteria category. Final Result Grade Derivation Grid In order to be successful in the Practical Examination, a participant must obtain: 9 or more A / B grades and no more than 1 D grade OR 8 or more A / B grades and no D grades - 14 - Assessment Criteria Class III Composite Cavity Preparation Criteria describe an ideal preparation for a tooth with minimal caries. Evaluation will consider the extent of caries present. Score External Outline Form Internal Form Finish - Optimal extension based on location and extent of caries - Optimal resistance and retention form - Smooth cavosurface A present - Gingival margin supra-gingival - No damage to adjacent teeth, Assessment tooth beyond preparation or gingiva based on extent of caries present with no unnecessary removal of tooth structure - All internal line angles rounded margin - No debris or caries (infected dentin) B - Minor over-preparation - Minor over-preparation - Minor damage to adjacent tooth corrected by enameloplasty - Minor damage to assessment tooth beyond preparation margin corrected by enameloplasty - Minor roughness C - Under-extended < 0.5mm - Over-extended < 0.5mm - Gingival margin at gingiva - Minor damage to adjacent tooth correctable by enameloplasty - Minor damage to assessment tooth beyond preparation margin correctable by enameloplasty - Minor damage to gingiva - Minor unsupported enamel - Inadequate resistance and retention form - Too deep > 2.0 but < 3.0mm - Unnecessary removal of internal tooth structure - Sharp line angles - Unacceptable roughness - Presence of debris D - Overextended > 0.5mm - Cavitation not included - Gingival margin sub-gingival - Major damage to adjacent tooth requiring restoration - Major damage to assessment tooth beyond preparation - Major damage to gingiva - Significant unsupported enamel - Unacceptable resistance and retention form - Too deep > 3.0mm - Excessive over-preparation. - Alternate design or RCT required - Caries remaining on axial or pulpal - Caries remaining at dentinoenamel junction - 15 - Class II Amalgam Cavity Preparation Criteria describe an ideal preparation for a tooth with minimal caries. Evaluation will consider the extent of caries present. Score External Outline Form Internal Form Finish - Proximal and/or gingival margins clear adjacent teeth 0.5mm - Optimal resistance and retention - Smooth cavo-surface A or less - Gingival margin supra-gingival - Optimal buccal-lingual width based on location and extent of caries present - Occlusal extension (if present) is appropriate - No damage to adjacent teeth, Assessment tooth beyond preparation or gingiva form based on location and extent of caries present with no unnecessary removal of internal tooth structure - Gingival and occlusal floors parallel to occlusal plane - All internal line angles rounded margins - All unsupported enamel removed - No debris or caries (infected dentin) B - Adjacent tooth cleared 0.5 - 1.0mm - Minor overextension of outline, including occlusal extension (if present) - Minor damage to adjacent tooth corrected by enameloplasty - Minor damage to assessment tooth beyond preparation margin corrected by enameloplasty - Minor over-preparation occlusally or axially - Minor under-preparation occlusally or axially - Small area of roughness C - Proximal margin not cleared - Proximal margin cleared 1.0 - 1.5mm - Proximal wall flared - Gingival margin at gingiva - Significant under-extension - Unacceptable buccal-lingual width, including occlusal extension (if present) - Minor damage to adjacent tooth correctable by enameloplasty - Minor damage to assessment tooth beyond preparation margin correctable by enameloplasty - Minor damage to gingiva - Minor unsupported enamel - Unacceptable roughness - Minor areas of unsupported enamel - Presence of debris D - Proximal margin cleared > 1.5mm - Gingival margin sub-gingival - Significant overextension of outline, including occlusal extension (if present) - Major damage to adjacent tooth requiring restoration - Major damage to assessment tooth beyond preparation margin requiring restoration - Major damage to gingiva - Significant unsupported enamel - Pulpal floor too deep: 2.5 - 3.0mm - Pulpal floor too shallow 1.0 1.5mm - Occlusal floor too deep - Axial wall too deep 2.5 - 3.0mm - Axial wall/occlusal floor too shallow: 1.0 - 1.5mm - Unnecessary removal of tooth structure - Divergent walls - Sharp line angle - Undefined line angle - Questionable retention - Pulpal floor too deep > 3.0mm - Pulpal floor too shallow < 1.0mm - Occlusal floor too shallow < 