Doctor of Dental Surgery Programme

ENDODONTICS

COURSE GUIDEBOOK DB 305C

2012 Edition

UNIT OF ENDODONTOLOGY & ENDODONTICS DEPARTMENT OF OPERATIVE DENTISTRY FACULTY OF DENTISTRY UKM

Contributors

Wan Noorina Wan Ahmad Dalia Abdullah Jasmina Qamaruz Zaman Safura Anita Baharin Shalini Kanagasingam Irwan Soo Mohd Amin Soo Yew Hsu Zenn

Copyright 2012 by UKM Publications No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise unless with prior written permission of the publisher or the Faculty of Dentistry of Universiti Kebangsaan Malaysia (UKM). Requests for the permission is to be addressed to the Department of Operative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM).

Preface
In the nam e of God the m ost Gracious the m ost M erciful. Read! And your Lord is the m ost Generous. W ho has taught (the w riting) by pen. H e has taught m an that w hich he knew not. (A l-A laq, 3-5 A lQuran)

This course book has been written for the undergraduate DB305C Endodontic Course which is a partial fulfillment for the DDS Programme. It is intended to spell out the course synopsis and describes the whole content of the 3-year course. All three modules have been listed and the modes of teaching and assessment method have been addressed to provide an insight to all users on the course learning outcomes. Inevitably these can be used as guidelines to stay in line with the objectives of the course as a well as the programme. As there is never likely to be sufficient number of endodontists to treat more difficult cases, undergraduate teaching of practical endodontics should results in competent dental practitioners in the near future especially in the clinical endodontics. Currently with the long life learning generic skills and the importance of continuing education, it is no longer acceptable to rely solely on text books and lecture learning. Gaining clinical experience and critical reading on relevant evident based articles are other options to be the forefront in the field. There has been vast improvement in treatment procedures. With the introduction of nickel-titanium alloys complicated systems has been reduced to a much simpler system and more recently the introduction of single file endo. The use of Mineral Trioxide Aggregate (MTA) has enable repair and management of open apices easily. Advances in diagnostic techniques such as the use of cone beam computed tomography have truly revolutionized endodontics. Therefore all dental practitioners including future dentists should all take full use of the advancement in endodontic technology and apply them in the fundamentals in endodontology. I wish to express well wishes to all undergraduate dental programme and I do hope that the course would benefit you and your future patients. My sincere thanks also go to my fellow colleagues, full time and part-time lecturers, tutors and trainees that have been tirelessly dedicated their time in teaching and guiding the future dentists in building their knowledge and clinical skills especially in the field of endodontics. May Allah bless us all.
W an N oorina W an A hm ad BDS, MClinDent(Endo),MFDSRCSEng Course coordinator 2012


TABLE OF CONTENTS

Preface

CHAPTER 1 : COURSE DESCRIPTION

Introduction

4
4 4

Course synopsis

Course learning outcomes

5-6 7-10 11

Matrix Course learning outcomes vs Programme outcomes Course structure

CHAPTER 2

12
12 13-14 14 14

Academic staff Part time lecturers Staff availability Notice Board

CHAPTER 3
Module 1 Module 2 Module 3 Module 4

15
16-22 23-27 28-30 35-37

CHAPTER 4

32

Evaluation of course learning outcomes Examination and assessment

32-35 36 36 37-42

Marks for continuous assessment Clinical requirements

Endodontic treatment codes Calculation of final marks

42-43 44 45-47 47-48 49

Final Professional Examination Recommended Reading References Appendix

 Chapter 1

Course Title: Course Code:

1.1 Introduction

Endodontics DB 305C

Endodontology and Endodontics is a discipline in dentistry that has steadily developed during the late twentieth century. Previously, this subject comes under the wing of Operative Dentistry course, but with the vast development of the subject in the study of the disease ie apical periodontitis in etiology, microbiology and treatment, the department felt that it should stand on its own as a separate course from Operative Dentistry. Studies on epidemiology have shown that the standard of endodontic treatment carried out by general dental practitioners in Europe is not that high and it was suggested that this may be related to the quality and quantity of education and clinical experience received during undergraduate training. It is now a trend to teach this subject in clinical area dedicated to this purpose. No such study has been done in Malaysia so far but with the similar content of traditional Operative Dentistry course, the scenario may not differ so much. It is therefore very important to ensure that undergraduate training in Endodontics is undertaken to a level that ensures that standards in clinical practice improve. As it is, the demand for endodontic treatment is increasing due to a greater interest among the general population in preserving their teeth into old age. 1.2 Course Synopsis Endodontology is concerned with the study of the form, function and health of, injuries to, and diseases of the dental pulp and periradicular region, their prevention and treatment. The aetiology and diagnosis of dental pain and diseases are integral parts of endodontic practice (European Society of Endodontology, 1997). Endodontics can be defined as clinical treatment that includes any procedure to maintain the vitality and health of the pulp and periapical tissues. The procedures include pulp capping, pulpotomy, pulpectomy, root canal treatment, retreatment and surgical endodontics. The course consists of theoretical, practical and clinical aspects. It begins in the third year with a combination of a structured academic course of lectures, problem-based seminars and tutorials, in tandem with preclinical technique exercise and ends in the fifth year. Some of the contents of the topics that have been covered in other courses would not be repeated in this course. For example, the topic on pulp space anatomy would have been covered in Dental Anatomys tooth morphology lecture and therefore would not be repeated. Once the students complete these preclinical exercises, they must pass the competency tests before starting their clinical practice. Endodontic treatment will be undertaken on patients within the context of comprehensive patient care. Students are expected to

 complete a certain number of cases treated to gain the requisite clinical experience and each stage of the treatment will be assessed by clinical supervisors. The final assessment will be carried out at the end of the 5th year in the final professional examination.
DDS Programme Outcomes (PO)

Endodontics Course Learning Outcomes (CO)

Knowledge: 1. Describe the biology, anatomy and physiology of the oral and perioral tissues 2. Describe the microbiology of pulpal and periapical disease. 3. Describe the aetiology, pathology, clinical presentations and treatment options for diseases affecting the pulp and periradicular tissues 4. Describe the properties of commonly used endodontic materials 5. Describe the pharmacotherapeutic agents used in the management of pulpal and periradicular disease 6. Describe the implications systemic health disorders may have on non-surgical endodontic treatment 7. Describe the principles and practice of dental radiology in respect to endodontic treatment 8. Describe the principles and practice of local anaesthesia for the treatment of pulpal and periradicular disease 9. Describe the principles and practice of the use of rubber dam in endodontically related procedures 10. Describe the principles and practice of vital pulp therapy and preventive Endodontics 11. Describe the principles and practice of dental trauma 12. Describe the principles and practice of non-surgical root canal treatment for immature teeth 13. Describe the principles and practice of non-surgical root canal treatment 14. Describe the principles and practice of non-surgical root canal retreatment 15. Describe the principles and practice of the management of endodontic emergencies 16. Describe the principles of surgical Endodontics 17. Describe the cross infection control measures in Endodontics Clinical Skills: 18. Examine a patient using contemporary diagnostic methods to evaluate the head and neck region and to reach a diagnosis of the patients oral and craniofacial health status. 19. Assess the teeth, supporting structures to determine pulp and periapical status 20. Diagnose pulp and periradicular diseases 21. Formulate a comprehensive treatment plan to promote endodontic treatment as part of holistic care and implement treatment in a safe, properly sequenced and timely manner. 22. Utilize critical thinking in assessing technical and scientific information during endodontic treatment and use problem solving skills related to the comprehensive dental care of patients

(1)

Apply knowledge in basic and clinical sciences to practice safe and independent dentistry (PO01)

(2)

Use critical thinking and problem solving skills related to comprehensive care of patients.(PO03)


(3) Provide appropriate oral health care within the scope of general dentistry for the child, adolescent, adult, geriatric and medically compromised patient.(PO04) 23. Prescribe pharmacotherapeutic agents appropriately in the management of pulpal and periradicular disease 24. Practice the principles and techniques of dental radiology in relation to Endodontics 25. Administer local anaesthesia for the treatment of pulpal and periradicular 26. Apply rubber dam in endodontic procedures 27. Carry out vital pulp therapy 28. Carry out non-surgical root canal treatment for vital and non-vital uncomplicated cases safely and competently 29. Manage cases of endodontic emergencies 30. Monitor and evaluate the effectiveness of non-surgical endodontic treatment 31. Manage a diverse patient population with endodontic problems and have the interpersonal and communication skills to function successfully in a multicultural work environment.

