The Boards

The Boards
Les Quan’s ABE Study and

Test Taking Guide, 2010
Diplomate, American Board of Endodontics - 2006

Chair – Mentoring/Website Committee of the C.O.D.
Why ?
• Achieving the highest level of knowledge
and skill possible
• Continually pursuing new knowledge and
experience
• Fully understanding and applying new
research and advances to the practice of
endodontics, and
• Ensuring the highest possible quality of
care of the patient.
My excuses……..
• In 1984 Diplomates in the Specialty
consisted of grandfathered individuals
• No additional formal training
• The 2 endodontists who I admired most

where grandfathers
• I was totally occupied with building a

practice!
My answer today
• Board Certification is the process by

which an endodontist in the United States,
documents by written, practical and/or
simulator based testing a mastery of the
basic knowledge and skills that define
an area of dental specialization.
Based on Practicing Diplomates
2010
2004
One More
Ghosts One More

55Ghosts
ghosts
3 Ghosts Ghosts
Ghosts Only
FIVE
Diplomates!
X
28 Endodontists,
37 28 Endodontists, 915,855 population
I was recently speaking to a board member of the
American Association of Endodontists. We agreed that
many endodontists have been deeply affected by the
recession. He told me he knew of some practices down
15% or more. Endodontics has almost never seen a
downturn—let alone one this significant!
What happened?
I believe many endodontists take their
relationships with referring dentists for
granted.
Roger Levin, October 2009
Food for
Thought
The Boards
Timing
Recommendations
One year timeline is now available
Orals
Graduation &
ABE Written Exam
residency 1 Year
Case
Portfolio
Start of Residency
Getting Started
Know all the rules!

Get the CD from ABE
Written Examination - Grading
1. The Written Examination contains 200

questions.
2. Questions are multiple choice, consisting
of a stem with four or five foils
3. It is a PASS – NO PASS exam
4. 98% pass rate (2008)
5. Each question is statistically evaluated
Written Examination - Grading
My older age wasn’t held

against me!
Where do you start
studying when you
graduated from dental
school 30 years ago?
…and the VAHLB 20
years ago?
Where I started from…..
1. What are the rules?

2. What do I need to relearn?
3. Assemble resources
4. Get the information into long
term memory, efficiently
What to study?
The Written Examination
Phase I of the certifying examination of the American Board of Endodontics is a four
hour written examination consisting of 200 multiple choice questions, divided evenly
between morning and afternoon sessions. According to the ABE, the questions are
designed to test recall as well as the ability to apply knowledge, interpret information,
and solve problems. Subject areas include anatomy, biochemistry, embryology,
general and oral pathology, microanatomy, immunology, inflammation,
microbiology, pharmacology, vascular and neurophysiology, pulpal and
periradicular pathobiology, radiology, oral medicine, biostatistics, clinical
endodontics, dental materials related to endodontics, related dental disciplines,
and classic and current literature. Although there is no one single text or review
course that can totally prepare one for a written exam, a number of excellent review
courses are offered during the year and are strategically scheduled near the times
when board examinations are given.
Because of the contemporary and constantly developing nature of a number of critical
areas, particular study should be also directed towards HIV and hepatitis
immunology and virology; management of diabetes, hypertension, thyroid
disease, and renal failure; antibiotics, analgesics, and local anesthetics; basic
concepts of cellular and molecular biology; anaerobic bacteria and current
genus and species identification; differential diagnosis of radiolucent and
radiopaque lesions; wound healing; and guided tissue and bone regeneration.
American Association of Oral and
Maxillofacial Surgeons
$2,470
American Association of Oral and
Maxillofacial Surgeons – Cont’d
$1,140
ABE “Approved”
Knowledge Base of Endodontics
Dr. Quan’s
Knowledge Base of Endodontics
FREE!
Review Courses
• Loma Linda
• Michigan
• Albert Einstein - Pennsylvania
Review Courses - Ranked
1. Albert Einstein
2. Michigan
3. Loma Linda
I went to them all, and got a