1.0mm - Occlusal floor too deep > 3.0mm - Axial wall too deep > 3.0mm - Excessive over-preparation. - Alternate design or RCT required - Inadequate retention - 16 - - Gross roughness - Grossly unsupported enamel - Caries remaining on axial or pulpal - Caries remaining at dentinoenamel junction Full Gold Crown Preparation Appropriateness of occlusal clearance will be measured from the spatial relationship with the proximal teeth Score Path of Draw and Axial Preservation of Tooth Vitality & Structural Finish and Margin Convergence Durability - Optimal path of insertion - Optimal preparation has been performed to permit - Margin optimally placed, defined and A - No undercuts - Axial convergence 6° - 10° fabrication of a functional restoration - Preparation is smooth and has no sharp areas - No damage to adjacent teeth - Reduction - Axial 0.5 - 1.0mm - Occlusal 1.5mm identifiable - Margin appropriate to crown material - Margin smooth, continuous and has no steps - Margin width 0.5mm - Positioned 0.5mm supra-gingival - No debris - No damage to gingiva B -Minor undercuts. Manageable by lab. - Axial convergence 10° - 20° - Reduction - Axial 1.0 - 1.5mm - Occlusal 1.0 – 2.0mm - Minor damage to adjacent tooth corrected by enameloplasty - Located supra-gingival 0.5 - 1.0mm - Located sub-gingival < 0.5mm C - Will not draw. Modification required. - Will not draw. Adjacent tooth requires modification. - Axial convergence 20° - 25° - Reduction - Axial < 0.5mm - Occlusal 0.5 – 1.0mm or 2.0 to < 3.0mm - Sharp cusps - Sharp line angles - Minor damage to adjacent tooth correctable by enameloplasty - Indistinct, discontinuous or rough - Located supra-gingival 1.0 to < 2.0mm - Located sub-gingival 0.5 to < 1.0mm - Incorrect form - Unsupported enamel (lipping) - Presence of debris - Minor damage to gingiva D - Will not draw. Major modification required. - Will not draw. Adjacent tooth requires major modification. - Axial convergence >25° - Reduction - Axial - no preparation or > 1.5mm - Occlusal < 0.5 or > 3.0mm - Pulp exposure - Major damage to adjacent tooth requiring restoration - Alternative preparation or RCT needed - Grossly indistinct, discontinuous or rough - No discernible margin - Located supra-gingival > 2.0mm - Located sub-gingival > 1.0mm - Grossly unsupported enamel (lipping) - Major damage to gingiva - Margin not appropriate to crown material - 17 - Metal-ceramic Crown Preparation Appropriateness of occlusal clearance will be measured from the spatial relationship with the proximal teeth Score Path of Draw and Axial Preservation of Tooth Vitality & Structural Finish & Margin Convergence Durability - Optimal path of insertion - Optimal preparation has been performed to permit - Margin is optimally placed, formed and A - No undercuts - Axial convergence 6° - 10° the fabrication of an esthetic and functional restoration - Preparation is smooth and has no sharp areas - No damage to adjacent teeth - Reduction: Buccal, mesial, distal 1.2mm Lingual 0.5mm Incisal/occlusal 2.0mm identifiable - Margin is smooth, continuous and has no steps - Width of margin: Buccal 1.2mm - 1.5mm Lingual 0.5mm - Margin positioned 0.5mm supra-gingival - No debris - No damage to gingiva - Margin appropriate to crown material B - Minor undercuts. Manageable by lab - Axial convergence 10°-20° - Reduction: Buccal, mesial, distal 1.2 - 1.5mm Lingual 0.3 – 1.0mm Incisal/occlusal 2.1 – 2.5mm - Minor damage to adjacent tooth corrected by enameloplasty - Located supra-gingival 0.5 - 1.0mm - Located sub-gingival < 0.5mm C - Will not draw. Modification required - Will not draw. Adjacent tooth needs modification - Axial convergence 20° - 25° - Reduction: Buccal, mesial, distal 0.5 - 1.1mm or 1.5 - 2.5mm Lingual < 0.3 or 1.0mm – 1.5mm Incisal/occlusal 1.0 – 2.0mm or 2.5 – 3.0mm - Sharp cusps - Sharp line angles - Minor damage to adjacent tooth correctable by enameloplasty - Indistinct, discontinuous or rough - Incorrect form - Unsupported enamel (lipping) - Located supra-gingival 1.0 – 2.0mm - Located sub-gingival 0.5-1.0mm - Presence of debris - Minor damage to gingiva D - Will not draw. Major modification of tooth required - Will not draw. Adjacent tooth requires major modification - Axial convergence > 25° - Reduction: Buccal, mesial, distal < 0.5 or > 2.5mm Lingual - no preparation or >1.5mm Incisal/occlusal < 1.0 or > 3.0mm - Major damage to adjacent teeth requiring restoration - Pulp exposure - Alternate preparation or RCT needed - Grossly indistinct, discontinuous or rough - No discernible margin - Grossly