(4)

Adopt a caring attitude and sensitivities towards patients and their families, colleagues and the whole community (PO05) Demonstrate interpersonal and communation skills to function effectively in a multicultural society and work environment (PO06) Collaborate with other health professionals and relevant agencies in health promotion and disease prevention. (PO07)

(5)

32.Communicate with the patient of the risks and benefits of the proposed endodontic treatment plan and take consent for treatment 33. Apply dental public health and health promotion principles and practice as they relate to pulpal and periradicular disease and dental traumatology

(6)

34. Recognize the limits of their expertise and seek consultation with other specialists/endodontists to facilitate holistic patient care. 35. Liaise with colleagues for multidisciplinary planning and management of treatment and comprehend the relationship of Endodontics with other dental and medical disciplines and the possibilities for adjunctive treatment


DDS Programme Outcomes (PO) Endo learning outcomes (CO)

PO1

PO2

PO3

PO4

PO5

PO6

PO8

PO11

KNOWLEDGE 1. Describe the biology, anatomy and physiology of the oral and perioral tissues Describe the microbiology of pulpal and periapical disease Describe the aetiology, pathology, clinical presentations and treatment options for diseases affecting the pulp and periradicular tissues Describe the properties of commonly used endodontic materials Describe the pharmacotherapeutic agents used in the management of pulpal and periradicular disease Describe the implications systemic health disorders may have on non-surgical endodontic treatment Describe the principles and practice of dental radiology in respect to endodontic treatment Describe the principles and practice of local anaesthesia for the treatment of pulpal and periradicular disease Describe the principles and practice of the use of rubber dam in endodontically related procedures 3 3

2.

3 3

3.

4.

3 3

5.

6.

7.

8.

9.

10. Describe the principles and practice of vital pulp therapy and preventive Endodontics 11. Describe the principles and practice of dental

PO12

P07

P09

P10


trauma 12. Describe the principles and practice of non- surgical root canal treatment for immature teeth 13. Describe the principles and practice of non- surgical root canal treatment 14. Describe the principles and practice of non- surgical root canal retreatment 15. Describe the principles and practice of the management of endodontic emergencies 16. Describe the principles of surgical Endodontics 17. Describe the cross infection control measures in Endodontics CLINICAL SKILLS 18. Examine a patient using contemporary diagnostic methods to evaluate the head and neck region and to reach a diagnosis of the patients oral and craniofacial health status. 19. Assess the teeth, supporting structures to determine pulp and periapical status. 20. Diagnose pulp and periradicular diseases 21. Formulate a comprehensive treatment plan to promote endodontic treatment as part of holistic care and implement treatment in a safe, properly sequenced and timely manner. 22. Utilize critical thinking in assessing technical 3 2

3 3

2 3

3 2

3 2


and scientific information during endodontic treatment and use problem solving skills related to the comprehensive dental care of patients 23. Prescribe pharmacotherapeutic agents appropriately in the management of pulpal and periradicular disease 24. Practice the principles and techniques of dental radiology in relation to Endodontics 25. Administer local anaesthesia for the treatment of pulpal and periradicular 26. Apply rubber dam in endodontic procedures 27. Carry out vital pulp therapy 28. Carry out non-surgical root canal treatment for vital and non-vital uncomplicated cases safely and competently 29. Manage cases of endodontic emergencies 30. Monitor and evaluate the effectiveness of non-surgical endodontic treatment OTHER SKILLS 31. Manage a diverse patient population with endodontic problems and have the interpersonal and communication skills to function successfully in a multicultural work environment 32. Communicate with the patient of the risks and 3 3 3

3 3

3 3


benefits of the proposed endodontic treatment plan and take consent for treatment 33. Apply dental public health and health promotion principles and practice as they relate to pulpal and periradicular disease and dental traumatology 2 1 3 1 1

34. Recognize the limits of 3 their expertise and seek consultation with other specialists/endodontists to facilitate holistic patient care. 35. Liaise with colleagues for multidisciplinary planning and management of treatment and comprehend the relationship of Endodontics with other dental and medical disciplines and the possibilities for adjunctive treatment 36. Recognize the role of lifelong learning and self-assessment in maintaining competency. 37. 2

3 = COURSE PROVIDES CONTENT AND EXPERIENCES THAT CONTRIBUTE DIRECTLY TO THE DEVELOPMENT OF COMPETENCIES (must know) 2 = COURSE PROVIDES KNOWLEDGE WITH LIMITED SKILLS THAT CONTRIBUTES TO SOME OF THE COMPETENCIES (should know) 1= COURSE PROVIDES OPPORTUNITIES FOR LEARNING EXPERIENCES THAT CONTRIBUTE TO THE DEVELOPMENT OF ONE OR MORE COMPETENCIES. SPECIFIC EXPERIENCES VARY AMONGST STUDENTS (nice to know)

10


Course Structure The course is structured into 4 main modules. The teaching starts from the Year 3 through to Year 5.

Module Module 1 Fundamental in endodontics Basic Biomedical sciences on endodontology Technical skills in endodontics Module 2 Clinical endodontics I Management of simple endodontic cases ( anterior & premolars) Module 3 Clinical endodontics II Management of molar endodontic cases Other related endodontic cases

Yr 3

Yr 4

Yr 5

MILESTONE: SIM COMPETENCY TEST PROGRESS TEST CLINICAL REQUIREMENTS PROF PART 3 MILESTONE: SIMULATION COMPETENCY TEST

Evaluation will be carried out at the end of every module. Marks are accumulative and will contribute towards the 50% continuous assessment marks. Students must pass the continuous assessment mark in order to sit for the final examination at the end of Year 5.

11

 Chapter 2 2.1 ACADEMIC STAFF Full time lecturers from the Department of Operative Dentistry.

No. 1

Name Dr. Wan Noorina bt. Wan Ahmad BDS, MClinDent in Endodontology, MFDSRCSEng Senior Lecturer and Clinical Specialist in Endodontology and Endodontics Coordinator of Endodontology and Endodontics Course e-mail: [email protected]

Phone ext: 7864

2 Associate Professor Dr Dalia bt. Abdullah BDS, MClinDent in Endodontology, FDSRCSEd Senior Lecturer and Clinical Specialist in Endodontology and Endodontics e-mail: [email protected] 7769

3 Dr Jasmina bt. Qamaruz Zaman (sabbatical leave) BDS, MSc in Restorative Dentistry, MFDSRCSEng Senior Lecturer and Clinical Specialist in Restorative Dentistry e-mail: [email protected] 7816

4 Dr. Safura Anita bt. Baharin DDS, MClinDent in Endodontology, MFDSRCSEng, DipCDSc Senior Lecturer and Clinical Specialist in Endodontology and Endodontics e-mail: [email protected] 7759

5 Dr Shalini Kanagasingan BDS , MClinDent in Endodontology, MRD RCSEdin, MFDSRCSEng. Lecturer and Clinical Specialist in Endodontology and Endodontics e-mail: [email protected] 7969

12


6 Dr Irwan Soo Mohd Amin Soo DDS (UKM), MDS (Endo) Hong Kong, AdvDipEndodont Hong Kong, M Endo RCS Edinburgh Lecturer and Clinical Specialist in Endodontology and Endodontics email: [email protected] Dr Ahmad Faudzi Muharriri DDS (USU-Indonesia), Spesialis I Konservasi Gigi (UI) Lecturer and Clinical Specialist in Conservative Dentistry email: [email protected] 7723

7. 7722

8 Dr. Yew Hsu Zenn DDS (UKMal) DClinDent Prosthodontics (Adelaide) Lecturer and Clinical Specialist in Prosthodontics Coordinator for Operative Dentistry Course e-mail: [email protected] 7869

Departments Secretaries: Cik Norazean Adam Pembantu Tadbir e-mail: [email protected]

7829

10 Pn Noradila Yacob Pembantu Tadbir email: [email protected] 7967

Part time lecturers:

