Operative (D3only

Projected
Q Completion
Date
ty

Complete

Patien

d Date3

t #1

Complete

Patien

d Date3

t #1

Verified2

Total Prerequisites for C

ompetencies (8):
Four Amalgam Restoration
s:
Class I
Class II-1

1
1

Class II-2

Class V

Four Composite Resin Rest

orations:
Class I

Class II

Class III or IV

Class V

Competencies: D3 Year Onl

y
ClassI (elective)

ClassII (required)

ClassIII / IV (required)

Total Competencies for D3

Year (3)

Operative (D4only
)

Projected
Q Completion
ty

Verified2

Date

.
Class II Alloy

Class II Composite

Class III or IV (Composite)

Total Competencies for D4 Year (3) *

two done on mockboards and one before mockboards
Projected
OD/OMD3/D4

Complete
Completion
Da
Qty.
d Date3
te

Emergency Exams as Prerequisites (10

) use code D0140
Emergency Examas Prerequisite-1

Pati Verif
ent
#1

ied2

Emergency Examas Prerequisite-2

Emergency Examas Prerequisite-3

Emergency Examas Prerequisite-4

Emergency Examas Prerequisite-5

Emergency Examas Prerequisite-6

Emergency Examas Prerequisite-7

Emergency Examas Prerequisite-8

Emergency Examas Prerequisite-9

Emergency Examas Prerequisite-10

CDCE (Clinical Diagnosis

Competency Exams) 6Emergency Forms Complet
ed and Submitted
Emergency Patient Competency Ex

am-1
Emergency Patient Competency Ex

am-2
Emergency Patient Competency Ex

am-3
Emergency Patient Competency Ex

am-4
Emergency Patient Comp Exam-5 (

D4 Year Only)*
Emergency Patient Comp Exam-6 (

D4 Year Only)*
*no less than 2 completed during t
he D4 yr
OMCEP
(Oral Medicine Clinical Experien
ce Portfolio)
Medical Consultations (a
tleast 1 must before an ASA III or

IV patient)
Problem-Oriented Medical History
Summaries (at least 3 must before

ASA III or IV patients)

Student Presentation /
Oral Med. Faculty Eval

CDWCE
(Clinical Diag. Written Compet
ency
Exam, Spring D4 Year, >70%)

Pediatrics

Projected
Q Completion D
ate
ty

Complet

Pati Verif

ed Date3

ent

ied2

#1

.
Treatment Plan-1

Treatment Plan-2

ClassII Amalgam/Compositeon Pri

mary Molars(1)

Pulpotomy-(1)

SSC (1)

Sealants (4)
Sealant-(1)

Sealant-(2)

Sealant-(3)

Sealant-(4)

Space Maintenance (1)

Special Needs (1)

Nitrous Competency (1)

Plus minimum of 20 days in Peds.

Clinic

Oral Surgery

Projected
Q Completion D
ate
ty

Complet

Pati Verif

ed Date3

ent

ied2

#1

.
Written Competency D3 Year

Written Competency D4 Year

Treatment Planning

Projected

Complet
Completio
Q
ed Date3
n
Date
ty
.

D3 Year
Completed Treatment Plans through D3
Planning Program- 20%
Competencies (2)

of course grade

Pati Verif
ent
#1

ied2

Ideal Treatment Plan Written Competency

(due March 1)- 40% of course grade

D3 Case- Based Examination

(graded by group mgr springsemester)
40% of course grade; also a component of

CPMI grade
D4Year
Competencies: (2)
D4 Case-Based Examination (fall
semester)-

60% of course grade

Treatment Plan Case Complete Presentati
on
(graded by group manager, due spring se

mester)40% of course grade; also a component

of CPMII grade

Periodontics D3/D4

Projected

Q Completio ed Date3
ty n Date
.