unsupported enamel (lipping) - Located supra-gingival > 2.0mm - Located sub-gingival > 1.0mm - Major damage to gingival - Margin not appropriate to crown material - 18 - Endodontic Access Preparation Score External Outline Form - Optimal extension to obtain A appropriate access to all canals - Optimal removal of any unsupported structures - No over extension - Adequate extension to permit removal of pulp horns Internal Form Finish - Optimal internal tooth structure removed to allow access to canals - Optimally tapered access preparation walls - Optimal smoothness of walls and cavosurface - No pulp material left on walls of chamber - No debris B - Slightly under-extended < 1.0mm - Slightly overextended < 1.0mm - Slightly excessive removal of internal tooth structure - Slightly over-tapered - Adequate smoothness - Minor pulp material present on walls of chamber - Minor debris present C - Obstructed access to canals - Significantly over extended 1.0 -2.0mm - Excessive removal of internal tooth structure - Inadequate taper - Gouging of tooth walls - Marginal ridge undermined - Inadequate smoothness - Significant pulp material present on walls of chamber - Unacceptable debris present D - Chamber not accessed - Canal not accessed - Excessively overextended > 2.0mm - Grossly excessive removal of internal tooth structure - Reverse taper - Excessive gouging of walls - Perforation - Separated instrument in canal - Excessive roughness - Excessive pulp material present on walls of chamber - Debris obscuring chamber or canals - 19 - Provisional Crown Restoration Score Margin Contour and Adaptation - Margin not over/under extended A - Margin not over/under contoured - No excess material in/on soft tissue - No excess material on hard tissue - Preparation margin intact Morphology and Occlusion Polish and Other - Optimal contour for gingival health, esthetics and durability - Optimal interproximal contacts - Optimal occlusal contact - Restoration can be removed - Optimal polish - No roughness or porosities - Restoration material is hard setting, tooth coloured plastic resin B - Over-extended < 0.5mm - Under-extended < 0.5mm - Over-contoured < 0.5mm - Under-contoured < 0.5mm - Slightly over-contoured - Slightly under-contoured - Slight infra-occlusion - Adequate polish C - Over-extended 0.5 - 1.0mm - Under-extended 0.5 - 1.0mm - Over-contoured 0.5 - 1.0mm - Under-contoured 0.5 - 1.0mm - Excess material in/ on soft tissue - Excess material on hard tissue - Damage to tooth margin - Over-contoured - Under-contoured - Proximal contact too light - Proximal contact too occlusal - Proximal contact too gingival - Proximal contact too tight - No proximal contact < 0.5mm open - Supra-occlusion <1.0mm - Infra-occlusion <1.0mm - Unacceptable roughness - Porosities - Minor excess material remaining on adjacent teeth - Minor damage to soft tissue or adjacent teeth D - Over-extended > 1.0mm - Under-extended > 1.0mm - Over-contoured > 1.0mm - Under-contoured > 1.0mm - Gross amount of excessive material in/on soft tissue - Gross amount of excessive material on hard tissue - Needs major revision or new provisional - Significantly over contoured - Significantly under-contoured - No proximal contact > 0.5mm open - Broken or cracked restoration - Restoration cannot be removed - Supra-occlusion > 1.0mm - Infra-occlusion > 1.0mm - Gross roughness - Gross porosity - Inappropriate restorative material - Excess material remaining on adjacent teeth - Significant damage to soft tissue or adjacent teeth - 20 - Class II Composite Resin Restoration These criteria do not include shade matching, which is NOT part of the evaluation. Restoration Quality and Polish Score Margin Contours and Function A - Uniform smoothness/polish - No stains, inclusions or incremental lines - Junction of tooth/ restoration not detectable or slightly detectable with explorer - No excess resin past preparation margin - No damage to adjacent teeth, assessment tooth or gingiva -Physiologic tooth contours of occlusal and proximal surfaces optimally restored - Optimal proximal contact restored - No excess resin in/on soft tissue and/or other teeth B - Some areas needing more polish - Minor stains, inclusions or incremental lines of resin not affecting durability or esthetics - Minor amount of resin beyond preparation margin - Minor damage to adjacent tooth and/or assessment tooth corrected by enameloplasty - Under- or over-contoured < 0.5mm - Proximal contact placed slightly too occlusal, gingival and/or too broad C - Generalised roughness, scratches