Kol. (Dr) Roza Anon Binti Mohd Ramlee BDS MSc in Restorative Dentistry FDSRCSEd Clinical Specialist in Restorative Dentistry (Special interest Endodontics)

Kol (R) Dr. Ikmal Hisham Bin Ismail BDS MSc in Restorative Dentistry FDSRCSEng Clinical Specialist in Restorative Dentistry

Dr. Lam Jac Meng BDS MSc in Endodontics Clinical Specialist in Endodontics

Dr Mary Soo Wai Kuan BDS MDSc in Endodontics

13


5 Dr. Army Empol BDS MSc in Restorative Dentistry Clinical Specialist in Conservative Dentistry 8 Lt. Kol Dr Mohamad Asri bin Din BDS MClinDent in Restorative Dentistry MFDSRCSEng Cert in Conservative Dentistry Clinical Specialist in Restorative Dentistry 9 Dr Majinah Ahmad BDS MDSc PhD Clinical Specialist in Endodontics Trainee Lecturers: a) Dr. Farinawati bt Yazid, DDS (study leave) b) Dr Goo Chi Ling, DDS (study leave) c) Dr Tew In Meei , DDS (study leave) Part time tutors: a) b) c) d) e) f) Dr. Naresh Kumar a/l Shantilal, BDS Dr. Catherine Chong Hing Ying, BDS Dr. Rosni bt Adam, BDS Dr. Adibah bt Nadaruddin BDS Dr Chan Yuet Ngoh DDS Dr Jenizan b Nordin BDS

Staff Availability Hours Should you want to make appointments to see the Head of Department and other permanent staffs please contact the department secretary. The part-time staff will be available on the designated day only. Notice Boards Notice boards are located at the corridor in front of lift on the 3rd floor, Block Q. Please check this notice board periodically to keep you up-to-date with any changes involving the department. Also note that some announcement can be made in the e-learning portals eg i-folio.

14

ENDODONTIC MODULES

15

Chapter 3

3. 1. List of Modules (Includes Lecture/demonstration topics its contents and specific objectives) MODULE 1- Year 3 This module consists of a series of lectures, demonstrations, simulation exercises, tutorials and clinical sessions. No Lecture topics Contents Specific Learning Outcomes By the end of the Semester lecture students should be able to: / Hours 1. Introduction to - Definitions of 1/1 a. Define endodontology and endodontics endodontology endodontology and b. Recognize the course structure and how it fits into and endodontics overall programme outcome endodontics - Scope of endodontic c. Explain the scope of endodontic treatment course DB 305C treatment d. Explain why root canal needs to be carried out - Why treatment is e. Describe stages of root canal treatment needed? f. Describe the standards of treatment - Stages of treatment g. List the factors that determine success of treatment including coronal restoration Determination of treatment outcome Introduction to endo course (How the endo course fits into the DDS programme outcome, course learning outcomes) Clinical Requirements Assessment Management of Patients Management of Emergency Patients Pulpal irritants Pulpal pathology Classification of pulpal disease Classification of periradicular pathology Regeneration of periradicular lesions following endodontic treatment Non endodontic periradicular lesions Bacteria associated with endodontic infections Infection control, treatment principles Adjunctive antibiotic therapy Stages of procedures to arrive to a diagnosis List of special investigations

h. Describe the learning outcomes of endo course i. Explain the competencies to be achieved in the course j. Plan to achieve clinical requirements throughout the course k. Strategize on the methods to excel in the continuous assessment component

2 Pathology of the pulpal and peri-radicular tissues -

a.

3. Endodontic microbiology -

Characterize aetiological factors causing pulpal inflammation. b. Explain the mechanism of spread of inflammation in the pulp and periradicular tissues, and its consequences. c. Explain why the pulp has difficulty in recovering from severe injury. d. Classify pulpal and periradicular lesions. e. Describe the step involved in healing (resolution) of periradicular lesions following successful root canal treatment. f. Identify in general, non-endodontic lesions that may simulate endodontic periradicular lesions. Define terms associated with endodontic microbiology e.g. biofilm, pellicles, synergitic environment. b. Understand infection control as applied to endodontic practice. c. Discuss systemic antimicrobial therapy for endodontic infections a. Define and differentiate between patients symptoms and objective findings. b. Interpret the signs and symptoms and clinical findings in identifying the pulp and periradicular a.

1/1

1/1

4.

Diagnosis and treatment planning

1/1

16


Diagnosis of pulpal and periradicular status General and specific treatment planning Importance of the sequence of treatment Prognosis and its determination diseases. State the importance of obtaining the medical history pertaining to endodontic treatment. State the importance of and the procedures used for extraoral and intraoral examination of soft and hard tissues in relation to endodontic pathology. Describe and perform the tests used for pulpal and periradicular diagnosis including EPT, thermal, percussion and palpation, test cavity, selective anaesthesia, radiograph and transillumination. State the pulpal and periradicular diagnosis, using appropriate terminology, according to the diagnostic findings. Describe conditions in which root canal treatment is indicated and contraindicated. Identify problems (operative complications, cracked tooth, periodontal problems, isolated difficulties, restorability, strategic value, patient management, medical complications, abnormal root or pulpal anatomy, impact trauma, restricted opening) that require treatment modifications. Describe the sequelae of caries progression Describe the pathological changes due to inflammation Explain, in general the signs and symptoms of irreversible pulpitis Describe the emergency treatment for irreversible pulpitis Perform pulp extirpation on teeth that requires emergency treatment Describe the significant of determining tooth restorability prior to endodontic treatment. Describe the different methods available to determine the restorability of the tooth. Describe and perform the methods used to isolate a severely broken down teeth prior to root canal treatment. Describe and perform various techniques of temporization of severely broken down teeth. 1/1

c. d. e.

f. g. h.

Emergency dental treatment

1/1

Sequelae of deep caries lesion ie irreversible pulpitis Tissue response to inflammation Sign and symptoms of irreversible pulpitis Clinical Management on emergency dental cases. Criteria of a restorable tooth Rationale on the need to prepare the tooth for build-up prior to root canal treatment Management of teeth with insufficient tooth structure prior to endodontics Reasons for special instruments Instruments characteristics, usage, sterilization and handling List of instruments in groups: examination set, access cavity, canal preparation and obturation materials

a. b. c. d. e.

Preparation of teeth prior to root canal treatment

a. b. c. d.

Endodontic instruments and materials

Pulp space anatomy

Methods of determining pulp space anatomy Variations of root and

a. Define and design a basic set of instruments appropriate for these procedures: diagnosis, emergency treatment, canal preparation, obturation and bleaching. b. Describe the general physical properties of endodontic instruments and show how these characteristics are related to their use. c. Describe the design of the more common canal preparation instruments and their mode of use (Niti Protaper and Stainless Steel K-files). d. Explain the basis for sizing and taper (standardization) of hand instruments. e. Describe proper use of instruments to prevent breakage within the root canal. f. Recognize visible changes in instruments that will predispose to breakage. a. Draw common shapes of roots in cross section and common canal configurations in these roots. b. Describe the most common root form and pulp space anatomy for each root.

