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AACD Accreditation Testing Protocol for Dentist

Version: January 2008

Written Examination

The Written Examination tests the candidate’s foundational knowledge in cosmetic dentistry. Dentists who are knowledgeable in all phases of cosmetic dentistry are expected to pass the test. Failure to pass the Written Examination indicates that a candidate would likely benefit from further education in cosmetic dentistry prior to attempting the submission of clinical cases.

The Written Examination is administered at the Annual Scientific Session and at additional dates as directed by the American Board of Cosmetic Dentistry. The Annual Scientific Session is held in the spring at different locations, and is publicized well in advance of the meeting date.

Eligibility for the Written Examination

To be eligible to take the Written Exam at the next Annual Scientific Session, the following requirements must be met:

• Membership in good standing (dentist or lab tech)
• Registered and paid in full to attend the upcoming Annual Scientific Session
• Application completed and fee paid for the Written Examination

Application and Fees

Application for the Written Examination is made through the Executive Office of the Academy. An application will be mailed on request, or is available on the AACD web site www.aacd.com. A non-refundable written examination fee of US $350 must accompany the application.

Postponement

If the Written Exam is postponed in writing at least two months in advance an administrative fee of US $75.00 must be paid to reschedule. With less than two months notice, an administrative fee of US $125.00 will be required to reschedule. Failure to appear for a scheduled written examination will result in forfeiture of the entire fee.

Content

Foundational knowledge in cosmetic dentistry includes all disciplines of dentistry with an emphasis on those subjects with a special relevance to esthetics. Subjects may include, but are not limited to:

• Smile design
• Adhesion
• Materials
• Occlusion
• Porcelain restorations
• Resin restorations
• Posterior esthetic restorations
• Bridges and pontics
• Implants
• Color/shade
• Whitening
• Periodontics
• Orthodontics
• Laboratory communication
• Photography

Some questions will be included that are based on scenarios of clinical cases concerned with cosmetic dentistry.

Type of Exam/Grading

The Written Examination is a multiple-choice test. Each question is referenced to a textbook or referred source to insure its validity. A list of referenced sources is provided with and sample exams are available on the AACD web site.

In order to have credibility with the dental community, all steps are followed to ensure that the exam complies with the established rules of testing. A representative of a testing agency is present when the exam is compiled. The educational testing and measurement consultant is also responsible for grading the exam and presents the results to the American Board of Cosmetic Dentistry. For more information contact the Credentialing Department at the Executive Office.

Sample Exam

Some questions will be taken from the Written Exam each year and will be released in the form of a sample exam. The sample exams may be purchased on the AACD web site.

Time Limit

There is a time limit to complete the entire Accreditation process. The final step in the process, the Oral Examination, must be taken and passed by the fifth Annual Scientific Session that follows having passed the Written Examination.

Clinical Case Submissions/Examination

The Clinical Case Submissions are the core of the Accreditation exam process. The Clinical Case Submissions allow the candidate to demonstrate diagnostic skills and clinical excellence. Five specific types of cosmetic dental treatment have been chosen to cover a variety of techniques.

Prerequisites for Submission of Clinical Cases

• To submit Clinical Cases, the following requirements must be met:
• Candidate must have passed the Written Examination.
• Candidate must have attended two workshops: the Accreditation Workshop and the Criteria Workshop. These workshops are offered at the Annual Scientific Session and at additional dates as directed by the American Board of Cosmetic Dentistry. Verification of attendance must be on record with the Credentialing Department at the Executive Office.
• Continuous membership in good standing during the entire process.
• Attended at least half of the Annual Scientific Sessions since taking the Written Exam or receiving a written exam waiver in the year 2002 for transition candidates.
• Submission form completed and fee paid for each Clinical Case as submitted.

The Five Required Case Types

There are five case types that must be successfully completed. These cases will allow the candidate to demonstrate excellence in a range of disciplines that cover important aspects of cosmetic dentistry.

