Fellowship | IBMRE

Fellowship in Micro-restorative and endodontics

Definition

“Fellowship in Micro-restorative and endodontics” is a prestigious qualification, which carries with it a responsibility to enhance the current practice of restorative dentistry endodontics by using contemporary magnification technologies. The program is designed for well-motivated candidates who remain zealous in their pursuit of knowledge and clinical skill as they practice and teach the specialty of restorative dentistry and endodontics to the highest standards.

Value of Certification

To achieve diplomate status and become a fellow, a restorative dentist and endodontist should exhibit excellent self-motivation and exceptional commitment to continuing professional growth

On certification, the fellow would understand the importance of:

1. Achieving necessary skills in managing routine and advanced restorative & endodontic scenarios using modern magnification technology.
2. Constantly enhancing the existing knowledge by pursuing new arenas in magnification technology.
3. Complete understanding and application of cutting edge research in the practice of micro restorative and endodontics.
4. Ensuring the highest possible patient centric quality of care.

PREAMBLE

Microscope enhanced restorative dentistry and endodontics is a science with an established theoretical and scientific base and widespread clinical applications in restoration, rehabilitation, regeneration, maintenance and promotion of optimal function of the dental hard tissues, dental pulp and periradicular tissues. Micro restorative endodontists, study and practice the basic and clinical sciences including the biology of the human teeth, the etiology, diagnosis, prevention and treatment of diseases and injuries of the enamel, dentine, pulp and associated periradicular conditions. They diagnose and manage various restorative and endodontic scenarios using magnification tools. These practitioners contribute to society and the profession through practice, teaching, administration and the discovery and application of new knowledge about magnification techniques.

Learning experiences are provided under the guidance and supervision of competent faculty through workshops, contact sessions and learning assignments. The designed curriculum will prepare the restorative dentists and endodontists, to be an autonomous, effective, safe and a compassionate professional, who practices collaboratively in a variety of clinical and academic setups , responsive to the current and future needs of the restorative and endodontic health care system.

VISION:

To create a platform that nutures and recognises talented micro restorative dentist and endodontist who shall lead to provide quality dental care services using advanced magnification technology in restorative dentistry and endodontics.

MISSION:

To recognize highly competent, knowledgeable, service-oriented, micro restorative and endodontic practitionerswho by virtue of their critical and integrative thinking along with clinical reasoning, and ethical values, render evidence based precision treatments that conserve and maintain the health of the teeth and surrounding supporting structures that contribute to the long term success through contextual, and collaborative foundations of microscopic practice.

ESSENTIAL REQUIREMENTS

The following “essential requirements” specify those attributes that the faculty consider necessary for completing the professional education enabling each graduate to subsequently enter clinical practice. The purpose of this curriculum is to delineate the cognitive, affective and psychomotor skills deemed essential for completion of this program and to perform as a competent micro restorative dentist and endodontist who will be able to evaluate, plan & execute various treatments using magnification.

Cognitive learning skills:

The Participant must demonstrate the ability to receive, interpret, remember, reproduce and use information in the cognitive, psychomotor and affective domains of learning to solve problems, evaluate work and generate new ways of processing or categorizing similar information listed in course objectives.

Psychomotor skills:

The participant must demonstrate the following skills.

1. Manual tasks:

a. Manoeuvring the magnification devices, other supports/accessories or chair to aid in positioning, moving, or treating a patient effectively.

b. Competently perform magnification enhanced restorative dentistry and Endodontics

2. Fine motor/hand skills:

a. Legibly record data, evaluations, tests, patient care notes etc. through written assignments (including diagrams) and/or standard softwares used in hospital/clinical settings in a timely manner and consistent with the acceptable norms of clinical settings.

b. Safely apply and adjust the dials or controls of the magnification tools.

c. Safely and ergonomically position the patient and the operating dentist to achieve maximum magnification benefits.