or voids that require correction - Stains, inclusions or incremental lines of resin that require correction - Deficiency/void at margin < 0.5mm - Excess resin beyond preparation margin requiring correction - Minor damage to adjacent tooth and/or assessment tooth correctable by enameloplasty - Minor damage to gingiva - Under- or over-contoured 0.5 - 1.0mm - Poorly defined morphology - Proximal contact placed too occlusal and/or gingival, or too broad or too tight/rough - Excess resin in/on soft tissue and/or other teeth - Marginal ridge slightly inconsistent with adjacent tooth - Light proximal contact D - Excessive roughness, scratches or voids - Excessive Stains, inclusions or incremental lines of resin requiring replacement of entire restoration. - Major corrections required - Deficiency/void at margin > 0.5mm - Gross amount of excess resin beyond preparation margin - Major damage to adjacent tooth and/or assessment tooth requiring restoration - Major damage to gingiva - Under- or over-contoured > 1.0mm - Lack of physiologic contour - No proximal contact - Marginal ridge disharmony > 1.0mm - Gross amount of excess resin in /on soft tissue and/or other teeth - Restoration fractured or loose - 21 - Class IV Composite Resin Restoration These criteria do not include shade matching, which is NOT part of the evaluation. Score Restoration Quality and Polish Margin - Uniform smoothness - Junction of tooth/ restoration not detectable or A Contours and Function - Physiologic tooth contours restored - Optimal proximal contact restored - No excess resin in/on soft tissue and/or other teeth - Appropriate occlusal contact - Uniform polish matching tooth surface - No contamination of resin (no stains or inclusions) slightly detectable with explorer - No excess beyond preparation margin - No damage to adjacent teeth, assessment tooth or gingiva B - Areas needing more polish - Minor contamination of resin not affecting durability or esthetics of restoration - Minor excess resin beyond preparation margin - Minor damage to adjacent tooth corrected by enameloplasty - Minor damage to assessment tooth beyond preparation margin corrected by enameloplasty - Under- or over-contoured < 0.5mm - Proximal contact placed slightly too incisal, gingival and/or too broad C - Unacceptable roughness, scratches or voids - Contamination of resin that requires correction - Deficiency/void at margin < 0.5mm - Excess resin beyond preparation margin requiring correction - Minor damage to adjacent tooth correctable by enameloplasty - Minor damage to assessment tooth beyond preparation margin correctable by enameloplasty - Minor damage to gingiva - Under- or over-contoured 0.5 1.0mm - Poorly defined morphology - Light proximal contact - Proximal contact placed too occlusal and/or gingival, or too broad or too tight/rough - Excess resin in/on soft tissue and/or other teeth - Excessive occlusal contact D - Excessive roughness, deep scratches or excessive voids - Excessive contamination of resin requiring replacement of entire restoration. - Deficiency/void at margin > 0.5mm - Gross amount of excess resin beyond preparation margin - Major damage to adjacent tooth requiring restoration - Major damage to assessment tooth requiring restoration - Major damage to gingiva - Under- or over-contoured > 1.0mm -- Lack of physiologic contour - No proximal contact - Gross amount of excess resin in /on soft tissue and/or other teeth - Restoration fractured or loose - 22 - Class II Amalgam Restoration Score Surface quality - Uniform smoothness A Margin Contours and Function - Junction of tooth/restoration not detectable with explorer - No debris/loose amalgam in soft tissue - No damage to adjacent teeth, assessment tooth or gingiva - Physiologic tooth contours of occlusal and proximal surfaces optimally restored - Optimal proximal contact restored - Optimal occlusal contact B - Some areas of roughness - Margin slightly detectable - Minor damage to adjacent tooth corrected by enameloplasty - Minor damage to assessment tooth beyond preparation margin corrected by enameloplasty - Slightly under-contoured - Slightly over-contoured - Proximal contact slightly too occlusal - Proximal contact slightly too gingival - Proximal contact slightly broad C - Roughness or scratches requiring correction - Excess amalgam at margin < 0.5mm - Deficiency at margin < 0.5mm - Void at margin < 0.5mm - Debris/loose amalgam in soft tissue - Minor damage to adjacent tooth correctable by enameloplasty - Minor damage to assessment tooth beyond preparation