EPA 4C: Endodontics

Endodontics	Meets Expectations of the Graduate	Progressing	Below Expectations	Critical Error

Isolation and Tissue Management	Optimal isolation under the limits of the case	Rubber dam placement requiring minor correction (such as flossing through contact point or use of caulking agent)	Rubber dam torn, or not retracted from the wings of the clamp	Not able to place rubber dam, incorrect tooth isolated, or clamp not ligated with floss
Access Preparation
Location, size, and shape	Correct location Shape and size reflects the internal anatomy	Correct location and shape Size: up to 1.5mm smaller or bigger	Distally or medially located Wrong shape size: > 1.5mm smaller or bigger	Compromised cusps or ridges (Restorability)
Extension	Correct extensions	Not reaching the limits of ONE of the extensions	Going beyond ONE of the extensions	Not reaching ALL the limits of the extensions (too small) or going beyond ALL the extensions (too large)
Deroofing	ANTERIOR: Access deroofed the chamber with no pulp horns remaining and/or connection between Removal of the lingual shoulder	ANTERIOR: Partial catching of the probe on ONE or TWO of the walls (partial unroofed pulp horn) Incomplete lingual shoulder removal	ANTERIOR: Deep catching of the probe on ONE or MORE walls (partial unroofed pulp horn) Incomplete lingual shoulder removal	ANTERIOR: Only pulp horn located, chamber not de-roofed. No removal of the lingual shoulder
Deroofing		PREMOLAR AND MOLAR: Access deroofed the chamber with no pulp horns remaining and/or connection between	PREMOLAR AND MOLAR: Partial catching of the probe on one or two walls	PREMOLAR AND MOLAR: Deep catching of the probe on ONE or MORE walls (partial unroofed pulp horn)	PREMOLAR AND MOLAR: Only pulp horn located, chamber not deroofed
Gouging	Internal walls and floor of the pulp access without bur indentation or slight bur indentation	Internal walls and floor of the pulp shallow bur indentation on ONE or TWO of the side walls	Internal walls and floor of the pulp access with deep bur indentations that does not perforate or compromise integrity	Internal wall or floor of the pulp access perforated
Caries Removal
	Complete caries removal with the removal of undermine tooth structure and removal of questionable restoration	Caries removed but cavity left unadjusted for temporary or permanent restoration	Partial removal of caries and or undermined tooth structure	Presence of caries
Work Length Determination
File Position	File is 1mm short to "zero" from the radiographic apex	File is 1.5mm short/beyond the radiographic apex	File is 2mm short/beyond the radiographic apex	File is more than 2mm short/beyond the radiographic apex
Reference Point	Rubber stopper seated perpendicular to a reliable repeatable point	File must be removed to reach the reliable repeated point	Reference point using a rubber stopper not identified clinically or by radiograph	Reference point using a rubber stopper not identified clinically or by radiograph
Root Canal Instrumentation
Taper	Canal evenly tapered throughout preparation to WL (shown on final radiograph)	Canal tapered with small irregularities	Canal shows significant irregularities	Canal with perforation
Maintaining Original Canal Shape	Absence of canal transportation, zipping, striping, ledges or perforations	Slight ledge	Transportation or instrument separation	Stripping, zipped foramen and any other type of perforation
Intracanal Medication	Calcium hydroxide fill is homogenous and in appropriate length (2 mm from the radiographic apex)	Calcium hydroxide fill has minor voids and/or is not at the appropriate length (between 2 to 5 mm short of the WL and/or minimal extrusion)	Calcium hydroxide fill has significant voids and/or is more than 5mm short of the WL	No calcium hydroxide fill or extreme amount of medication is extruded
Root Canal Obturation
Tug Back	Master gutta-percha cone with tug back is at the WL	Master gutta-percha cone with slight resistance to removal only	No tug back at all
Master Cone Selection	Master cone is 0.5–1.5mm short to radiographic apex (1.0mm is ideal) (consistent with WL file Rx)	Master cone is at the radiographic apex	Master cone is short 1.5mm or more of the radiographic apex	Master cone is beyond the radiographic apex or more than 1.5mm short of the radiographic apex
Apical Condensation	5–7mm apical down pack radiograph shows gutta-percha in proper length with no voids in apical third of canal No sealer extrusion or minimum amount of sealer extrusion	5–7mm apical down pack radiograph at the radiograph apex. Minor voids in the apical third Some sealer extrusion	5–7mm apical down pack radiograph not in the proper length (shorter). Presence of voids in the apical third of canal	5–7mm apical down pack radiograph not in the proper length (longer) and/or with significant voids in the apical third of canal Extreme amount of sealer extrusion or no sealer used
Final Condensation	Final obturation radiograph shows gutta-percha at control length (similar to WL file and MC radiographs 0.5–1.5mm) Overall filling with no voids or small voids in non-critical area	Final obturation radiograph shows gutta-percha at the radiographic apex Minor voids	Final obturation radiograph shows filling that is 1.5mm shorter or more form radiographic apex Significant voids	Final obturation radiograph shows filling beyond apex Overall filling with large voids in critical areas (ex. apical foramen)
Proper Cleaning	Proper cleaning of the pulp chamber from gutta-percha and sealer Gutta-percha removed to CEJ or removed apically 1–2mm from CEJ	Gutta-percha removed from the pulp chamber (at CEJ or 1–2mm from CEJ) but sealer not properly cleaned	Gutta-percha removed from the pulp chamber more than 3mm from CEJ Sealer not properly cleaned	Gutta-percha and/or sealer not removed from pulp chamber at all

Stainless Steel Crown Periodontics