“feel” for what I didn‘t know
Albert Einstein •Pulp and Periradicular
Biology
•Local Anesthesia and
Analgesic Control of
Postoperative Pain
•Differential diagnosis and
Histopathology of
Periapical Tissues
•Mechanisms of
Endodontic Pain
•Management of the
Medically Compromised
Patient
•Pharmacology of Pain
•Facial Space Infections of
Odontogenic Origin
•Periapical Inflammatory
Responses and their
Regulation
Michigan •Biology of the Pulp
•Immunology
•Endodontic Microbiology
•The Medically Compromised
Patient
•Differential Diagnosis of
Periradicular Lesions
Odontogenic Origin
•Clinical Pharmacology
•Pain
•New Developments in
Instrumentation
•Endodontic Surgery
Loma Linda
•Pulp Biology
•Host-Pathogen
Relationships: Balance of
Power
•Extra-Radicular Living and
Non Living Agents
•Endodontic Pain Control
•Orafacial Infections
•Infractions and Vertical
Fractures
MICHIGAN PENNSYLVANIA LOMA LINDA
•Pulp and Periradicular
•Biology of the Pulp •Pulp Biology
Biology
•Immunology •Host-Pathogen
•Local Anesthesia and
Relationships: Balance of
•Endodontic Microbiology Analgesic Control of
Postoperative Pain Power
•The Medically
•Differential diagnosis and •Extra-Radicular Living
Compromised Patient
Histopathology of and Non Living Agents
•Differential Diagnosis of
Periapical Tissues •Endodontic Pain Control
Periradicular Lesions
•Mechanisms of •Orafacial Infections
Endodontic Pain
Odontogenic Origin •Infractions and Vertical
•Management of the Fractures
•Clinical Pharmacology
•Pain Patient
•New Developments in •Pharmacology of Pain
Instrumentation
•Endodontic Surgery Odontogenic Origin
•Periapical Inflammatory
Responses and their
Regulation
Covered Topics
• Many identical topics to study

• UNIQUE EXCEPTIONS!
• “New developments in Instrumentation”,
Dr James Johnson (resource disk)
• “Differential Diagnosis and Histopathology
of Periradicular Lesions” , Dr. Gordon
Pringle (resource disk)
Review Courses 2009-2010
1. COD/Columbia
• March 12-14, 2010
2. Bender, Seltzer & Grossman
• Later this year
What I studied first

The Sciences
Dental Decks
• 1-800-457-7126
• Deckscorp.com
• Part One and Two NDB exam
– Radiology
– Endodontics
– Oral Pathology
– Dental Anatomy and Occlusion
– Microbiology & Pathology
– Anatomic Sciences
Gray’s Anatomy Flashcards
Head and
Neck - Only
Websites
Quick Review
Sources!
LINKED
43
(Included on Resource Disk)
Sample website
32
Free PowerPoint Lectures

(Included on Resource Disk)
TOOTH TISSUES: Pulp WABeresford
ENAMEL
GINGIVA
DENTINE
ALVEOLAR BONE CEMENTUM
PERIODONTAL
PULP LIGAMENT/
PDL
DENTAL PULP: Functions
Service tissue keeping its Odontoblasts alive

for slow defensive responses in the dentine
Providing antimicrobial defense for the

dentine and itself
Providing sensory feedback from the dentine,

but for what purposes?
TOOTH TISSUES: Pulp & its roles WABeresford
ENAMEL
GINGIVA
DENTINE
ALVEOLAR BONE CEMENTUM
PERIODONTAL
PULP LIGAMENT/
PDL
Service tissue keeping its Odontoblasts alive for slow

defensive responses in the dentine
Providing antimicrobial defense for the dentine and itself
Providing sensory feedback from the dentine, but for
what purposes?
PULP CHAMBER
CORONAL PULP HORN
ACCESSORY
CANAL
ROOT CANAL
APICAL FORAMEN
PULP REGIONS
ODONTOBLAST
LAYER
Cell-poor
ZONE OF WEIL PULP PROPER/
- peripheral pulp PULP CORE
PULP ELEMENTS - Mucoid connective tissue
MATRIX -
Ground substance
Reticular fibers
Collagen I
fibers Elastic fibers
CELLS -
Odontoblasts
Fibroblasts
Macrophages
Mast cells
Leukocytes
Blood vessels
Nerves
Lymphatics
PULP INNERVATION Sub-odontoblastic plexus
in cell-poor zone of Weil
1
2 3
Nerves: sensory (V) to