margin correctable by enameloplasty - Minor damage to gingiva - Under-contoured < 0.5mm - Over contoured < 0.5mm - Light proximal contact - Proximal contact too occlusal - Proximal contact too gingival - Proximal contact too broad - Proximal contact too tight - Poorly defined morphology - Marginal ridge disharmony < 1.0mm - Supra-occlusion D - Excessive roughness or scratches that cannot be polished - Deep or excessive voids other than at margin - Excess amalgam at margin > 0.5mm - Deficiency at margin > 0.5mm - Void at margin > 0.5mm - Grossly excessive debris/loose amalgam in soft tissue - Major damage to adjacent tooth requiring restoration - Major damage to assessment tooth requiring restoration - Major damage to gingiva - Under-contoured > 0.5mm - Over-contoured > 0.5mm - No proximal contact - Marginal ridge disharmony > 1.0mm - Restoration fractured or loose - 23 - Radiographic exercise Score A B C D Bitewing - Appropriate film selected and oriented - Appropriate teeth and interdental areas demonstrated and centred (film should include from the distal of the 4 to the mesial of the 7) - Occlusal plane half-way film and // to lower edge of film - No cone cut - No horizontal overlapping of interproximal surfaces - No foreshortening or elongation - Appropriate film selected and oriented - Appropriate teeth and interdental areas demonstrated - <5% cone cut not affecting the nominated area - Horizontal overlapping < to middle of the enamel - Slight (<10%) foreshortening or elongation - Appropriate film selected and oriented - Nominated teeth not completely demonstrated - One interdental area specified for the bitewing film is not demonstrated - Film indicator incorrect - Cone cut affecting small part of the nominated area - Horizontal overlapping beyond the middle of the enamel - Moderate (10-25%) foreshortening or elongation - Significant vertical overlapping of bitewing image with the tissues of both jaws demonstrated - Film reversed - Inappropriate film selected - Inappropriate film long axis orientation - Nominated teeth not demonstrated (e.g. wrong side/jaw) - A large part of the nominated area is not visible - Cone cut involving large part of nominated area - Horizontal interproximal overlapping beyond the enamel - Gross (>25%) foreshortening or elongation - Vertical overlapping of bitewing image with inadequate coverage of the tissues of one jaw Periapical - Appropriate film selected and oriented - Appropriate teeth and interdental areas demonstrated and centred - Apex and 2 mm of adjacent tissue demonstrated - Film indicator (“dot”) to the occlusal / incisal in periapical films - No cone cut - No horizontal overlapping of interproximal surfaces - No foreshortening or elongation of PA image - Appropriate film selected and oriented - Appropriate teeth and interdental areas demonstrated - Apex and 2 mm of adjacent tissue demonstrated - Nominated tooth not centred - Film indicator (“dot”) to the occlusal / incisal in periapical films - <5% cone cut not affecting the nominated area - Horizontal overlapping < to middle of the enamel - Slight (<10%) foreshortening or elongation - Appropriate film selected and oriented - Nominated teeth not completely demonstrated - A small part of the nominated area is not visible and/or the apex is visible but no periapical bone - Film indicator incorrect - Cone cut affecting small part of the nominated area - Horizontal overlapping beyond the middle of the enamel - Moderate (10-25%) foreshortening or elongation - Film reversed - Inappropriate film selected - Inappropriate film long axis orientation - Nominated teeth not demonstrated (e.g. wrong side/jaw) - A large part of the nominated area is not visible - Apex of tooth not demonstrated - Cone cut involving large part of nominated area - Horizontal interproximal overlapping beyond the enamel - Gross (>25%) foreshortening or elongation - 24 - Rubber Dam Application Score A - Criteria Appropriate clamp Stable clamp Clamp secured with an appropriate length of dental floss Orientation provides an unrestricted airway Dam inverted on all isolated teeth All punch holes in appropriate positions Dam and frame positioned for optimal access, safety and moisture control and patient comfort B All of the above, except for one or more of the following deficiencies: - Dam is inverted on teeth in operative area only - Minor deviations in punch hole locations - Dam or frame positioning needs minor adjustment for optimal access, safety, moisture control or patient comfort C One or two of the following