3. Visual acuity:

a. Read written and illustrated material in the English language, in the form of online educational material, textbooks, literature and patient’s chart.

b. Observe active online content.

c. Visualize training videos, projected slides/overheads, X-ray pictures and notes displayedon a blackboard/whiteboard/ computer screens.

d. Receive visual information from patients, for purposes of evaluation.

e. Receive visual information from treatment environment

f. Receive visual cues as to the patient’s tolerance of the magnification assisted intervention.

4. Auditory acuity:

a. Hear lectures and discussion in an academic and online educational setting.

5.Communication:

a. Effectively communicate information and safety concerns in a timely manner and within the acceptable norms of academic and clinical settings.

b. Receive and interpret written communication in both academic and clinical settings in a timely manner.

c. Participants must be able to communicate quickly, effectively and efficiently in oral and written english with all members of the health care team.

AFFECTIVE LEARNING SKILLS:

The participant must be able to:

1. Demonstrate respect to all people, including co- participants, teachers, patients and medical personnel, without showing bias or preference on the grounds of age, race, caste, sexual preference, disease, mental status, lifestyle, opinions or personal values.
2. Demonstrate appropriate affective behaviour and mental attitude in order not to jeopardize the emotional, physical, mental, and behavioural safety of patients and other individuals with whom one interacts in the academic and clinical settings and to be in compliance with the ethical standards of the profession.
3. Acknowledge and respect individual values and opinions in order to foster harmonious working relationships with colleagues, peers, and patients.

GENERAL REGULATIONS

1. The certification and fellowship of the board for micro-restorative and endodontics, an affiliate body of Indian association of conservative dentistry and endodontics, India may be granted to those who possess a two year experience after postgraduate in conservative dentistry and endodontics registrable in the register of dentists for India and to other international micro-restorative and endodontics specialists who comply with the regulations.

2. The requirements to present for the examination are:

a) MDS or equivalent and should be in good standing in relation to the maintenance of the IACDE life membership/ international restorative and endodontic bodies
b) Evidence of satisfactory completion of two years clinical/academic experience in an institution/clinical setup recognised by the faculty. Candidates are required to submit certified, documented evidence of their training
c) Eligibility certificate from the board after verification of academic qualifications ( The decision of the board members is deemed final)
1. i) Email your current CV
2. ii) Send a formal copy of your qualifications to-date, and two letters of recommendation confirming any training you have undertaken related to the field of microscopic dentistry.
d) Complete the requisite contact sessions/online lectures. Online assessments should be completed within the stipulated time
e) Properly documented clinical cases with complete history, photos and radiograohs must be sent to the board office for assessment (atleast 28 days before the final examination)

EXAMINATION SCHEME

Examination will test the candidate's understanding of diagnosis and treatment planning over a wide range of problems in endodontics together with his/her expertise in carrying out comprehensive endodontic treatment using magnification tools.

The examination consists of the following components:

Part I

(At the end of the six months or after completion of the third module whichever is earlier)

a. Two Assignments duly accepted by the assigned mentor
b. A one hour forty minute paper containing 100 multiple choice questions

Part II

At the end of one year or after completing the prerequisites

1) A one hour presentation of the case records of patients personally treated by the candidate. Case histories should describe the examination, diagnosis, treatment planning and management of the patient who has received advanced endodontic care, using microscopes.

The presented cases must include:

( Document template would be provided)

a) Ten(10) cases of molar root canal therapy treated and documented using a microscope.
b) Five(5) cases of Non- surgical Endodontic retreatments using microscope.
c) Three(3) cases of special endodontic treatments (Management of class III fractures, Regenerative endodontics, Single step apexification,MTA obturations etc. performed using microscope)
d) Two(2) cases of surgical micro endodontics ( 1 anterior + 1 Posterior)
e) Two(2) cases of inlay/onlay
f) Two(2) patients treated with veneers (1 direct and 1 indirect)
g) Two(2) cases of Diastema closure using composite restoration
h) Two(2) class IV composite restorations
i) Two(2) class III composite restorations
j) One(1) case of management of initial carious lesions
k) Two(2) anterior crown preparationsto recieve lithium disilicate restoration
l) Two(2) posterior crown preparations to recieve zirconia restoration
(All cases have to be properly documented and should be accompanied by pre-operative, intra-operative, post-operative and follow-up radiographs and photographs using the template. Patient consent forms to be submitted)

2) A 30 minute oral examination.