1. Six or more indirect restorations (treating upper incisors and canines)
   
2. One or two indirect restorations (treating upper incisors; adjacent teeth must have no indirect restorations)
   
3. Tooth replacement (options: laboratory fabricated bridge or implant)
   A. Bridge: at least one pontic must be replacing an upper incisor and/or canine
   
   B. Implant: must involve placement of an implant root form into an upper anterior edentulous space. The edentulous space is defined as being devoid of any root structure. (Pre-op x-rays and photographic views must show edentulous space or failing tooth prior to implant placement.) Replacement of a crown on an existing implant is not acceptable for this case type.
   
4. Anterior direct resin (options: Class IV or diastema closure)
   A. Class IV direct resin restoration: replacing at least 10% of the facial surface (treating upper incisors)
   
   B. Diastema closure: 1 mm or greater diastema, which involves placement of direct resin on two adjacent teeth (treating upper incisors and/or canines)
   
5. Six or more direct resin veneers (treating upper incisors and canines) (Technique Case)

Note: ALL required teeth treated must be upper anterior teeth and permanent. When additional teeth are treated they are judged using the same criteria as the required teeth. Only one case type per patient may be used.

Submission Procedure

A total of five Clinical Case Submissions must be examined and passed to complete the second part of the Accreditation process. From one to five clinical cases may be submitted at a time by mail, however, only one of each case type may be submitted at a time for evaluation.

Clinical Case Submissions must be mailed and received on the deadline date to the Credentialing Department at the Executive Office and include all of the required materials for the case to be examined at the next available examination session.

Be sure to follow the protocol exactly. Check and double check that you have included all the required materials. All materials submitted become property of the AACD.

1. Clinical Case Submission Form

The candidate will be mailed Clinical Case Submission forms after passing the Written Examination and all other prerequisites have been completed. All information must be complete and legible.

2. Fee

The non-refundable submission fee is US $150.00 per clinical case submitted.

3. AACD Photographic Release Form

This form is to be submitted with each Clinical Case and signed by the candidate and patient. The form grants permission to the AACD for use of the images submitted for Accreditation. Cases suitable for submission for Accreditation, must be submitted without restrictions or limitations placed on the Photographic Release Form.

4. Photographic Documentation

The Protocol for Digital

The AACD will not define specific equipment requirements, however, the AACD has outlined criteria to produce image quality equal to, or better than, 35mm slide film. The protocol and equipment recommendations are expected to evolve with advances in technology.

Image Criteria

Digital image quality is contingent upon five distinct factors related to the image itself. Proper setup and use of your camera and adjunctive photographic equipment maximizes results.

• Correct Color
• Correct Exposure
• Depth Of Field
• Good Tonal Range
• Image Sharpness

Capture Equipment Criteria

Professional grade digital cameras are recommended

An example of a professional grade camera would be a Single Lens Reflex Digital Camera with a macro lens capable of manual focus and selectable magnification ratio with a lens mounted flash. The digital camera should be capable of capturing at least 5 Megapixels and be able to capture images as “RAW” files.

Many consumer grade digital cameras capture images that are visibly degraded due to small capture chips and internal firmware. They may also lack the ability to control exposure and depth of field during macro image capture.

Camera Set-Up (Variables are set in the camera menus)

1. Set internal clock to correct time
   
2. Capture images as RAW files (Required)
   Different camera manufactures use different names for this type of file.
   
3. Select Lens Magnification Ratio as Shown In The AACD “Photographic Documentation and Evaluation in Cosmetic Dentistry” (A Guide to Accreditation Photography.) Make any necessary magnification conversions to produce an image magnification comparable to the images illustrated in the photography guide. Typically a conversion is necessary between the ratios dictated for a film camera to produce the same result with a digital camera. Once the ratio has been determined, that ratio or magnification should be consistently maintained throughout the before and after photographic series. The lens magnification conversion that is needed for most digital SLR cameras is 1.5 (Cameras with sensor size of 14mm x 9.3mm).
   