deficiencies: - Unnecessary trauma to gingiva or teeth - Unstable or no clamp - Unsecured or inadequately secured clamp - Patient airway compromised - Dam not over wings of clamp - Frame incorrectly oriented - Dam not inverted in operative area - Dam not through all interproximal contact points - Punch holes improperly positioned - Tears or holes compromising function - Dam or frame positioning must be altered for access, safety, moisture control or patient comfort - Inappropriate or excessive use of caulking agent (i.e. Oroseal) D Three or more of the above deficiencies or: - Dam not placed in allotted time - Improper position of dam and frame not allowing treatment on indicated tooth - Major tears or holes compromising function - 25 - Record of Procedures Participants may be required to perform the Record of Procedures on one of the Assessment Days. Participants will record all procedures performed on that day (except the Rubber Dam application), on the supplied “Record of Procedures” form. The Record of Procedures should be completed assuming that: each procedure is performed on a different patient the patient has no changes in medical history local anesthesia has been administered for each procedure any prepared teeth were restored during the session any restored teeth were prepared during the session provisional crowns were cemented during the session. In order to preserve anonymity, do NOT sign the Record of Procedures. Participants should use their ADC ID number in place of a signature. Records should comply with the Dental Board of Australia’s ‘Guidelines on Dental Records.’ It is NOT necessary to include any more patient or treatment information than is illustrated in the following examples. Examples of appropriate entries: Record of Procedures DATE 10/10/12 10/10/12 10/10/12 PROCEDURES Reviewed medical history - no change Right inferior alveolar nerve block 2.2mL 2% lidocaine, 1:80,000 adrenaline Tooth 46, MOD amalgam preparation and restoration with Tytin amalgam Reviewed medical history - no change Buccal infiltration anesthesia 2.2mL 2% lidocaine 1:80,000 adrenaline Tooth 33 MIBL composite resin preparation and restoration with Z250, Shade B2 (etch/bond) Reviewed medical history – no change Right Left inferior alveolar nerve block 4.4mL 2% lidocaine 1:80,000 adrenaline Prepared 34 for metal-ceramic crown, porcelain occlusion and porcelain butt margin on buccal Methylmethacrylate provisional crown fabricated, cemented with ProTemp provisional cement Vita shade 3L 1.5 - 26 - ADC ID NUMBER (do not sign) 123456 123456 123456 Examples of errors include: Incorrect or incomplete record of procedures. No or inappropriate date. No or inappropriate record of updating medical history. No or inappropriate record of type, quantity or location of local anesthesia. No or incorrect tooth number identified. No or incorrect restored surfaces identified. No or inappropriate type of restorative or provisional material identified. No or inappropriate cement type identified. No or inappropriate restorative material brand identified. Incorrect technique or improper use of material identified. No shade recorded. Record not written in ink. Record not legible. Inappropriate correction of entry (original entry not visible through correction). No ID number. ID number in inappropriate location. Scoring Grid: Score Criteria A - Appropriate and accurate record of all procedures. B - One error on Record of Procedures. C - Two or three errors on Record of Procedures. D - More than three errors on Record of Procedures. - No entries on Record of Procedures. - 27 - Infection Control Participants will perform all requirements as if they were working on actual patients. Infection control and material hygiene procedures will be observed by Assessment Invigilators. Participants will NOT be informed of any recorded violations. It will be assumed that all instruments are sterile at the beginning of Day 1. If an instrument or treatment material is dropped during a procedure, a participant must notify an Invigilator who will ask the participant to describe how the situation should be handled in actual patient treatment and give permission to pick up the instrument or material. The only modifications to infection control procedures for the purposes of this Assessment are allowing the wearing of treatment gloves while: Loosening the clamp that allows the patient’s head position to be adjusted and adjusting the head. Using the amalgamators. Pressing the button to take radiographs. Examples of unacceptable