1/1

1/1

17


pulpal anatomy Alterations that might occur with age and other factors c. List the average length, number of roots, and most common root curvatures of each tooth d. Characterize the more frequent variations in root and pulp space anatomy of each tooth. e. Explain why standard periapical radiographs do not present the complete picture of root and pulp space anatomy. f. List and recognize the significance of iatrogenic or pathological factors that may cause alterations in pulp space anatomy g. Discuss location and importance of accessory canals h. Describe the common variations in pulp space anatomy resulting from developmental abnormalities and state their significance eg dens evaginatus, dens invaginatus etc. i. Recognize errors that may cause difficulties or failures in root canal treatment owing to lack of knowledge of pulp space anatomy. a. Identify major objectives of access preparation in The objectives of both anterior and posterior teeth access preparation Importance of straight b. Explain why straight-line access and removal of pulp horns are critical. line access c. Understand reasons for removing unsupported Initial canal tooth structure, existing restorations and caries negotiation during the access preparation. Procedural techniques d. Describe in detail the procedures involve in making and errors an endodontic access opening. e. Describe how to determine distance from the occluso-incisal surface to the root of the chamber. f. Identify common errors on specific teeth that may occur during access preparation and know how to correct them. g. Describe the techniques for locating difficult to find chambers or canals. h. Describe the techniques for negotiating fine canals The objectives of canal a. Describe the rationale for cleaning and shaping the pulp space. preparation b. Describe the crown down concept in detail. Chemo-mechanical c. Describe the technique for pulp extirpation. technique of cleaning d. List the properties of the ideal irrigant and identify Rationale of shaping which irrigant meets most of these criteria. and ideal shape e. Describe the needle irrigation technique that Crown down concept produces the maximum irrigant effect. and its importance f. Discuss the properties and role of chelating and Clinical procedures of calcifying agents. hand ProTaper g. Discuss the properties and role of intracanal, inter- technique & Modified appointment dressings. ProTaper technique h. Describe the hand ProTaper technique. Use of Medicaments i. Define how to determine the final appropriate and list of common apical file size. medicaments Alternative procedures j. Draw a diagram of the perfect / correct shape of the final preparation. k. Distinguish between apical stop, apical seat and open apex. l. Understand the importance of recapitulation. a. Demonstrate the step-by-step technique for Anatomy of apex and obtaining estimated and final working lengths. rationale of b. Describe how to designate and maintain a stable determining the reference point. working length for c. Describe the significant and location of apical canal preparation constriction in relation to working length. Estimation of working d. Describe the working principle of apex locators. length using

Access cavity

1/1

10

Pulp space cleaning and shaping

1/1

11

Working length determination

1/1

18


radiographs and apex locator device Rationale using the most suitable file to take diagnostic radiograph to confirm working length Limitations/disadvant ages of radiographic method to determine working length e. f. g. h. Describe the significance and location of apical constriction in relation to working length. Differentiate between the minor and major apical foramen. Describe the importance of straight line access and coronal flaring prior to wl determination. Describe the relationship between anatomical apex, radiographic apex, and the actual location of the apical foramen.

12

Pulp space obturation

Timing Materials Lateral condensation obturation technique using ProTaper GP Dealing with procedural errors a. b. c. d. e. f. g. h.

Describe the purpose of obturation and the reasons why inadequate obturation may result in failure. Define and differentiate between lateral and vertical condensation techniques and suggest where each is indicated. Describe the lateral condensation technique. Discuss the significance of depth of spreader penetration during condensation. Describe the procedures in preparing and fitting of a master gutta-percha cone. Describe the technique for mixing and placing root canal sealer. Discuss the technique for removing excess sealer and obturating material from the chamber and why this process is necessary. Discuss the clinical and radiographic criteria for evaluating the quality of obturation. Describe the possible problems that might be encountered in canal preparation procedures Describe various possible problems to be encountered in obturation technique. Problems in obturation procedures

1/1

13

Trouble- shooting in hand ProTaper Technique

a. b. c.

1/1

List of demonstration & simulation exercises in module 1 Year 3

No 1. Demonstration & simulation topics Demo mounting teeth onto plaster block Selection of 7 teeth Max incisor (leave unmounted) Mounted Mand incisor Max/mand canine Max premolar Mand premolar Molar Max/mand molar (badly broken tooth mounted on blue tray) Taking, developing and mounting radiographs Demonstration should have been done in Simulation Recognise the anatomy of teeth i.e. both the crown and root morphology Appreciate the site and distance of the apical/lateral foramen to the root apex. Learning objectives By the end of demonstration & simulation student should be able to: Demo sessions (x3hours) 1 (Sim staf) Practical Session(s) (x3hours) 1

2.

Take good quality radiographs Perform developing procedures to produce good quality radiographs Document the radiographs for record

19


Operative Dentistry Course 3. Demo radiographic interpretation and reporting to use radiographic assessment form to guide in assessment endodontic case difficulty form keeping purposes- proper mounting and labeling of radiographs Interpret radiographs correctly Identify the normal structures of the images in the radiographs Detect the pathological details Accumulate the information from the radiograph and anticipate the challenges that may arise before attempting treatment Assess the level of difficulty when performing the rct procedures 1 2

4. Demo access cavity preparation using natural teeth (total: 7 teeth) Maxillary incisor (with pulp extirpation & temporary filling placement) Mandibular incisor Max/mand canine Maxillary premolar Mandibular premolar Maxillary and mandibular molar.(Exercise access only on 6 teeth) (7 teeth x 3 hours) Demo pulp space cleaning & shaping using :- ProTaper For Hand Use files Curved resin block Premolar Molar (see demo 8) Modified ProTaper Technique Curved resin block Max incisor (unmounted) -

Explain why straight line access and removal of pulpal horns are critical Discuss the importance of removing caries or restorations first before entering the pulp chamber during access cavity stage Describe procedures and sequence of complete access preparations Recognise errors and correct them 2 6

5.

Describe the objectives of cleaning and shaping Explain the significance of initial apical files and its determination Explain the significance of master apical file and how to determine the appropriate master apical file Distinguish apical stop, apical seat and open apex and how obturation is achieved in each situation List ideal properties of an irrigant Rationale for using selected irrigant systems Discuss the properties and role of intracanal medicaments.

6.

Demo removal of temporary restoration, coronal flaring and working length determination Pre-op radiograph for mounted teeth Apex locator (using unmounted max incisor)

Explain the limitation of using pre-operative radiograph to estimate working length Explain and describe how does the apex locator works Perform working length estimation using both techniques Describe how to confirm the working length using radiographic technique Use critical thinking to decide on the adjustment of working length Perform paralleling technique when taking radiograph for teeth with superimposed roots Achieve acceptable quality of obturation Describe the standards of obturation Describe the technique and its problem solving

7.

Demo obturation On all the prepared canals Single cone technique

20


Cold lateral condensation 8. Demo preparation of tooth prior to root canal treatment on Badly broken down max/mand molar mounted on a blue tray with adjacent teeth Perform banding and build up of badly broken down tooth Perform pulp space clean, shape and obturation on molar tooth Perform post endodontic restoration (Nayyar core) on obturated molar 1 2 Note apical size more than F3 would require hybrid technique using endo gauge to custom fit the adjusted size.

Evaluation of Module 1 Completion of simulation exercises on all teeth Competency Test : Access Cavity Upper Premolar Progress test MSA/OSCE Total hours of lectures: Total sessions of demonstration & simulation Total hours of evaluation

10(s) To check SLT

20(s) 3(s) 2 sessions 13 hours 30(s)

List of tutorials in module 1 Year 3

No 1. Isolation List of tutorials 2. Diagnosis & treatment plan (PBL) 3. Difficulty in achieving anaesthesia (PBL) Explain why apprehension and anxiety, fatigue, and tissue inflammation create difficulties in obtaining profound anaesthesia. Describe patient management techniques that will facilitate obtaining adequate anaesthesia. List techniques that are helpful in giving painless injections. Describe the routine approach to conventional local anaesthesia - when and how to anaesthetize. Describe circumstances that create difficulties in obtaining Make accurate diagnosis prior to attempting treatment Describe the appropriate treatment plan to manage the cases Communicate with the patient of the risks and benefits of the proposed endodontic treatment plan, and take consent for treatment Apply oral health education principles and practice as they relate to pulpal and periradicular disease and dental traumatology Discuss the reasons for rubber dam isolation during treatment Describe the different technique of rubber dam placement How to manage salivary seepage Indicate cases which are difficult to isolate and should consider prior management to endodontics Learning Outcomes By the end of tutorial students should be able to: 2/1 Semester/Hours

2/1

2/1

21


profound anaesthesia using conventional techniques. Describe when to employ supplemental methods of obtaining pulpal anaesthesia if standard block or infiltration methods fail. Review techniques of periodontal ligament and intrapulpal injections. Discuss how to obtain anaesthesia for specific pulpal and periradicular conditions: irreversible pulpitis, symptomatic teeth with pulpal necrosis (acute apical abscess) and asymptomatic teeth with pulpal necrosis (chronic apical periodontitis) Describe the importance of radiograph in endodontics Radiographic interpretation and the use of radiographic assessment form

4.

Endodontic radiography (PBL) Endodontic instruments (PBL)

2/1

5.

