EPA 4C: Occlusal Appliance Therapy

Accurate, complete impression or scan with proper extensions, anatomy, and detail.

No distortion, voids, stitch errors, or missing anatomy that would compromise fit or function.

Impression or scan is generally acceptable; minor deficiencies present (e.g., small voids, limited detail, minor distortion, or incomplete capture of an isolated area).

Impression or scan has significant distortion, voids, incomplete coverage, or missing anatomy that may compromise fabrication, fit, or accuracy.

Unusable impression or scan; inaccurate, incomplete, or so distorted that fabrication cannot proceed reliably.

Centric Relation (CR) record obtained using anterior deprogrammer, leaf gauge, or bimanual manipulation.

Maximum Intercuspation (MI) record obtained in patients with stable occlusion.

Facebow transfer or equivalent digital method used when indicated.

Appropriate record material used (rigid PVS or wax) with slight VDO increase for adequate clearance.

Bite record is generally acceptable; minor errors, incomplete records, or limited clinical judgment present.

Jaw relation record is inconsistent, incomplete, or inaccurate.

Appropriate record selection or technique not demonstrated.

Incorrect jaw relation record that could produce harmful occlusion, or failure to recognize an inappropriate record for the clinical situation.

Complete, accurate prescription with design specifications, appliance type, and details fabrication.

Includes design features, materials and relevant instructions.

Prescription is generally adequate; minor details missing, incomplete, or requiring clarification.

Design is appropriate overall, but one or more elements may need faculty or lab clarification.

Prescription is incomplete, vague, or unclear; key design details missing in a way that could affect fabrication, fit, or function.

Appliance design decisions are not fully justified or do not align with the clinical situation.

Learner must rewrite laboratory prescription.

Incorrect design likely to cause harm, appliance failure, or inappropriate result.

Prescription errors significant enough to compromise fabrication or patient care.

Learner must rewrite laboratory prescription.

Evaluates appliance before try-in.

At delivery, evaluates seating, retention, comfort, tissue clearance, and identifies needed adjustments accurately and independently.

Evaluates appliance before try-in and generally assesses fit at delivery; may need guidance to identify or prioritize minor concerns (e.g., pressure spots, roughness, retention issues, or seating discrepancies).

Recognizes concern(s), though some guidance may be needed.

Does not adequately evaluate appliance before or during try-in.

Misses clear problems in workmanship, seating, comfort, or fit that should be recognized at delivery.

Fails to recognize a clearly unacceptable appliance before or during try-in.

Proceeds with an appliance that presents significant concerns with fit.

Even, simultaneous point contacts of opposing supporting cusps or incisal edges achieved on a flat occlusal surface.

Contacts opposing implant restoration(s) are lighter than natural tooth contacts or demonstrate Shimstock clearance.

Adjustments identified and completed independently.

Centric contacts generally acceptable; minor refinement needed to improve stability or occlusal harmony.

Recognizes need for adjustment, though some guidance may be needed.

Centric occlusion is uneven, unstable, or inappropriate.

Adjustments incomplete and do not achieve an acceptable result.

Learner does not recognize the issue(s).

Adjustment causes occlusal disharmony or an occlusal scheme that compromises the appliance or patient comfort.

Appropriate occlusal scheme for patient and appliance type.

Canine guidance (or anterior guidance) with immediate posterior disclusion during lateral and protrusive excursions.

No balancing-side interferences on posterior teeth.

Group function used appropriately when clinically indicated.

Adjustments identified and completed independently.

Excursive occlusion generally acceptable; minor refinement needed to improve guidance, disclusion, or occlusal harmony.

Recognizes the issue(s), though some guidance may be needed.

Excursive occlusion is inappropriate.

Balancing interference(s) present.

Learner does not recognize the issue(s).

Adjustments cause occlusal disharmony.

Persistent balancing contact(s) present that may compromise function or harm the patient.

Anterior guidance in protrusion achieved.

Crossover achieved with central incisors, or a combination of central and lateral incisors.

Contacts appropriate and consistent with the planned occlusal scheme.

Anterior guidance and appropriate crossover contacts achieved; minor refinement needed to improve contact pattern or occlusal harmony.

Recognizes the issue(s), though some guidance may be needed.

Anterior guidance or crossover occlusal contacts are inappropriate.

Learner does not recognize the issue(s).

Anterior guidance and crossover contacts not achieved, resulting in an unacceptable occlusal scheme.

Polishes appliance to achieve a smooth, finished surface without alterations.

Provides clear instructions with a defined follow-up plan.

Polishes with generally acceptable technique; may need guidance on appropriate medium, sequence, or extent of finishing.

Instructions and follow up provided but lack detail, clarity, reinforcement or organization

Polishing incomplete or performed with an inappropriate medium or technique, resulting in a suboptimal finish.

Instructions and/or followup limited, incomplete, or unclear.

Polishing technique causes damage, distortion, or an unacceptable surface finish.

No meaningful patient instruction or follow-up guidance provided.