Prerequisites for Competencies

Preventive Counseling(3)-OHI, Dietar
y, or Tobacco Counseling
Preventive Counseling-1

Preventive Counseling-2

Preventive Counseling-3

Comprehensive Periodontal Exams (4)

Comprehensive Periodontal Exam-1

Comprehensive Periodontal Exam-2

Comprehensive Periodontal

Exam-3
Comprehensive Periodontal
Exam-4
QuadSRP (5)-1-3Teeth=

Complet

Pati Verif
ent
#1

ied2

1/2Quad
QuadSRP-1

QuadSRP-2

QuadSRP-3

QuadSRP-4

QuadSRP-5

Periodontal Re-evaluation(1)

Competencies (ByEndofD
3Year)
PreventiveCounselingOHI, Dietary, or Tobacc

o Counseling-1
Preventive CounselingOHI, Dietary, or Tobacc

o Counseling-2
Comprehensive Perio Exam-

1
Comprehensive Perio Exam-

2
QuadSRP-1

QuadSRP-2

Periodontal Re-evaluation

Periodontics D3/
D4 Continued

Projected
Q Completio
n Date
t

Complete

Patien

d Date3

t #1

Verified2

y
.

Benchmarks Needed for Mo

ckBoard Eligibility in RED

Competencies to be Com
pleted by Graduation
(incl. Requirements for D
3 Year
and MockBoard Eligibilit
y)
Preventive CounselingOHI, Dietary, or Tobacc

o Counseling-1
Preventive CounselingOHI, Dietary, or Tobacc

o Counseling-2
Preventive CounselingOHI, Dietary, or Tobacc

o Counseling-3
Preventive CounselingOHI, Dietary, or Tobacc

o Counseling-4
Preventive CounselingOHI, Dietary, or Tobacc

o Counseling-5
Comprehensive Perio Exam-1

Comprehensive Perio Exam-2

Comprehensive Perio Exam-3

Comprehensive Perio Exam-4

Quad SRP-1

Quad SRP-2

Quad SRP-3

Quad SRP-4

Quad SRP-5

Periodontal Re-evaluation

Periodontal Re-evaluation

PhaseII Completed Periodontitis Case-

1*
PhaseII Completed Periodontitis Case-

2*
*evaluated by Case Report Form
(narrative)

Periodontics D3/D4 Con

tinued

Projected
Qt Completio
n Date
y.

Complete

Pat Verified

d Date3

ien
t#
1

Essential Clinical Experiences

(Incl. Prerequisites and Competen
cies)
Preventive Counseling (8)

Comprehensive Periodontal Exams (8)

Quad SRP and Rooting Planning (10)
Periodontal Re-evaluations (3)
Periodontal Surgical Assist/Observe
with Graduate Periodontics- Comple
ted as a Rotation (1)

Notes:

AsofDate:

Orthodontics

Projected
Qt Completio
n Date
y.

Complete

Pat Verified

d Date3

ien
t#
1

Patient Consults (5) Recommend

3 D3 Year
and 2D4Year/2PointsEach
Patient Consult (D3 Year)-1

Patient Consult (D3 Year)-2

Patient Consult (D3 Year)-3

Patient Consult (D4 Year)-1

Patient Consult (D4 Year)-2

Enter Code D9310 into Axium for Credit

Competency Exam: Spring of D4 Year

Schedule Review Session & Exam January of

D4 Year

Notes:

As of Date:
Fixed Par
tial Dent
ures

Proc
ed
ure
Co
de

Projec
Q tedSta
t rt Dat
y e
.

Presen Proje
t Ste cted
Pat
Sta
p Co Comp
ien
leti
rt
de4
t#
on
Dat
1
Dat
e
e

Comp
lete
dD
ate
3

V
e
ri
fi
e
d
2

Units of Cro
wn
and Bridge
(12)
Crown and
Bridge D3Year
-1
Crown and
Bridge D3Year
-2

Students failing to complete minimum stated procedures by May 30,2015 (Class2016)

will receive an incomplete grade. Extensions of this incomplete grade into September 15,2015
will result in the grade being lowered one (1) full letter grade.