Nerves:
autonomic 1 PULP
2 ODONTOBLASTS
3 DENTINAL TUBULES
Blood vessels
PULP ELEMENTS - Mucoid connective tissue
MATRIX - Ground
substance Reticular
fibers Collagen I fibers
Elastic fibers
CELLS -
Odontoblasts
Fibroblasts
Macrophages
Mast cells
Leukocytes
Blood vessels
Nerves
Lymphatics
& Denticles & Fibrosis with aging

DENTICLES/ PULP STONES
Hard mineralized bodies found in
the pulp or the dentine
TWO TYPES:
P
U 1 TRUE - constructed of dentine
L by ectopic odontoblasts & showing
P dentinal tubules
2 FALSE - mineralized connective
tissue, etc, (not made of dentine)
Both may show layering/lamellar patterns

from incremental growth
DENTICLES/ PULP STONES:
further classification by place
Hard mineralized bodies found in the pulp
or the dentine
THREE SUBTYPES:
P 1 FREE - in the pulp

U 2 IMBEDDED - enclosed in the
L dentine as this has slowly grown
P inwards
3 ATTACHED - partly imbedded
TOOTH GERM: Pulp development
DENTAL ORGAN DENTAL LAMINA
MESENCHYME
DENTAL PAPILLA
DENTAL SAC/FOLLICLE
ALVEOLAR BONE
TOOTH TISSUES: Sources
ENAMEL
DENTAL ORGAN DENTAL LAMINA
DENTINE
MESENCHYME
PULP
CEMENTUM
DENTAL PAPILLA
PDL
DENTAL SAC/FOLLICLE
ALVEOLAR BONE
A BONE
DENTAL LAMINA TOOTH
DENTAL ORGAN ENAMEL

Ameloblasts
DENTAL PAPILLA DENTINE

Odontoblasts
mesenchyme PULP
CT cells
DENTAL SAC/FOLLICLE CEMENTUM
Cementoblasts
PDL
Fibroblasts
ALVEOLAR BONE
A BONE
Osteoblasts & ‘clasts
Crest
DENTAL LAMINA TOOTH
DENTAL ORGAN ENAMEL
DENTAL PAPILLA DENTINE

PULP
DENTAL SAC/FOLLICLE CEMENTUM
PDL
LAMINA DURA
ALVEOLAR BONE
SUPPORTING
BONE
Plate
Spongy bone
TOOTH GERM
Outer dental epithelium
DENTAL LAMINA
Stellate reticulum
Stratum intermedium
DENTAL SAC/FOLLICLE
Inner dental epithelium DENTAL PAPILLA
Vessels Nerves
FURTHER ROOT FORMATION
PULP
differentiates
HERTWIG’S
ROOT
SHEATH
grows to
lengthen root
Epithelial diaphragm Odontoblast recruitment site

Text Books
Text Books
My Texts
1. Inflammation 5th edition, Trowbridge/Emling
2. Dental Pulp, Hargreave/Goodis
3. Pathways of the Pulp, 8th Edition, Cohen/Burns
4. Endodontics, 5th edition, Ingle/Bakland
5. Dental Management of the Medically

Compromised Patient, 6th Edition, Little, et al
I didn‘t read every chapter!

Inflammation
Trowbridge/Emling
Important text. The whole

book is informative
Dental Pulp
Hargreaves/Goodis
• The BEST of the Bunch!

Dental Pulp
Hargreaves/Goodis
• History of Pulp Biology
• Development of the Pulpodentin complex
• Dentin Formation and Repair
• Pulpodentin complex
• Pulp as a Connective Tissue
• The Circulation of the Pulp
• Nerve Supply of the Pulpodentin Complex and
Response to Injury
• Pain Mechanisms of the Pulpodentin Complex
• Pharmacologic Control of Pain
• Histology of Pulpal Inflammation
Dental Pulp – CONT’D
Hargreaves/Goodis
• Molecular Mediators of Pulpal Inflammation
• Pulpal Infections Including Caries
• Calcium Hydroxide and Vital Pulp Therapy
• Repair of Pulpal Injury by Dental Materials
• Permanent Restorations and the Dental Pulp
• Pulpal Effects of Thermal and Mechanical Irritants
• Interrelationship of the Dental Pulp and Apical
Periodontitis
• Root Resorption
• Differential Diagnosis of Odontalgia
• The Dental Pulp in Systemic Disorders
2 nd
EDITION
April 2010
Release
Ingle’s Endodontics6
Ingle, Bakland, Baumgartner
• Chapters 5, 7, 8, 12, 13
• Current Edition - 2008
Pathways of the Pulp 9th ed.
Cohen/Hargreaves
Chapters: 3,12,13,15
• Non Odontogenic Toothache
• Structure and Function of the Dentin- Pulp
Complex
• Pathobiology of Primary Apical Periodontitis
• Endodontic Microbiology & Tx. of Infections
Pathways of the Pulp 9th ed.
Cohen/Hargreaves
Chapters:16,17,18
• Endodontic and Periodontic
Interrelationships
• Dental Traumatic Injuries
• Analgesics in Endodontics
Dental Management of the Medically
Compromised Patient
Little, Falace, et al
Grey pages – Dental Management