Describe the basic set of instrumentation appropriate to the procedures General physical properties of endodontic instruments Describe the design and shape of the common canal preparation instrumentation Describe the proper use to prevent separation Recognize the visible changes that will predispose to the instrumentation separation

2/1

Evaluation during tutorial classes: All students will be evaluated during the tutorial classes. Marks will be given based on the contribution of the students towards the learning activities. The generic skills that will be assessed include: 1) 2) 3) 4) Communication skill Team work skill Leadership skill Evidence on the use of information technology resources

(Refer to Seminar/Tutorial evaluation form,/students participation form)

SLT students here

22


MODULE 2 Introduced in Year 4 This module consists of lectures, tutorials and clinical sessions No Lecture Topics Contents Learning Outcomes By the end of lecture students should be able to a. Identify the aetiology of emergencies which occur prior to, during and after endodontic treatment. Recognize what constitutes a real emergency. List the factors that relate to a greater frequency of inter- appointment and post-obturation flare-ups. Describe and outline a sequential approach to the management of endodontic emergencies. Outline the examination procedures required to identify a source of pain and establish a pulpal or periradicular diagnosis. Describe when pretreatment emergencies might occur and how to manage these emergencies. Outline the steps involved in treatment of painful irreversible pulpitis, necrotic pulp with acute apical periodontitis, acute abscess including the indications and procedure for incision and drainage. Describe detail pharmacological support therapy used in endodontic emergencies to reduce pain and control inflammation an infection. Semester/Hours

1.

Endodontic emergencies

a.

Diagnosis and treatment of pre, intra and post endodontic emergencies

1/1

b. c.

d. e.

f. g.

h.

23


2. Modified Double flare Technique a. b. 1/1

Instruments usage Clinical procedures Trouble-shooting in technique

Describe the modified double flare technique and the clinical procedures Describe the possible problems to be encountered during the clinical technique Describe the modified double flare technique and the clinical procedures Describe the possible problems to be encountered during the clinical technique

3.

Canal Obturation of Modified Double Flare Preparation (Lateral Condensation technique) Procedural accidents

Instruments usage Clinical procedures Trouble-shooting in technique

a. b.

1/1

4.

Describe the causes, prevention and treatment of a varieties of trouble shootings Prevention and management of sodium hypochlorite accidents Recognize and describe cause, prevention and treatment of: i. pulp chamber perforation; ii. ledging; iii. separated instruments; iv. crown and root perforations; v. underextended obturation; vi. overextended obturation; vii. incomplete obturation; viii. vertical root fracture; ix. post space preparation mishaps; x. obliteration of canals with dental materials or dentine shavings. Delineate the anatomical pathways of communication between the dental pulp and periodontal ligament. Describe the effects of pulpal disease and endodontic procedures on the periodontium. Describe the effects of periodontal disease and procedures on the pulp. Identify which clinical diagnostic tests and findings are important in the differential diagnosis of periodontal-endodontic problems. Understand the treatment requirements and sequencing according to diagnostic findings. Recognize when treatment has been successful or has failed and develop an alternative treatment plan. Identify which complex cases should be considered for referral a.

1/1

5.

Perio-Endo Relationships

Communications between pulp and periodontium Mutual effects of the disease Classification and differential diagnosis of perio-endo lesions

a.

2/1 To coincide with Periodontology Course DF364C Year 4

b. c. d.

e. f.

g.

24


6. Tooth resorption a. Define and classify the different types of tooth resorption. b. Describe the aetiology and pathogenesis of tooth resorption. c. Describe the sign and symptoms, clinical examinations and diagnosis of tooth resorption. d. Describe the management of internal and external root resorption. e. Explain the outcome and prognosis of the treatment of tooth resorption. a. Describe the clinical and radiographic features of the following: enamel fracture; crown fracture without pulpal exposure; crown fracture with pulpal exposure; root fracture; crown-root fracture; tooth luxations; (concussions, subluxations, lateral luxations, extrusive luxations, intrusive luxations); avulsions; alveolar fractures b. Describe possible short- and long- term responses of the pulp; periradicular and hard tissues to these injuries. c. List the pertinent information needed when examining patients with dental injuries (from medical history, nature of injury, and symptoms) d. Describe the diagnostic tests and procedures used in examination of dental injuries and interpret the findings. e. Describe the appropriate treatment strategies (both at time of the injury and at follow up) for various types of traumatic injuries. f. Identify the criteria for success and failure of various treatment modalities. g. Define canal obliteration and factors determining the appropriate treatment strategy. h. Differentiate between surface, inflammatory and replacement resorption (ankylosis) and their respective treatment strategies. i. Describe the differences in treatment strategy for traumatic dental injuries in the primary and permanent dentitions. 1/1

Classification, clinical presentation and investigations Management of causes

7.

Dental Trauma

Examination, diagnosis and endodontic management of specific injuries Prognoses of traumatized teeth according to classification of dental trauma

1/2

25


Evaluation: Progress test/ OSCE Completion of Modified Double Flare exercise Clinical endodontics Completion of endodontic treatment on o 1 anterior tooth/single rooted tooth from Yr 3 and o 1 premolar tooth (Yr 4)

List of tutorials in module 2 Year 4

No 1. Preparation of teeth prior to root canal treatment List of tutorials 2. Working length determination 3. Pulp space cleaning and shaping Pulp space obturation Discuss the objectives of cleaning and shaping Understand the role of ultrasonic in endodontics Describe types of irrigating solutions and the purpose of use. Describe the term continuous taper in shaping the canal Evaluate quality of obturation using radiographic criteria Recognise the timing of obturation List of obturating materials Describe in brief techniques of obturations Describe techniques of removing obturating materials List ideal properties of a sealer Define endodontic emergencies Diagnosing emergencies Describe the clinical management of emergencies Plan the management of a traumatized tooth according to dental trauma classification. Identify the types of classification Plan proper management for a given lesion. 2/1 Explain why the working length will vary Explain and describe how does the apex locator works How to mark and maintain a stable reference point Managing sclerotic canals 2/1 Explain why protection is necessary prior to endodontics Recognize when an existing restoration should be replaced or repaired Describe the interappointment temporary restoration and techniques for the placement Describe temporary post core systems and provisional restorations Learning Outcomes By the end of tutorial students should be able to: 2/1 Semester/ Hours

4.

2/1

5.

Endodontic Emergencies

2/1 2/1

6.

Dental Trauma

7.

Endo-Perio Lesions

2/1

26


Evaluation during tutorial classes: All students will be evaluated during the tutorial classes. Marks will be given based on the contribution of the students towards the learning activities. The generic skills that will be assessed include: 5) 6) 7) 8) Communication skill Team work skill Leadership skill Evidence on the use of information technology resources

(Refer to Seminar/Tutorial evaluation form,/Students Participation Form)

SLT year 4

27


MODULE 3 Introduced in Year 5 In this module there will be lectures, seminars and tutorials

No Lecture Topics Contents Learning Outcomes By the end of lecture students should be able to: Briefly cover the technological advancement in endodontics Current available devices in the general dental practices Various methods of visualization including magnification Current development technology in radiography The action and use of rotary in endodontics a. Understand the rationale of technological advancement in endodontics. b. Describe in general the devices and materials now available for endodontic practice. c. Discuss various methods of increasing magnification and visualization during diagnosis, treatment planning and treatment management in endodontics. d. Identify the developing technology in radiography and imaging and explain their present and future applications e. List methods for enhancing the delivery of irrigants. f. Discuss the rationale, advantages and limitations of electronic apex locators. g. Define the differences between stainless steel and nickel titanium intracanal instruments. h. Describe the action and use of rotary instruments for both cleaning and shaping canals. i. Describe the alternative obturation techniques that use heated gutta percha and solid core systems. j. Discuss some post-crown removal systems. a. b. c. d. e. f. g. h. i. j. k. 3. Root canal re- The differences between initial cases and root canal re- treatment cases The indications for root canal a. b. Recognize the indications for root canal retreatment. Assess feasibility of retreatment in various clinical situations. Define success and failure in root canal treatment. Describe the methods used to determine success and failure. State the approximate range of expected outcomes of root canal treatment in routine uncomplicated cases. Describe and rank the factors that influence the outcome of treatment. Describe how to explain the prognosis to the patient. Evaluate and provide a critique for the prognosis of a case before, during and after treatment. Describe the importance of recall. Discuss the recall intervals required to determine success and failure. Recognize when a case has failed. Identify causes, other than endodontic causes that may lead to failure of treatment. State the prognosis of retreatment of endodontic failures. 1/1 Semester/ Hours

1.