FEES:

Application fees: INR 2000

Course fee: INR 2,00,000

The cases will be assessed using the following criteria

Adapted (AAE criteria for assessment)

Adapted(AAE criteria for assessment)

CURRICULAR FRAMEWORK

DURATION:

On and half years ( 18 months, 6modules, 2 contact sessions and two examinations)

MAXIMUM OF THREE YEARS AFTER THE SECOND CONTACT SESSION.

Module 1

Unit code: EL1 (Entry level 1)

Credit value: 15

Guided learning hours: 40

ONLINE CONTENT AND LECTURES

S.No	Learning/ Subject area	Learning hours	Credits
1.	Diagnosis/differential diagnosis in endodontics	4	1
2.	Pulpal and periapical disease	4	1
3.	Radiology and 3D imaging in endodontics	2	1
4.	Pain of odontogenic and non-odontogenic origin	4	1
5.	Pain control	4	1
6.	Endo-Perio lesions	2	1
7.	Treatment planning	4	2
8.	Root canal anatomy	4	1
9.	Magnification a) Introduction to magnification b) History of magnification c) History of magnification in dentistry d) Options for magnification	2	1
10.	Loupes What are Dental loupes Benefits of loupes Anatomy of loupes Optics of loupes ...simplified Important Parameters and deciding factors for limitations in loupes Types of dental loupes How to choose Dental loupes for personal use Accessories Testing the loupes Maintenance	2	1
11.	Introduction to microscopes: • Anatomy of the dental operating microscope • Detailed discussion of components • Optics and optical components of the microscope • Different magnifications and its utilities
12.	Patient and operator positioning	2	1
13.	Isolation	2	1
14.	Basics of micro dentistry a) Adjusting IPD b) Parfocalling c) Gross and fine adjustments d) Microphotography and documentation	2	1

Module 2

Unit code: ML1 (Mid level 2)

Credit value: 15

Guided learning hours: 40

ONLINE CONTENT AND LECTURES

S.No	Learning/ Subject area	Learning hours	Credits
1.	Endodontic access cavities: clinical guidance, instruments and techniques.	4	1
2.	Traditional access and minimal access preparations	4	1
3.	Locating calcified root canal orifices under magnification : instruments and operative techniques.	2	4
4.	Initial scouting ,mechanical exploration and glide path establishment of fine and curved root canals with stainless steel files and nickel-titanium instruments.	2	4
5.	Use of reciprocating hand pieces for stainless-steel files.	2	4
6.	Nickel titanium rotary instruments: designs, procedures, advantages and limitations	2	4
7.	Endodontic motors and handpieces for nickel-titanium instruments.	2	4
8.	Electronic apex locators to determine working length.	2	4
9.	Root canal shaping: the principles and techniques of root canal preparation with nickel titanium rotary instruments.	8	4
10.	Irrigation: solutions, delivery devices and operative techniques. Active and passive irrigation devices and techniques	4	1
11.	Intracanal medicaments: rationale and options available	2	1
12.	Errors during root canal instrumentation: stripping, ledgesetc	2	1
13.	Breakage of instruments: causes, prevention and managing of the errors.	4	2

Module 3

Unit code: ML2 ( Mid level2 )