Summary
• Entire Book is good
Medical Emergencies in the
Dental Office
• Malamed & Darby Home Study

Course*
*(resource disk)
Lecture
• Dental Management of the

Medically Compromised Patient
Donald Falace
*(resource disk)
Dental Management of the
Patient
Donald Falace, DMD
Professor and Division Chief
Oral Diagnosis and Oral Medicine
Objectives of the Course
• Help you identify patients with various types of
medical problems who might be at risk for
having problems as a result of dental treatment
• Help you to plan and deliver dental treatment
in such a way as to avoid or minimize the
chances of an adverse event or outcome
occurring, thus protecting your patients from
injury, disease or adversity.
• Help you to avoid litigation, anxiety, sleepless
nights and heartache.
What do we do in the course of providing
dental treatment that can affect the
physical and emotional health and well
being of a patient?
• Instill fear • Expose to radiation
• Inflict pain • Expose to dental
materials
• Inject local anesthetic
solutions • Prescribe medicines
• Inject potent • Alter oral function
vasoconstrictors • Alter appearance
• Cause bleeding
• Dictate body position
Risk Assessment?
Can we provide dental treatment to this patient
without endangering their (or our) health and well
being?
Yes. No problems are anticipated, and treatment
can be delivered in the usual manner.
Yes. The potential for problems exists, however,
modifications can be made in the delivery of
treatment that reduces risk to an acceptable level.
No. Potential problems exist that are serious
enough to make it inadvisable to provide elective
dental treatment.
Risk Assessment
Physical/Emotional Dental Procedure

-stability -invasiveness
-control -trauma
-tolerance -blood loss
-reserve -duration
Most Common Medical
Emergencies in Dental Practice
• Syncope • Hyperventilation
• Mild Allergic Reaction • Epinephrine Reaction
• Angina Pectoris • Insulin Shock
• Postural Hypotension • Cardiac Arrest
• Seizures • Anaphylaxis
• Asthmatic Attack • Myocardial Infarction
Many of these events are preventable, or at least the chances

of them occurring can be lessened
Reference Sources: Basic
Medical Information
• Little,J, Falace,D,
Miller,C, Rhodus,N:
Dental Management of the
Patient, 6th ed, Mosby,
2002 (~$55)
• The Merck Manual (~$35)
• Harrison’s Principles of
Internal Medicine (~$125)
• Cecil’s Textbook of Internal
Medicine (~$139)
• Internet (PubMed, Medline,
eJournals, Google scholar,
MD Consult)
Reference Sources: Drug
Information
• Drug Information Handbook
for Dentistry (Lexicomp)
~$45
• Physician’s Desk Reference
– PDR ~ $95
– OTC drugs
– Nutritional supplements
– Herbal medications
• Facts and Comparisons
• Drug Information for the
Health Care Provider
(USPDI)
• Internet
Internet Based Websites for Drug
Information
• Med center library website (Micromedix)
• Google scholar
• www.ada.org
• www.drugs.com
• www.factsandcomparisons.com
• www.fda.gov/cder/drug/default.htm
• www.lexi.com
• www.nlm.nih.gov
• www.rxlist.com
Clinical Examination
• General appearance
• Behavior
• Vital signs
• Head and neck
• Oral tissues
• Radiographs
Laboratory Tests
• Determine coagulation status (von Willebrand’s,
hemophilia)
• Determine level of anticoagulation (coumadin)
• Screening for blood glucose (periodontal disease,
burning mouth)
• Screen for infectious disease (hepatitis C, AIDS)
• Screening for liver function (hepatitis C, cirrhosis)
• Screening for kidney function (renal failure)
• Complete blood count with differential [CBC with
diff] (burning mouth, unexplained oral lesions)
Medical Consultation
• Purpose:
– Verify or clarify information
– Determine risk for doing dental
treatment on the patient
– Determine if any changes are
required in the delivery of
dental treatment
• Be brief and to the point
• Letter, FAX, phone call
• Response should attached to or
recorded in the patient’s chart
Phone Consultation
• Often the physician will not be available to talk to you
directly
• You may instead talk with a nurse or receptionist who will
convey what the physician has said or who will tell you
what is in the chart
• It is mandatory to document this conversation, to include
to whom you spoke and what was said
• Direct, written confirmation of this consult is advisable for
medico-legal reasons
• Suggestion: Write a brief summary of the conversation and
FAX it to the physician; include a statement to the effect
that if they disagree with the summary, they should FAX
their correction to you within 24 hours; your FAX should
be attached to the chart
ABC’s of
Problem
Identification
Antibiotics
Anesthesia
Anxiety
Allergy
Bleeding
Chair position
Drugs
Devices
Equipment
Emergencies
• Are there any potential problems
related to the provision of dental
care?
– If not, proceed with treatment in the usual

