The Twelve Commandments
- Demonstrate mastery in a wide variety of complex nonsurgical and surgical cases.
- Ensure all documentation is complete.
- Have at least a one-year recall examination and documentation; longer if possible.
- Use only original, high quality radiographs or direct digital radiographs.
- Type case histories and clearly label supporting documentation.
- Justify treatment selection and unusual treatment approaches.
- Provide definitive clinical diagnoses and use consistent, mainstream terminology.
- Be precise, clear, thorough and concise.
- Keep abbreviations to a minimum.
- Use acceptable grammar and correct spelling.
- Duplicate the entire portfolio.
- Submit the case histories portfolio early in the eligibility period.
Selection of Cases
Most cases are filed or stored alphabetically. It is helpful to arrange them by case type. For example, put all potential surgical cases together in one category. Place hemisections, root amputations, anterior root-end resections with and without root-end fillings, posterior root-end resections with and without root-end fillings, and exploratory surgeries in one section. This will allow a review of similar cases. Then a decision can be made to select the best cases.
After the candidate writes a case report, suggest that it be put away for a few days and then reviewed again. Make any deletions or additions at that time. This approach will provide a more objective point of view. This can be repeated two or three times, if necessary.
The Board specifies the case types and sequencing of the cases in the portfolio. The order, procedure categories, and the number of cases REQUIRED in EACH category are listed below.
DIAG (1 Case) Diagnostic evaluation of the patient (dental or systemic) is the most significant feature of this case. One year evaluation is required with appropriate images and/or radiographs.
EMERG (1 Case) These cases must show emergency treatment procedures in addition to endodontic procedures. For example, an incision and drainage, trephination and prescription of medications with the rationale for their usage fits into this case type.
MED COMP (1 Case) This case must show endodontic management of a medically compromised patient. This category requires MODIFICATION of treatment timing or procedures.
Simply recognizing and/or documenting a medical problem does not meet the criteria, nor does prescribing prophylactic antibiotic coverage or treating patients with common medical conditions. Patients on anticoagulant therapy or those receiving chemotherapy or radiation treatments may fulfill this category if your treatment has to be modified in some way.
NS RCT (2 Cases) These cases must demonstrate difficult nonsurgical root canal therapy. This includes teeth with calcified canals, curved and/or long canal systems, unusual anatomy, etc.
These TWO nonsurgical cases MUST include a maxillary molar and one mandibular molar.
RETX (1 Case) These cases must include nonsurgical retreatment of previously endodontically treated teeth. Case MUST be a molar.
S RCT (1 Case) Case must demonstrate surgical root canal treatment. A posterior (molar) surgery with root-end resection and root-end fillings
OTHER (3 Cases) Each case must demonstrate a DIFFERENT procedure. These can be procedures from the following areas:
Trauma (management of traumatic injuries and their sequelae, such as crown/root fractures, luxations, avulsions etc.) Apexification Perforations or resorption treatment Intentional replants/transplants/implants Hemisection/root amputation Endo-perio/endo-ortho/endo-pedo including apexogenesis and other vital pulp therapy
As the candidate prepares the case histories portfolio, remember that the goal is to present the highest quality endodontic care possible. The portfolio is the only means by which a candidate can communicate to the examiners the excellence and specialness of his or her abilities as an endodontic clinician. In preparing the cases for submission to the Board, strict attention to detail will give the candidate the best chance to successfully complete this phase of the board certification process.
Preparation of a Case Histories Portfolio
The case histories portfolio is a direct reflection of the candidates skills as a practitioner. Only the highest quality cases should be submitted for review by the Board. Preparation of the case history reports is time consuming and possibly the most demanding of the board requirements. All case histories need to have complete documentation, proper diagnosis and treatment, and recall documentation. Without exception, excellent quality radiographs or digital images should be the standard. Selected photographic 2×2 slides are highly recommended to document unusual or complex procedures. The portfolio should portray the abilities of the clinician and clearly communicate to the Board that the quality of the candidates work is the reason why Diplomate status should be awarded. It is the exclamation point that sets this specialist practitioner apart and justifies board certification. The case histories portfolio MUST demonstrate the broad range of the candidates endodontic abilities and MUST be their best!!!
Although reasons for failure of the case portfolios are varied, the more common problems are poor case selection, poor documentation and poor quality radiographs.
The Board provides the candidate with a Case History Evaluation Form that serves as a table of contents to identify and classify the cases in the portfolio. The fifteen cases MUST be placed in the proper order and include all of the required categories. The Board requires that each case be reported as one category only and focus only on one tooth, even if multiple procedures were performed and multiple teeth were involved. Furthermore, even though a case is complex (multiple categories, multiple teeth), it cannot be used more than once in the portfolio. A mentor can assist a candidate in determining the predominant category for each case and tooth to be reported.
Example: (from the case history evaluation form)
Patient No. Tooth No. Operation Performed 1 23 DIAG 2 15 EMERG 3 2 MED COMP 4 3 NS RCT 5 31 NS RCT 6 30 RETX 7 19 SCRT 8 15 OTHER 9 19 OTHER 10 30 OTHER As a candidate prepares the cases, remember that a thorough and accurate representation of the way the cases were treated is the goal. Make every effort to limit the narrative to the spaces provided on the form. The examiners have many cases to review, so verbosity is verboten. Be PRECISE and CONCISE.