Credit value: 15

Guided learning hours :30

ONLINE CONTENT AND LECTURES

S.No	Learning/ Subject area	Learning hours	Credits
1.	Gutta percha and canal sealers: technical, biological and handling properties.	2	1
2.	Techniques and materials of root canal obturation: i. Lateral condensation of cold gutta-percha ii. Vertical compaction of warm gutta-percha iii. Thermo-mechanical compaction of gutta-percha	4	2
3.	Preservation of vitality of the teeth: technical, biological and handling properties of MTA and biodentine.	6	3
4.	Diagnosis and treatment of painful emergencies.	4	2
5.	Biofilms	2	1
6.	Postendodontic restoration: principles, the newer materials and techniques for anterior and posterior teeth.	4	2
7.	Procedures for Improving adhesion	2	1
8.	Choosing between direct and indirect restoration.	2	1
9.	Endodontic posts: why and when.	4	2

Module 4

Unit code: AL1 ( Advanced level1 )

Credit value: 15

Guided learning hours :40

ONLINE CONTENT AND LECTURES

S.No	Learning/ Subject area	Learning hours	Credits
1.	Root perforations: Prevention and repair with MTA and Biodentine.	2	1
2.	Immature teeth: Endodontic treatment of teeth with large and open apices.	4	1
3.	Root resorptions: Etiologies, diagnosis and treatment.	4	1
4.	Root fracture: Etiologies, diagnosis and prevention.	2	1
5.	Bleaching of endodontically treated teeth.	4	1
6.	Dental traumatic injuries: Treatment of root fracture, luxation and avulsion.	4	1
7.	Retreatment decisions and treatment planning in endodontics.	2	1
8.	Removal crowns and bridges.	2	1
9.	Removal of prefabricated metallic and fiber posts, and cast post and core from single rooted tooth and molars.	4	1
10.	Solvents and removal of obturation materials: paste, gutta-percha, resin	2	1
11.	Removal broken posts, silver points and broken instruments.	2	1
12.	Managing ledge, block and calcification.	2	1
13.	Reshaping root canal with manual and rotary instruments.	2	1
14.	Revascularization and regeneration	4	2

Module 5 Microsurgical Endodontics

Unit code: AL2 ( Advanced level 2 )

Credit value: 10

Guided learning hours : 30

ONLINE CONTENT AND LECTURES

S.No	Learning/ Subject area	Learning hours	Credits
1.	Introduction to microsurgical principles, including diagnosis using cbct, root resection and retrograde preparation, management of the apical third, retrograde filling materials, the palatal approach, grafting materials, endodontic–periodontic lesions, and complex surgical cases. a) Indications for endodontic surgery. b) Medical considerations of the patient. c) Presurgical preparation of the patient. d) Armamentarium and Preparation of the instruments and materials. e) Anatomic considerations. f) Anesthesia. g) Flap design and incision. h) Elevation and retraction of the flap. i) Osteotomy. j) Curettage. k) Apicoectomy. l) Root and preparation. m) Perforation. n) Root amputation. o) Hemorrhage control. p) Root end filling materials. q) Root end filling procedure. r) Suture materials and suturing. s) Immediate postsurgical care. t) Postsurgical complications. u) Postsurgical evaluation and suture removal. v) Failure and success in endodontic surgery.	30	10

Module 6: Micro-restorative dentistry and endodontics

Unit code: AL1 (Advanced level 1)

Credit value: 15

Guided learning hours :20

S.No	Learning/ Subject area	Learning hours	Credits
1.	Instruments and instrumentation techniques for micro-operative procedures	5	10
2.	Cariology Risk analysis Early detection	5	10
3.	Operative management of carious lesion Rationale Minimal invasive dentistry Enamel preparation Carious dentine removal Peripheral caries(EDJ) Caries overlying the pulp Distinguishing the zones of carious dentine Step wise excavation	10	10
4.	Soft tissue handling Tooth preparations for direct/ indirect restorative procedures under magnification a) Direct composite retorations: classII, class III, class IV , diastema closures b) Indirect: Material considerations, procedures for inlays, onlays, crown and veneers	10	10