Advances in endodontics

1/1

2.

Success and failure in endodontics

Define success and failures in endodontics Methods used to determine success and failures How to explain prognosis to patients Recognize when endodontics fail

1/1

28


treatment re-treatment Differentiate cases that are appropriate to refer and those that should be attempted Management of root canal re-treatment c. d. e. Recognize clinical condition that may contraindicate retreatment. Differentiate between those cases appropriate for treatment by the GDP and those that require specialist attention. Communicate to the patient the reasons for failure as well as the indications and contraindications for retreatment, and suggest alternative treatments. Understand the basic armamentarium and techniques for removing commonly used obturation materials from the canal. Communicate to a specialist the objectives for referring a case for consultation and treatment.

f. g.

4.

Surgical endodontics

Surgical terminology Indications for apical surgery including root end preparation Prognosis of apical surgery The principles of flap design The principles of suturing

1/2

a. Discuss the role of endodontic surgery as compared to conventional root canal treatment or retreatment b. Recognize situations in which surgery is not the preferred form of treatment. c. Define the terms; incision for drainage, apical curettage, root end resection, root end preparation and restoration, root amputation, hemisection and bicuspidization. d. List the more common root end filling materials. e. Describe general patterns of soft and hard tissue healing. f. List and describe conditions that indicate referral to a specialist for evaluation and /or treatment

Evaluation

1/1 Progress test/OSCE/semester exam Competency test - Molar access cavity 2 ( s) Clinical endodontics Completion of endodontic treatment on at least o 1anterior tooth/single rooted tooth from Yr 3 or Yr 4 o 1 premolar tooth from Yr 4 o 1 molar tooth- from Yr 5

29


List of seminars in module 3 year 5 No 3. 4. 5. 6. List of seminars/Tutorials Seminar A Restoration of endodontically treated teeth Seminar B Evidence based Endodontics and Its Importance Seminar C Recognising your limitations: When to refer? Seminar D Practicing Endodontics With Multidiciplinary Approaches 2/1 2/1 2/1 2/1 Semester/Hours

Evaluation during seminar classes: All students will be evaluated during the tutorial classes. Marks will be given based on the contribution of the students towards the learning activities. The generic skills that will be assessed include: 9) Communication skill 10) Team work skill 11) Leadership skill 12) Evidence on the use of information technology resources (Refer to Seminar / Students participation form evaluation form)

SLT

30

COURSE EVALUATION

31

 Chapter 4

CLO

Module

Teaching & Learning Activities

Evaluation Method

KNOWLEDGE 1. Describe the biology, anatomy and physiology of the oral and perioral tissues 2. Describe the microbiology of pulpal and periapical disease. 3. Describe the aetiology, pathology, clinical presentations and treatment options for diseases affecting the pulp and periradicular tissues 4. Describe the properties of commonly used endodontic materials 5. Describe the pharmacotherapeutic agents used in the management of pulpal and periradicular disease 6. Describe the implications systemic health disorders may have on non-surgical endodontic treatment 7. Describe the principles and practice of dental radiology in respect to endodontic treatment 8. Describe the principles and practice of local anaesthesia for the treatment of pulpal and periradicular disease 9. Describe the principles and practice of the use of rubber dam in endodontically related procedures 10. Describe the principles and practice of vital pulp therapy and preventive Endodontics

Lecture (In Oral Biology lecture) Lecture Lecture Tutorial Clinical sessions Theory Mini test/OSCE, Final Exam Assessment in Endo Clinical Evaluation Book E & D form Theory Mini test/OSCE, Final Exam Theory Mini test/OSCE, Final Exam

Lecture Clinical sessions Lecture Clinical sessions

Theory Mini test/OSCE, Final Exam

Theory Mini test/OSCE, Final Exam

Lecture Clinical sessions Theory Mini test/OSCE, Final Exam

Lecture Tutorials Clinical sessions Lecture in ICD Tutorial Theory Mini test/OSCE, Final Exam Theory Mini test/OSCE, Final Examination

Lecture in Yr 2 (Operative) Theory Mini test/OSCE, Final Exam

Lectures Theory Mini test/OSCE, Final Exam

32


11. Describe the principles and practice of dental trauma Describe the principles and practice of non- surgical endodontics for deciduous teeth and immature teeth Describe the principles and practice of non- surgical root canal treatment Describe the principles and practice of non- surgical root canal retreatment Describe the principles and practice of the management of endodontic emergencies Describe the principles of surgical Endodontics Describe the cross infection control measures in Endodontics 3 Lectures Lectures Theory Mini test/OSCE, Final Exam Theory Mini test/OSCE, Final Exam

12.

13.

1, 2

Lectures Tutorials Lectures Theory Mini test/OSCE, Final Exam Theory Mini test/OSCE, Final Exam

14.

15.

Lecture Theory Mini test/OSCE, Final Exam

16. 17.

4 2

Lectures Lecture in Operative Theory Mini test/OSCE, Final Exam Assessment in Endo Clinical Evaluation Book Theory Mini test/OSCE, Final Exam Theory Mini test/OSCE, Final Exam

18.

Monitor and evaluate the effectiveness of non-surgical endodontic treatment CLINICAL SKILLS 1. Examine a patient using contemporary diagnostic methods to evaluate the head and neck region and to reach a diagnosis of the patients oral and craniofacial health status. 2. Assess the teeth, supporting structures to determine pulp and periapical status 3. Diagnose pulp and periradicular diseases 4. Formulate a comprehensive treatment plan to promote endodontic treatment as part of holistic care and implement treatment in

Lecture

2, 3, 4

Demonstration ICD Clinical sessions Assessment by practicing with clinical partner Assessment in Endo Clinical Evaluation Book

2, 3, 4

Demonstration ICD Clinical sessions Clinical sessions Demonstration ICD Clinical sessions Tutorial Assessment by practicing with clinical partner Assessment in Endo Clinical Evaluation Book Assessment in Endo Clinical Evaluation Book Assessment by practicing with clinical partner Assessment in Endo Clinical Evaluation Book

2, 3, 4 2, 3, 4

33


a safe, properly sequenced and timely manner. 5. Communicate with the patient of the risks and benefits of the proposed endodontic treatment plan, and take consent for treatment Apply dental public health and health promotion principles and practice as they relate to pulpal and periradicular disease and dental traumatology Utilize critical thinking in assessing technical and scientific information during endodontic treatment and use problem solving skills related to the comprehensive dental care of patients Practice the principles and techniques of dental radiology in relation to Endodontics 2, 3, 4 Demonstration ICD Clinical sessions Tutorial 2, 3, 4 Clinical sessions Assessment in Endo Clinical Evaluation Book Assessment by practicing with clinical partner Assessment in Endo Clinical Evaluation Book Assessment in Class

6.

7.

2, 3, 4

Clinical sessions Assessment in Endo Clinical Evaluation Book

8.

Simulation exercises Demonstration ICD Clinical sessions Demonstration ICD Clinical sessions Simulation exercises Demonstration ICD Clinical sessions Assessment in Simulation Book Apply on each other and being assessed Assessment in Endo Clinical Evaluation Book Clinical sessions Assessment by practicing with clinical partner Assessment in Endo Clinical Evaluation Book Assessment in Simulation Book Assessment by practicing with clinical partner Assessment in Endo Clinical Evaluation Book

9.

Administer of local anaesthesia for the treatment of pulpal and periradicular disease

2, 3, 4

10. Apply rubber dam in endodontic procedures

1, 2, 3, 4

11. Carry out vital pulp therapy

2, 3, 4

12.