manner
– If yes, then…
Answer this question….
• Are there any potential problems related to the
provision of dental care? If yes, then…
• How do I need to modify treatment

to avoid those problems?
Examples of Treatment Modifications
• Pre-op:
– prophylactic antibiotics
– sedative
– food intake
• Intra-op:
– upright chair position
– minimize or avoid epinephrine
– nitrous oxide
– hemostasis measures
• Post-op:
– analgesics
– anti-fibrinolytic agent
– antibiotics
Answer this question….
• Are there any potential problems related to the provision of dental
care?
– If not, proceed with treatment in the usual manner
– If yes, then…
• How do I need to modify treatment to avoid those problems?
• Are there any oral manifestations

related to the disease or it’s
treatment?
Oral
Manifestations
• Dry mouth
(xerostomia)
• Oral
ulcerations/lesions
• Burning
mouth/tongue
• Bleeding
• Gingival hyperplasia
• Fungal/bacterial
infections
Getting the information

into long term memory
Learning Aids
http://www.memorize-it.com/
Why Memorize·It?
Repetition plays a vital role in the retention of
information. The Dana Foundation study on
Better Teaching Through Brain Biology says
"Without this step of converting new learning
to long-term memory through repetition and
elaboration, students are unlikely to be able
to use it for a lifetime".
If you've ever used flashcards before and have
something you need to learn quickly, then
Memorize·It is for you.
The whole idea of learning is centered around

repetition.
The more you practice something, the better you

get and the more you know about it.
Purchase, download and sell flashcards on
every subject imaginable.
flashcardstation.com
You can have my decks…
My Decks
1. ABE Glossary of Endodontic Terms

2. Medically Complicated Patients
3. Memory Words
4. Sample Questions and Answers
5. Trowbridge – Q and A
6. Drug interactions
7. SBE Prophylaxis Guidelines
8. Quan’s Endodontic Sequence
Hardcopy and
Electronic formats
(Included on
Resource Disk)
Other information sources

Colleagues for Excellence
Colleagues for
Excellence Newsletter
Series
•Advances in Endodontic Surgery and Contemporary Endodontic Treatment

•Bisphosphonate-Associated Osteonecrosis of the Jaw
•Antibiotics and the Treatment of Endodontic Infections
•Endodontic Case Difficulty Assessment and Referral
• Disassembly of Endodontically Treated Teeth
•Coronal Leakage and Restoration of Endodontically Treated Teeth
•Taking the Pain out of Restorative Dentistry and Endodontics
•Treatment Planning: Comparing the Restored Endodontic Tooth and the
Dental Implant
•Endodontic Considerations in the Management of Traumatic Dental Injuries
•The Cracked Tooth
•Rotary Instrumentation: An Endodontic Perspective
•Obturation of Root Canal Systems
AAE Fact Sheets
Free Clinical Resources
The AAE has published nearly 20

official position statements and
treatment guidelines on various
clinical topics
www.aae.org
Glossary of Endodontic Terms
Glossary of Endodontic
Terms
Important!
Guide to Clinical Endodontics
Avulsed teeth and trauma
guidelines
SBE Regimens
My Decks

3. Memory Words
8. Quan’s Endodontic sequence
21 Years of Literature
(25 years, NOW!)
Literature
Review
Literature on the Written Exam
Exam questions cited both