   1. Magnification of (1.5) x (The setting on the lens barrel)
   
   2. 1:2 views set the lens on a digital camera to 1:3
   
   3. 1:1 views set the lens on a digital camera to 1:1.5
   
4. Maximize depth of field using high f-stops (minimized aperture)

Managing Images on a Computer

1. Set internal clock to correct time
   
2. Transfer the RAW camera image files from the camera directly to your computer hard drive.
   
3. Create a compressed JPEG image file by copying the RAW image file
   Choose a software tool to make compressed JPEG files of all the “RAW” files. Either use software from the camera manufacturer or an after-market software tool of your own choice. (i.e. PhotoShop, ThumbsPlus, acdsee)
   
   A. Open the RAW image with the software. Go to: file> save as> JPEG compressed> Quality> Maximum (100%, best quality, etc., Minimum Compression). Image quality must be more than adequate to judge the dentistry; free of saliva and debris, properly exposed, framed and focused. (See the Guide to Accreditation Photography for additional recommendations.)
   
   B. Some cameras have settings that create both a RAW and a high quality JPEG at the same time. Make sure the camera is set to the highest JPEG setting when using this feature.

NOTE: Scanned images will not be accepted for submission

(Instructions are a guide and not intended as a substitute for continuing education in digital photography and use of computer hardware and software.)

Image Editing

No Global, focal, fixed point or spot editing is allowed
Global, focal, fixed point or spot editing is strictly prohibited and considered fraudulent. This means even innocent changes such as cleaning up dust spots, cropping, rotating, resizing or eliminating red eye is not allowed.

Case Submission

Candidates will need to submit two separate disks (pre-op and post-op). On each disk, two folders: one folder with the required RAW images, RAW technique views, x-rays, case title and treatment listing and a second folder of these images in JPEG format.

Two separate compact disks must be submitted for each case. Each disc should be marked with the candidate’s AACD membership number, the case type-including the number and the file type.

Please open and review both pre-op and post-op disks to ensure all correct views and images are viewable. If your submission is incomplete, it cannot be evaluated.

The Protocol for Slides

Slide documentation will be accepted through November 1, 2008. Any case that cannot be completed by this date should be documented in the digital format.

Each slide should be marked with the candidate’s AACD membership number, case type number and photographic view number (as shown in diagram #1) but any other identifying marks should be made illegible.

Diagram 1

For example, View # 3 would be the full smile right lateral view, 1:2 magnification, non-retracted. Slides must be arranged in the exact order specified in diagram 2, pre-ops in one slide carousel and post-ops in another. Two slide carousels per Clinical Case Submission

Slide Arrangement – Diagram 2

Image quality must be more than adequate to judge the dentistry; free of saliva and debris, adequately exposed, framed and focused.

Given that your slides will not be returned, you may submit original slides, although it is recommended you submit duplicate slides of the highest quality. You will need an exact set to prepare and bring for the Oral Examination.

Title and Treatment List slides are necessary for each case. The required AACD template for these slides can be found on the AACD website at:

Title slide link: http://www.aacd.com/professional/accreditation/download/TitleSlide.pdf
Treatment slide link: http://www.aacd.com/professional/accreditation/download/TreatmentSlide.pdf

*Reminder –You need to click “save as” and rename your file to a designated area

Diagram 3

Accreditation Examination

Examiners will evaluate cases with appropriate media for image viewing and evaluating.

5. Additional Photographic Documentation for Case 5 (Technique Case)

Additional documentation is required to demonstrate the technique that was utilized to complete the direct resin veneer case. The following RAW images must be included in the submitted disk 1, folder 1 (pre-op) for digital or pre-operative carousel for slides (in the order listed below) and are to be documented in the written report.

These photos are to be taken at 1:2 magnification or digital equivalent.

1. Initial preparation, beveling and/or abrasion of tooth surfaces
2. Initial layer of restorative resin (after curing, before contouring)
3. Application of tints and opaquers (if used)
4. Final layer of resin (bulk layer, after curing, before contouring or finishing)
5. After contouring but before polishing.

If teeth are treated sequentially rather than simultaneously, use a central incisor to illustrate the first 4 steps. Step 5, prior to final polishing, should show all of the teeth, if possible.

6. Verification of Authenticity for Each Case

AACD upholds the highest standards of ethical behavior applicable to the profession of cosmetic dentistry and expects its members to do the same. Violation of these ethical standards in the Accreditation process is a matter that is taken seriously by The AACD and can result in permanent disqualification from the Accreditation process.