Manage emergency cases

1, 2, 3, 4

13. Carry out non-surgical root canal treatment for vital and non-vital uncomplicated cases safely and competently 14. Prescribe pharmacotherapeutic agents appropriately in

Lecture (In Operative Dentistry) Clinical sessions Lectures Clinical sessions Simulation exercises Clinical sessions

Lecture Simulation exercises

Clinical sessions Examination Simulation assessment Clinical requirements of RCT on 1 anterior tooth/single rooted tooth, 1 premolar tooth and 1 molar tooth Theory mini test, OSCE, Final Examination

34


the management of pulpal and periradicular disease OTHER SKILLS 1. Liaise with colleagues for multidisciplinary planning and management of treatment and comprehend the relationship of Endodontics with other dental and medical disciplines and the possibilities for adjunctive treatment 2. Recognize the limits of their expertise and seek consultation with specialists/endodontist s to facilitate holistic patient care. 3. Manage a diverse patient population with endodontic problems and have the interpersonal and communication skills to function successfully in a multicultural work environment. 4 Seminar PBL Clinical sessions Class presentation (Evaluation form)

Lectures

Theory mini test, OSCE, Final Examination

3, 4

Lectures Clinical sessions

Assessment in Endo Clinical Evaluation Book Class presentation (Evaluation form)

35

 1. ASSESSMENT and EXAMINATIONS The final grade for the course will be derived from 2 components i.e. the Continuous Assessment (CA) marks (50%) and the marks from the final assessment at the Final Professional Examination Part 3 (50%) which will be held at the end of Year 5. The continuous assessment marks will be taken from all the evaluations stated in all the 3 modules and will accumulate from Year 3 and continue until the end of Year 5. Students must pass the continuous assessment (marks must be 25% and/or above) in order to be eligible sit for the final examination. A. Marks for Continuous Assessment Marks for Continuous Assessment will be taken from a) Progress Tests (Mini tests, OSCE, MCQ/True & False questions or Quizzes) b) Assessment during tutorials, seminars and other learning activities such as students presentation during reflective learning on relevant topics c) Clinical Requirements
Continuous Assessment Module 1 Progress test Completion of simulation exercises Year 3 10% Must complete Must Pass Year 4 Year 5 10 Total (%)

Competency test in access cavity: upper premolar Module 2 Progress test Assessment in tutorial/presentation/seminar Module 3 Progress test Assessment in tutorial/presentation/seminar classes Competency test - Molar access cavity

10%

10

10% 10

Must Pass

20

Clinical Requirements: Minimum requirement on completed endodontics on:- 20% o 1 anterior tooth/single rooted tooth o 1 premolar tooth o 1 molar tooth o Other clinical procedures (see list pg 42-43) Total Percentage of Continuous Assessment

50

36

Reminder

Clinical Requirements Students are encouraged to do as many clinical procedures as possible. However, the students are expected to fulfill a set of clinical requirements during this course. These clinical requirements will be converted into assessment marks and it will contribute to the continuous assessment marks. Those who manage to do more than what is required will have marks contributed to the continuous assessment marks. If you fail to fulfill these requirements you may not be able to sit for the Final Professional Examination. (*Total numbers are cumulative from Year 3)
Endodontics (Anterior and premolar) Endodontics (Molar) Other treatment See list in page See list in page See list in page 2 1

Procedures

End of Year 3 End of Year 4

End of Year 5 *Minimum total cumulative root treated teeth by end of Year 5

a. When to start endodontic cases Students are encouraged to start endodontic treatment on an anterior tooth (upper and lower incisors and canine) in Year 3 as soon as you have completed the ICD modules as it is easier and far less challenging. You are permitted to start endodontic treatment in the clinics on these teeth as soon as you are given a case. However, the department recognizes that there may be difficulties in getting such case 37

 or patient; therefore leniency is given to students to carry out endodontic treatment on single rooted premolar (upper 5, lower 4 and 5) tooth and access must be carefully supervised by a competent clinical supervisor. Students are allowed to start on upper premolar only and only if they have passed the endodontic competency test in access cavity of the upper premolar and preferably have completed the obturation stage of premolars at the Simulation Clinic of year 3. Emergency management of dental pain such as access cavity and pulp extirpation stage can be carried out on any tooth at any point of Operative Clinical sessions. All treatment carried out must be evaluated by your clinical supervisor using the endodontic clinical evaluation forms provided by the department. How to get endodontic patients

i. To get a patient, you can request the specific endodontic case by filling up the endodontic request form, which is available from the Department of Operative Dentistry Office. Once the course coordinator has approved the permission, please proceed to the Klinik Pakar Endodontik to get a suitable patient as you requested from the DSA in-charge who will allocate a patient to you from a waiting list. You will receive only the relevant information about the patient and it will be your responsibility to retrieve the folder and start contacting the patient your self to arrange for the appointment according to your schedule clinical sessions. This patient is officially yours to handle the comprehensive treatment plan and manage the patient in total care. ii. Alternatively, if your operative/conservative patients may have the indications to start root canal treatment (RCT) then you should provide the treatment accordingly. The same goes if your periodontics or prosthodontics patients require RCT then please do so as part of comprehensive treatment care to your patients. iii. Referral cases. Occasionally a senior student may refer a single rooted RCT cases for you to manage. In this case, you must make sure that a referral letter is enclosed in the folder before you start the case. However, please take note that if you have been referred a case by your colleague then you are required to complete the specific case only. You are not required to complete the entire treatment plan for the patient, as the patient is NOT yours in the first place. When you have too many endodontic cases to handle, you are allowed to refer cases to the other students only if permission is granted from the course coordinator. This is only permissible 38

 if you have completed all the required cases but still have patients that are in need of RCT. A word of reminder that once a patient is registered under your care, it is your responsibility to see that the treatment plan on the referred case is carried out by your colleague. Referral to endodontists or postgraduates. This applies when you have attempted the RCT but along the treatment phase you encounter some challenges that are beyond your ability to provide the best treatment to patient. Therefore its is important that you fill in the endodontic case difficulty assessment form before you start the treatment as this will guide you if the case is suitable for your level to handle. Cases that should not be treated by undergraduate students include management of C shaped canals, re-treatment cases, broken instruments, treatment extending more than 8 visits and persistent exudation or bleeding. Properly written referral letters would be given as bonus marks ( see page 42-43) What are the forms to be used and where to get them? Form i. ii. iii. iv. v. vi. vii. viii. ix. x. xi. xii.

Venue All polyclinics All polyclinics Dept of Operative Dentistry Dept of Operative Dentistry Simulation Clinic All polyclinics Dept of Operative Dentistry All polyclinics All polyclinics Dept of Operative Dentistry Dept of Operative Dentistry Dept of Operative Dentistry

Consent for root canal treatment form Endodontic case difficulty assessment form Endodontic clinical evaluation form/book Endodontic simulation checklist form/book Endodontic competency test form Examination & Diagnosis (E&D) form Radiographic assessment form Root canal treatment form Seminar evaluation form Students participation form Folder checking form

Patient requests form/ Borang Permohonan Pesakit

39

Note/Reminder ENDODONTIC CLINICAL EVALUATION FORM

a. b.

Clinical work entered into the forms which are not signed by the supervisor will not be counted. Clinical work entered into the forms which does not contain the supervisors name in print will not be counted, even though the form is signed.

c. d.

Clinical work which has no grade/marks in the assessment column will not be accepted. Assessment of clinical work shall be graded as the following:- 4 Excellent- The student does not need any advice/guidance and is able to complete the stage of treatment without any help 3 Good- The student needs minimal advice/guidance and is able to complete the stage of treatment without any help 2 Satisfactory- The student needs considerable advice/guidance and some help to complete the stage of treatment 1 Borderline- There is some damage to the tooth and supervisor needs to help to complete the stage of treatment 0 Poor- Irreversible damage to the tooth structure despite given advice/guidance. Supervisor has to complete the entire treatment for the student.

e. The quality of the treatment including assessment of endodontic success and failures will be evaluated using these grades. These grades will be then converted into assessment marks and it will contribute to the continuous assessment marks. If you are required to repeat the same treatment on the same tooth (due to poor quality of restoration) that you have previously placed in the same patient, no marks will be given for the first treatment. f. You are expected to return a copy of the endodontic clinical evaluation form on the same day of your clinical session that involves root canal therapy. Please ensure that your clinical supervisor enters the assessment marks at the designated stage and grades are duly given for the completed 40

 stages only. Once this form is signed, you can tear off the printed WHITE printed sheet and hand this over to the DSA at Clinic Pakar Endodontic, Level 3, Block Q. The YELLOW copy is for your safekeeping. Note: The department reserves the right to modify these clinical requirements. You will be notified regarding any changes to the clinical requirements as soon as they are made. Please check the Department of Operative Dentistry notice board periodically and the e-learning portals to keep your up-to-date with any announcements.