infection control and material hygiene procedures include: Gloves not worn. Gloves worn outside of the operatory (except when using an amalgamator). Gloves have holes or tears. Unacceptable infection control procedures involving gloves such as wearing treatment gloves when retrieving an article from a non-sterile area such as a storage bin or cabinet or touching masks, glasses or hair. Mask not worn or not worn appropriately. Use of contaminated instruments or materials. Hands not washed. Contamination of operating area. Eye protection not used. Hair not appropriately controlled. Inappropriate attire. Unacceptable amalgam handling and disposal. Unacceptable handling and disposal of sharps. No or insufficient cooling water used with high speed hand piece - 28 - Infection Control Scoring Grid: A No violations of infection control. B One infection control violation. C Two infection control violations. D Three or more infection control violations. - 29 - Clinical Communication Candidates may be required to undertake a Clinical Communication role play as one of the assessment tasks. This will involve a clinical discussion with a simulated patient. Candidates will be given a clinical scenario to read prior to their allocated Communication session. The clinical scenario will provide information about the case, and may include history, examination, clinical photographs and/or radiographs. Candidates will then have 10 minutes to discuss a particular aspect of the case with the simulated patient. For example, candidates may be asked to explain a diagnosis or treatment option for a patient. Candidates must communicate the information to the patient to enable them to gain informed consent. Score Criteria - A - - B - Always attentive when the patient speaks Doesn’t interrupt when the patient is talking Asks questions when they do not understand the patient Uses words, terms and examples that would be clearly understood by the average patient Avoids jargon and dental terminology Speaks in a clear and understandable voice (tone, enunciation and pace) May interrupt the patient when speaking with their permission, to clarify meaning Mostly attentive when the patient speaks (sometimes distracted) Mostly uses words terms and examples that would be clearly understood by the average patient Sometimes uses jargon or dental terminology Mostly speaks in a clear and understandable voice (tone, enunciation and pace) C One or two of the following deficiencies: Inattentive when patient speaks Interrupts patient without permission Uses words/terms/examples that are confusing or inappropriate Moderate use of jargon or dental terminology Speaks in a voice that is difficult to understand (tone, enunciation and pace), that requires the patient to ask for clarification Inappropriate intrusion into personal space of the patient Inappropriate body language D Three or more of the above deficiencies or: Consistently inattentive to the patient when they are speaking Consistently uses confusing words, terms, jargon or examples which the patient cannot understand Overall message is not understood by the patient - 30 - Results Participants will receive a score for each requirement as determined by using the evaluation criteria for the requirement and the “Grade Derivation Grid”. The final result for each participant will be determined using the “Final Result” Grade Derivation Grid. The results of the Practical Examination will be posted on the ADC Candidate Portal. Posting of results will normally be done within 6 weeks. Candidates should check the ADC website for updates. Results will not be released by telephone, fax or email. Verification, Review and Appeal Candidates are referred to the ADC Appeal Policy for information regarding verification, review and appeal processes for the Practical Examination Repeats If a candidate fails the Practical Examination, they are permitted to apply again to repeat it, provided that their Written Examination and English language test results are still valid. There are no Supplementary Examinations for the Practical Examination, and the examination must be taken in full and passed in a single attempt. No credits or exemptions will be given for previous attempts at the Practical Examination. - 31 - Australian Dental Council Ltd PO Box 13278 Law Courts Victoria 8010 Australia Tel +61 (0) 3 9657 1777 Fax +61 (0) 3 9657 1766 Email: [email protected] Web: www.adc.org.au ABN 70 072 269 900 Version: 2014 (Sept 2014) - 32 -
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