Publication and Year,
Approximate number of Literature
Questions - 25
November 2005
Literature Review
Compilations
• San Antonio Guide

• VA QuickHit 2005*
• Literature index cards
• Quan’s ABE Study Guide
*Included on Resource Disk

Literature Review
Compilations


Literature Review
Compilations


Literature Review
Compilations


Index Card Literature Review
Literature Review
Compilations


2010 Review Syllabus
Outline – ABE Orals Study Guide
1. RADIOGRAPHIC EXAM
2. SUBJECTIVE AND OBJECTIVE EXAM
3. DIAGNOSIS
4. ETIOLOGY
5. PATHOGENESIS
6. APPLICATION OF BIOLOGIC PRINCIPLES
7. TREATMENT
8. COMPLICATIONS TO TREATMENT
9. MEDICAL COMPLICATIONS & MEDICAL EMERGENCIES
10. PROGNOSIS
11. WHAT I DO & WHY I DO IT
Effect of manual instrumentation on root canal bacteria
Mechanical instrumentation is the core method for bacterial reduction in the infected root
canal.
Byström & Sundqvist (43), Byström A, Sundqvist G., 9181 - Bacteriologic evaluation of
the efficacy of mechanical root canal instrumentation in endodontic therapy. measured
the reduction in bacterial counts cultured from infected canals by instrumentation with
hand stainless-steel instruments under irrigation with physiological saline solution.
Fifteen root canals with necrotic pulps and periapical lesions were instrumented at five
sequential appointments. The access cavity was sealed between the appointments with
a bacteria-tight temporary filling, but the canals were left empty with no antibacterial
dressing.
This procedure caused a substantial reduction in bacterial numbers, usually 100–1000-
fold, but achieving bacteria-free root canals proved difficult. After five
appointments, seven of the 15 root canals still contained cultivable bacteria (43).
Byström A, Sundqvist G., 9181 - Bacteriologic evaluation of the efficacy of mechanical
root canal instrumentation in endodontic therapy.
The relatively limited antibacterial efficiency of mechanical preparation was also reported
by Ørstavik et al. (44). Ørstavik 1991 - Effects of extensive apical reaming and calcium
hydroxide dressing on bacterial infection during treatment of apical periodontitis: a pilot
study. In fact, Cvek et al. (45) Cvek, 1976 - Antimicrobial effect of root canal debridement
in teeth with immature root. A clinical and microbiologic study. had already compared the
antibacterial effect of biochemical root canal cleansing in permanent non-vital maxillary
incisors with immature apices with those with mature roots.
Literature Review
Other resources
Literature Review
Other resources
University of Oregon
Current
thru 2008
http://www.ohsu.edu/sod/endo/endo_literature.html
•History of endodontics OSHU Classic Literature
•Tooth morphology
•Anatomy of the pulp and periapex
•Diagnostic procedures - pulp histology
•Radiographic Interpretation
•Endodontic Length Determination
•Vertical Root Fractures
•Pulpal Histopathology
•Pulpal Physiology
•Pulpal Response to Caries and Dental Procedures
•Mechanical Properties of Endodontic Instruments
•Endodontic Instrumentation Techniques
•Pulp Capping and Pulpotomies
•Endodontic Irrigation and Chelation
•Interappointment Medicaments and Temporary Fillings
•Endodontic Obturation; Methods and Materials
•Endodontic Sealers
•Prognosis of Nonsurgical Endodontic Treatment
•Endodontic Retreatment
•Restoration-Endodontically Treated Teeth
•Diagnosis of Non-Odontogenic Pain
•Focal Infection, Bacteremias, Anachoresis and the Hollow Tube Theory
•Pediatric Endodontics
•Use of Apical Barriers in Endodontics
OHSU Classic Literature – Cont’d
•Apexification and Apexogenisis