41

 ENDODONTIC TREATMENT CODES To help manage the students clinical requirements successfully, treatment codes system has been developed. Below is a list of the treatment codes that correspond to the percentage that a student entitles upon completion of the root canal treatment. ENDODONTIC TREATMENT (B3Tx) Max(%) Actual code a. 1 canal b. 2+ canals 3. Molar OTHER TREATMENT PROCEDURES (B3Bx Bonus) In addition to the completed root canal treatment, various clinical procedures that will be counted in the continuous assessment marks include: 1. Vital pulp therapy (B3B1) Procedures must have proper documentation. Clinical evaluation will be based on procedures (each step), placement of permanent restoration and at least 1 review post treatment (+ 3 months). The treatment includes: Direct pulp capping Partial pulpotomy (Cveks pulpotomy) 2. Cracked tooth management (B3B2) This includes diagnosis, confirmation of diagnosis (removal of filling), cementation of ortho band followed by referral to appropriate department (such as Prosthodontics, endodontic specialist clinic, extraction etc) 3. Removal of coronal restoration and single cone GP during retreatment (to be carried under the supervision of an endodontist) (B3B3) 4. Emergency procedures (B3B4) i. Drainage of the soft tissue abscess ii. Pulp extirpation followed by appropriate dressing iii. Management of flare-up in between endo treatment iv. Management of traumatized tooth including placement of soft splint v. Management of procedural errors eg sodium hypochlorite accident 42

1. Anterior 2. Premolar

4, 4 6 6 3, 5, 10

B3T1 B3T2a B3T2b B3T3

B-Department code; 3- Endodontic treatment; T-Treatment; x-no of treatment appeared on the list

 5. Preparation of tooth prior to root canal treatment (B3B5) i. Ortho band placement 6. Complex tooth build-ups (B3B6) 7. Bleaching techniques for root treated tooth (B3B7) 8. Endodontic referrals to specialists ( a printed referral letter with both clinician and supervisors signature) (B3B8) 9. Review post endodontic treatment (minimum 6 months) (B3B10) 43


CALCULATION OF THE FINAL MARKS IN THE FINAL PROFESSIONAL EXAMINATION (PART 3)

CONTINUOUS ASSESSMENT (50%)

MODULE MODULE MODULE CLINICAL 1 2 3 REQUIREMENTS (YR3) (YR4) (YR5) (CR) MARKS

FINAL EXAMINATION (50%)

THEORY PAPER OSCE

TOTAL 100%

10%

10%

10%

20%

50% (MCQ =20%) (MSA=30%)

50%

CLINICAL REQUIREMENTS FOR ENDODONTIC MARKING WEIGHTAGE (20%)

Procedure Minimum No of cases Maximum % Anterior 1 Premolar 1 Molar 1 1 Pulp therapy
5 4

2 Crack
2 2

3* Re-tx
2 2

4 Emer
2 2

5 Orto- band
5 4

6 Build up
2 2

7 Bleach
2 2

8 Refer
2

9 Rv
2

4%

Up to 6% (1 canal) (2 canals)

Up to 10%

0.5
(0.125)

0.5
(0.25)

0.5
(0.25)

0.5
(0.25)

0.5
(0.125)

0.5
(0.25)

0.5
(0.25)

0.5
(0.25)

0.5
(0.25)

*single cone GP only For additional completed root treated tooth, students will be given bonus marks that contribute to 2% of a maximum of 5% bonus. Note: The department has the right to change the total maximum percentage based on the overall class clinical performances to ensure high quality standards of treatment and products 44

 Final Professional Examination (Part 3) i. General Structure This examination will be held at the end of Year 5 and it will cover all the lecture topics given in Year 3 until the end of Year 5. The examination consists of 2 components, which is the written paper and OSCE. This examination will test your knowledge, understanding and the clinical application of the information that you have acquired since Year 3. At this level of your studies, you are expected to be able to answer clinically applied type of questions. The marking weightage of this examination is as in the previous page. ii. Requirements There are two requirements that you must fulfill before you are allowed to sit for the Final Professional Examination (Part 3) which are: a. Attendance of at least 80% for both lectures and clinics. Student participation form and attendance lists must be signed. b. Continuous assessment must pass i.e. at least 25% of the overall marks. iii. Format of the Final Professional Examination (Part 3) The examination comprises: a. One theory paper which consists of 2 parts i.e. Part I (MCQ) and Part II (MSA- short answers, fill- in-the-blanks) and b. An OSCE paper type questions a. The theory paper will comprise; Part I. Part I (MCQ) One mark will be deducted for each wrong answer. However, the minimum mark for the question will be 0. Part II (MSA- short answers, fill-in-the-blanks, one best answer etc). You must answer all questions. No marks will be deducted for the wrong answers given. b. OSCE paper OSCE stands for Objective Structured Clinical Examination. These questions are meant to test mostly the knowledge and practical skills in endodontics. You may have some tasks to be carried out at a specific station and must complete with in the given time. You may also be quarantine before and after the examination in order to assure confidentiality of the questions. 45

 iv. Pass/Fail Viva a. Candidates with a final rounded mark of 45 to 49 inclusive will be required to attend a Pass/Fail viva voce examination. The viva will be approximately 15 minutes in duration, and will be conducted by at least 3 examiners i.e. one from each unit. b. No marks shall be awarded for the viva. The candidates will only be awarded either a Pass or Fail. Candidates who are awarded a Pass will have their final mark raised to 50, whilst the marks of candidates who are awarded a Fail will not be amended. iv. Distinction Viva a. Candidates with a final rounded mark of 75 or above will be invited to attend for a Distinction viva voce examination. b. The viva will be approximately 15 minutes in duration, and will be conducted by at least 3 examiners i.e. one from each unit. c. No marks shall be awarded for the viva. Distinctions will be awarded at the discretion of the examiners on the basis of the performance in the viva. Successful candidates will be awarded a Pass with Distinction. v. Grading Following any pass/fail and distinction viva examinations, candidates will be awarded a grade as follows: A A- B+ B B- C+ C C- D 80 and above 75 79 70 74 65 69 60 64 55 59 50 54 45 49 44 0 46

 vi. Repeat Examination Any candidate who fails the Final Professional Examination (Part 3) will be required to re-sit the examination, subject to any provisions and requirements of the programme regulations. The repeat examination format will be the same as that detailed above but with the following provisions: a. The accumulated continuous assessment marks will not contribute towards the final mark of this exam. The final mark will be determined solely by this examination. b. No pass/fail viva will be conducted for this examination. c. Candidates will not be eligible to attend for a Distinction viva. d. Students who fail this repeat exam will be required to repeat the year i.e. the 5th year. You are required to complete all the clinical requirements for Year 5 (repeat) and attend all scheduled lectures, tutorials and clinics that have been arranged by the department. You will be barred from taking the Final Professional Examination (Part 3) if you fail to comply with this requirement. 4. Recommended Reading References a. Hartys Endodontics in Clinical Practice. 6th Edition. Bun San Chong; Churchill Livingstone Elsevier Limited, 2010. b. Pathways of the Pulp: Expert Consult 10th Edition. Hargreaves KM and Cohen S; Mosby, 2010. c. Pitt Fords Problem Based Learning in Endodontology. Patel S and Duncan H; Wiley-Blackwell, 2011. d. Principles and Practice of Endodontics. 4th Edition. Walton RE and Torabinejad M; Saunders Elsevier, 2009. e. Traumatic Dental Injuries . A Manual 3rd edition. Andreasen JO, Bakland LK, Flores MT, Andreasen FM, Andersson L; Wiley-Blackwell, 2011. 47

 5. Additional Reading References a. Endodontics: Problem Solving in Clinical Practice. Pitt Ford TR, Rhodes JS, Pitt Ford HE; Martin Dunitz, 2008. b. Successful LA for Restorative Dentistry and Endodontics. Reader AL, Nusstein J, Drum M; Quintessence Publishing, 2011. c. Professional Responsibility in Dentistry: A practical Guide to Law and Ethics. Graskemper JP; John Wiley & Sons Inc., 2011. 48

APPENDIX

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