As technology continually evolves, increasing opportunities exist for fraud. Although the AACD knows that few would resort to such unethical behavior, the AACD is committed to ensuring the integrity of the Accreditation process through proactive measures to verify supporting documentation for Clinical Case Submissions. Such measures are designed to maintain the integrity of the credential without imposing an undue hardship on candidates. To that end, verification documentation is accepted for either photographic slides or digital images in accordance with the following:

For Digital

Examiners are trained in specialized software tools to detect manipulation of the digital image in violation of this protocol including spot editing. Any alteration of images, falsification of information or attempt to mislead the examiners is grounds for immediate termination of the Accreditation process and permanent disqualification from obtaining Accreditation in the future.

For Slides

A roll of exposed but undeveloped slide film of the post-op treatment, having all 12 Accreditation views, is to be included with each Clinical Case Submission. These views should show the same final treatment as the slides submitted. Any alteration of images, falsification of information or attempt to mislead the examiners is grounds for immediate termination of the Accreditation process and permanent disqualification from obtaining Accreditation in the future. These slides will NOT be used Accreditation examination, but will be compared to the slides submitted with the clinical case submission and reports only to verify the authenticity of the case.

7. Radiographic Documentation

Post-operative periapical radiographs are required for all cases. An implant must also include a pre-operative radiograph prior to implant placement. Radiographs must be of diagnostic quality. Use as many radiographs as needed to show all required treated teeth. Additional treated teeth do not require radiographic documentation. In the event that the radiographic images submitted by the candidate suggest that there has been manipulation or editing of the image in violation of this protocol, it is grounds for immediate termination of the Accreditation process and permanent disqualification from obtaining Accreditation in the future.

For Digital

Radiographs are to be included on disk 2, folder 1 (post-op). Radiographs may be in one of three formats:

1. Digital x-ray image file
   
2. Photo image file (JPEG) of x-ray
   
3. Scanned x-ray image file (JPEG)

For Slides

Radiographs are to be mounted in x-ray slide mounts or duplicated as slides and placed in the appropriate slide carousel at the end of the pre-op or post-op series. All x-rays should be separated out to one x-ray per slide.

Note: For example, if four teeth are treated with crowns, radiographs showing all teeth must be included. All abutment teeth in the bridge must be shown. Only teeth that are crowned, used as bridge abutments or replacement teeth (implant) need be radiographed.

8. 4x6 Photographic Prints

A pre-op and post-op of each of the following four views (8 prints total) must be included with each of the 3 written reports. They must be mounted as shown in diagram 4 below:

View # 1 , Full Face (1:10 magnification)

View # 2 , Full Smile, frontal (1:2 magnification)

View # 5 , Retracted view, frontal (1:2 magnification)

View # 8 , Retracted view, frontal (1:1 magnification)

Diagram 4

These prints must match the digital images or the slides submitted with the case. It is recommended that the prints be made from the originals for an accurate match.

9. Written Report

The written report is to be submitted in the AACD template format, typed and bound. Reports are expected to be well organized, original, accurate and complete. Include the following information in the written report:

Title Page (as directed in template)
Introduction and chief complaint
History-medical and dental
Diagnosis and treatment plan
Description of treatment
References to literature pertaining to the treatment prescribed
8 Photographic Prints

Submit three (3) separate exact copies of the written report

Under no circumstances should names, acknowledgements (including partnering dentist, ceramist or specialists that may have been involved in the case) or any type of personal information be included in the written report.

Grading/Evaluation

Each case is judged anonymously by a panel of five examiners. A majority of “pass” votes are required to pass a case. The candidate may resubmit clinical cases until all five have received a passing score. When all five clinical cases have received a passing grade, the candidate is eligible to continue to phase three, the Oral Examination.

The format for the clinical cases must be followed exactly. Poorly produced or incomplete written reports and/or poor photographic or radiographic documentation could result in failure. Each case will be examined based on the Accreditation Examination Criteria. A Guide to Accreditation Criteria uses examples of previously presented cases to further clarify and identify criteria points being evaluated.

Resubmission Information

If a candidate does not complete the Accreditation process within the prescribed time period, the process must begin anew. There is no guarantee that a previously passed case, that is resubmitted, will pass again. Note: All materials submitted become property of the AACD.