Crown and
Bridge D4 Yea
r-1
Crown and
Bridge D4 Yea
r-2
Crown and
Bridge D4 Yea
r-3
Crown and
Bridge D4 Yea
r-4

Crown and
Bridge D4 Yea
r-5
Crown and
Bridge D4 Yea
r-6
Crown and
Bridge D4 Yea
r-7
Crown and
Bridge D4 Yea
r-8
Crown and
Bridge D4 Yea
r-9
Crown and
Bridge D4 Yea
r - 10

Notes:

Examples: Crowns, FPDs (exclude pontics), inlays/onlays, implant crowns/FP

Ds, CastPosts (Limit2)
*One of the 12 experiences must be a crown which
counts as a graded competency.
*A minimumof fivecompeted (or 4completeand 1in
lab) full coverage preparations are required
prior to the student being
eligiblefor the fixed prosthodontics competency examination.
These units do not include implant-supported restorations.
Prerequisites for mock board eligibilitySix completed clinical crowns/FPD, three of each (#9 all-ceramic, #5 PFM,
#3 Full Metal) on a dentaform per ADEX
requirements; SIM lab and South Lab
dispensaries will provide dentaforms and practice teeth
*The details for the dentaform preparations will be released during

the Advanced Concepts II class in D4 year.

*A minimum of six completed full coverage restorations are requ
ired prior to the student being
eligible for the ULSD mock exam for clinical fixed prosthodontics.
These units include teeth/implant-supported restorations.

As of Date:

CD&RPD

One CD/CD D3Year

One CD/CD D4Year

Proc
ed
ur
e
Co
de

Pr
oj
ec
Q te
t d
y St
. ar
t
D
at
e
2
2

Two Addition
al RPDs Plus
Competency
Exam
RPD- 1

RPD- 2

Competency Exam

Proje Com
Prese
cted
nt S
ple
Pa
Com
tep
te
tie
ple
Cod
d
nt
tio
e4
Da
St #1
n
te3
art
Da
Da
te
te

V
e
r
if
i
e
d
2

Miscellaneous CD/R
PD Procedures-(5 R
equired)5
Miscellaneous RPD Proc
edure- 1

Miscellaneous RPD Proc

edure- 2

Miscellaneous RPD Proc

edure- 3

Miscellaneous RPD Proc

edure- 4

Miscellaneous RPD Proc

edure- 5

Notes:

*For MockBoard eligibility,must have completed 1CD/CD +1RPD

Endodontics

D3Year

Proc
ed
ur
eC
od
e

Pr
Q oj
t ec
y te
. d
St
ar
t
Da
te

Presen Proje Com

t St cted
ple
Pa
Comp
Sta
ep C
ted
tie
leti
rt
ode4
Dat
nt
on
Da
e3
#1
Dat
te
e

V
e
ri
fi
e
d
2

Simulation Mode/Ty D3310

podont
Single Cana
l or Simple
Case Experi
ence
Single Cana
l or Simple
Case Experi
ence

6/13/14

6/13/14

NA

6/13/14

6/13/14

As of Date:
Single Canal Endodontic Competency (Simulation
/Typodont)

D4 Year
Endo Experience (Patient)
Endo Experience (Patient)

1
1

Molar Endodontic Competency (Simulation)

1
Notes:

(Footnotes)
1
- "X" in "Patient #" column = No patient available.
2
- "Verified" should be within Axium or specific discipline's notes. Should

contain date and instructor's initials.

3
- All "Completed Dates" should be a calendar date (MM/DD/YY). "Projected
Dates" may be more general (Mid September, etc.).
4
- All "Present Step Codes" will be the last step accomplished for a particular
appliance. (See attached list of step codes/discipline.)
5
- Miscellaneous Procedures include: CD or RPD relines, repairs, Essix
retainers and occlusal splints.

STEPCODES
Fixed Partial Dentures

Removable Partial
Dentures

FPPPrep completed

RPSDIPhase I Survey/Design

FPIImpression completed

RPSDIIPhase II Survey/Design

FPL

Case sent to Lab

RMICMaster Impressions Complete

RLF Case to Lab for Framework Constr.

Complete Dentures
Master Impressions Completed

CMIC

CLWS

Sent to Lab for Wax set-up

RFTIFramework Try-in
RLP Case to Lab for Processing
RDELProsthesis Delivered

CWTIWax try-in
CLP

Sent to Lab for Processing

CDEL Case Delivered

Endodontics
ERCIInstrumentation Complete