CONTACT SESSION ONE

CONTACT SESSIONS FOR HANDS ON EXPERIENCE

S.No	Hands on	Learning hours	Credits
1.	Orientation to dental microscopes Operating the microscope Focal length IPD adjustments Par focaling Using the beam splitter and assistant scope Operator positioning Patient positioning Microscope positioning Different placements of microscope in the operatory Ergonomics at operatory	10	25
2.	Access opening on extracted tooth under microscope Rubber dam placement Ultrasonics in endodontics Case discussions and use of CBCT	10	25
3.	Biomechanical preparation under microscopes(rotary instrumentation) Use of apexlocators Warm vertical condensation and 3D obturation using thermoplasticized gutta-percha Post obturation restorations and tooth preparations	5	25

The 25(twenty five) practical hours should be completed and certified by a recognized mentor

This contact session must be completed within the first 6 months or before the Part 1 examination (whichever is earlier)

CONTACT SESSION 2

CONTACT SESSIONS FOR HANDS ON EXPERIENCE

S.No	Hands on	Learning hours	Credits
1.	Management of calcified and difficult canals Retreatment Perforation repair Apexification Regeneration/ revascularization Instrument retrieval Post retrieval	8	25
2.	Diagnosis and case selection Flap design Microsurgical tools Soft tissue management Hard tissue management Root end preparations Root end filling Guided bone regeneration Suturing (Procedures to be performed on animal jaws or cadavers)	8	25
3.	Tooth preparations for Direct/ indirect restorative procedures under magnification a) Direct composite retorations: classII, class III, class IV , diastema closures b) Indirect: Material considerations, Procedures for veneers, inlays, onlays and crowns c) Cementation protocols	9

This contact session must be completed before the Part 2 examination

EXAMINATIONS:

PART ONE EXAMINATION : The exam is graded based on the grade points

PART TWO EXAMINATION : The exam is graded based on the grade points

GRADING SYSTEM

S.No	Grade	Grade Points
1	O (Outstanding)	10
2	A+(Excellent)	9
3	A (Very Good)	8
4	B+(Good)	7
5	B (Above Average)	6
6	C (Average)	5
7	P (Pass)	4
8	F (Fail)	0-3
9	Ab (Absent)	0

CREDIT POINT DISTRIBUTION

S.No	Details	Credit points	Credit Hours
1.	Module 1	15	40
2.	Module 2	15	40
3.	Module 3	15	30
4.	Module 4	15	40
5.	Module 5	10	30
6.	Module 6	10	30
7.	Contact session 1	25	25
8.	Contact session 2	25	25
9.	Part one examination	Grade	-
10.	Part two examination	Grade	-
11.	Clinical hours for completion of requisite cases (70 hours)	20	70
	Total	150	330

LEARNING RESOURCES:

Attention should be directed to contemporary literature. Key areas such as regeneration, wound healing, prophylacticantibiotic coverage, management of traumatized teeth and medically compromised patients should be given due importance. Additionally, latest editions of the following textbooks may prove as invaluable resources.

1. Syngcuk Kim and Samuel Kratchman,Microsurgery in Endodontics, Wiley Blackwell

2. Enrique Merino, Endodontic Microsurgery, Quintessence

3. Arnaldo Castellucci, Endodontics Vol:1,2,3; Tridente

4. Ingle JI, Bakland LK. Endodontics. Baltimore: Williams and Wilkins.

5. Malamed SF. Handbook of local anesthesia. St.Louis: Mosby.

6. Malamed SF. Medical emergencies in the dental office. St.Louis: Mosby.

7. Gutmann JL, Dumsha T, Lovdahl P, Hovland E. Problem-solving in endodontics. St. Louis: Mosby.

8. Seltzer and Bender’s The Dental Pulp, Hargreaves and Goodis

9. Arens DE, Torabinejad M, Chivian N, Rubinstein R. Practical lessons in endodontic surgery. Carol Stream (IL): Quintessence Publishing Company, 1998.