Oral Examination

Purpose

The purpose of the Oral Exam is twofold. The first purpose is to provide the candidate an opportunity to verify and authenticate passed casework. The candidate may be asked questions about case selection, diagnosis and treatment planning, materials and techniques on any of their passed clinical case submissions. The candidate’s knowledge should clearly demonstrate a familiarity and understanding of these cases. Additional questions may be asked that cover related topics considered relevant by the examiners.

The second purpose of the Oral Exam is to provide the candidate with an opportunity to demonstrate their treatment planning abilities. The candidate will be presented with information regarding a pre-selected case. Adequate time will be allowed for the candidate to formulate a treatment plan, which will then be shared and discussed.

Eligibility for Appearance at the Oral Examination

To take the Oral Exam at the next given date, the following requirements must be met:

• The candidate must have passed all five required Clinical Cases
• Continuous membership in good standing during the entire process
• Attended at least half of the Annual Scientific Sessions, starting with the session that
  the candidate took and passed the Written Exam or receiving a written exam waiver in the year 2002 for transition candidates
• Registered and paid in full to attend the upcoming Annual Scientific Session
• Application completed and fee paid for the Oral Exam

Application and Fees

The application for the Oral Examination will be sent to a candidate once the five Clinical Cases have been passed. The application and fee must be received at the Executive Office by the date specified by the American Board of Cosmetic Dentistry. The fee is US $400.00 and is non-refundable.

Postponement

The candidate may defer appearance for the Oral Examination as long as all three phases of the Accreditation process are completed within the time limit. If the Oral Exam is postponed in writing at least two months in advance an administrative fee of US $125.00 must be paid to reschedule. If the Oral Exam is postponed with less than two months notice, the fee will be forfeited.

Guidelines for Appearance at the Oral Examination

Dress professionally and be on time. You should be completely familiar with the five cases. Candidates will be required to bring one written report from each case passed.

For any Cases that were Completed with Digital Documentation

Bring pre-operative and post-operative images on two separate disks, two separate memory sticks or two separate USB external removable devices. Each disk or device will have two folders: one folder with the required RAW images, RAW technique views, x-rays, case title and treatment listing and a second folder of these images converted to JPEG files.

For any Cases that were Completed with 35mm Slide Documentation:

You will need to bring two 80 count slide carousels loaded with your original (or duplicate depending on what you submitted for your passed clinical case submissions) of pre-operative and post-operative slides of your passed cases. This should include all required technique views and pre-op and post-op radiographs.

Grading: Pass/Fail

Pass

With the successful completion of the Oral Examination, a candidate becomes an Accredited Member in the AACD.

Fail

A candidate may retake the Oral Examination one time as long as it will be completed within the five-year time limit. A second failure at the Oral Examination terminates the Accreditation process. Submission of a new written exam application is required to begin the Accreditation process again.

Accreditation Award Ceremony

With the successful completion of the Oral Examination, a candidate becomes an Accredited Member in the AACD. The recognition ceremony and presentation of the Accreditation award will be during the Dinner Gala at the next Annual Scientific Session.

Maintaining Accredited Member or Accredited Fellow Member Status

To maintain Accredited or Accredited Fellow Status, Accredited Members and Accredited Fellow Members must maintain active membership in the AACD. It is important for Accredited or Accredited Fellow Member dentists and technicians to stay abreast of advances in cosmetic dentistry. (An Accredited Fellow Member is an Accredited Member of the AACD who has met additional requirements established by the ABCD; Accredited Fellows must maintain Accredited status to remain an Accredited Fellow.)

One of the following is required once every three years:

1. Attend AACD Annual Scientific Session
2. Serve as an editor, editorial reviewer or contributing editor in a cosmetic dentistry publication
3. Author a published article in a cosmetic dentistry publication
4. Participate as a coordinator or lecturer in a cosmetic dentistry continuum
5. Attend the Criteria Workshop, lecture portion of the Advanced Accreditation Workshop or Examiner Calibration
6. Serve as a board or committee member in the AACD

Forms for verification on requirements will be mailed out annually by the Executive Office and submission of these forms are the responsibilities of each Accredited member. Five percent will be randomly reviewed and proof of verification will be required.