•Endodontic Trauma; Pathogenesis and Treatment
•Use of Antibiotics in Endodontics
•Endodontic Surgery: Prognosis and Treatment Planning
•Endodontic Surgery: Technique
•Endodontic Surgery: Materials
•Prediction/Treatment of Endodontic Pain
•Procedural Misadventures
•Use of Analgesics in Endodontics
•Endodontic/Periodontal Interrelationships
•Local Anesthetics : I
•Local Anesthesia : II
•Endodontic Microbiology/Immunology
•Pulpal and Periapical Disease
•Tooth Lightening: Internal and External
•Internal and External Resorption
•Orthodontic/Endodontics (Extrusion)
•Intentional Replantations/Transplantation
•Endodontic and Intraosseous Implants
•Medically compromised patients
Literature Review
Other resources
Navy - Bethesda
http://www.bethesda.med.navy.mil/Careers/Postgraduate_Dental_School/
http://www.bethesda.med.navy.mil/Careers/Postgraduate_Dental_School/Endodontics/L
iterature/index.aspx
My thoughts……..Cont’d
Good questions for each topic

Literature Review
Other resources
JOE Online Study Guide

JOE Online Study
Guide
Success and Failure in Endodontics:
Root Canal Anatomy:
Root Canal Debridement:
Lasers in Endodontics:
Obturation of the Root Canal System:
Pulpal and Periradicular Diagnosis:
Endodontic Surgery:
Procedural Accidents
Endodontic-Periodontal Interrelationships:
Management of the Immature Apex Tooth:
Uses of Calcium Hydroxide:
Traumatic Injuries:
Vital Pulp Therapy:
Treatment of the Primary Tooth:
Bleaching in Endodontics:
Endodontic Radiology:
Single-Visit Endodontics:
Endodontic Retreatment:
JOE Online Study
Guide
Coronal Microleakage:
Post Space Preparation:
Orthodontic Extrusion:
Glucocorticoids in Endodontics:
Microbiology in Endodontics:
Pain and Anxiety Control:
Immunologic Reactions and Endodontics:
Restoration of the Endodontically Treated Tooth
Sinus Tracts:
Relationship Between Systemic Diseases and Endodontics:
Medical Emergencies and Drugs:
Periradicular Lesions Not of Endodontic Origin:
Veterinary Endodontics:
Endodontics
The BIG picture
Endodontic Topics
Volumes 1 thru 16
Highly recommended – great information
The Philosophy behind
Endodontic Topics
Clinical dentistry based on the scientific
evidence
One topic per issue, the most qualified

scientists will present relevant and cutting edge
information on the chosen topic
5 year cycle of topics

Endodontic Topics
Volumes 1 thru 16 included

on the resource disc
Where I went from there…..
Test taking skills
30 years of catching up
www.pearsonvue.com
The test rules
• Four hours will be allotted to complete the
examination
• It is a computer-based Written Examination
• The Written Examination contains 200
questions
• Responses are recorded directly into the
computer.
• NOT PENCIL & PAPER!
The test rules
• Request two forms of identification (ID)
• Check IDs
• Capture electronic signature and verify that
signatures match
• Capture electronic fingerprint
• Capture digital photograph
• Distribute Candidate rules document
• Show Candidate where to store belongings
• Offer Candidate erasable note board and pen
• Admit
The test rules
• Personal items, such as cellular

phones, hand-held
computers/personal digital
assistants (PDAs) or other electronic
devices, pagers, watches, wallets,
purses, hats, bags, coats, books and
notes, are not allowed in the testing
room.
The test rules
• The Pearson Professional Center test

administrator will provide you with
an erasable note board and a marker
before you enter the testing room.
You may not remove these items
from the testing room at any time
during the exam, and you must
return all items to the test
administrator after the exam.
The test rules
• You may not write on the erasable

note board until after the exam has
been started.
• If you need to clean your note board
during the exam, raise your hand and
the test administrator will assist you.
The test rules
• Earplugs are available

from the test administrator
on request.
The test rules
• The Pearson test administrator will
log you in to your assigned
workstation, verify that you are
taking the correct exam and start the
exam. Please remain in your
assigned seat. Eating, drinking,
smoking and making noise that
creates a disturbance for other
Candidates are prohibited during the
exam.
The test rules
• To ensure a high level of

security throughout your
testing experience, you will
be monitored at all times.
Both audio and video will be
recorded.
The test rules
• To request an unscheduled break,
raise your hand to get the test
administrator’s attention. The
administrator will set your testing
workstation to the break mode and
restart the exam for you when you
return. The exam clock will NOT stop
while you are away.
The test rules
• You must leave the testing room for

all breaks. When you leave the
testing room, you will be
fingerprinted, and you will be
fingerprinted again before you re-
enter the testing room
The test rules
• If you do not follow the above rules,

if you tamper with the computer or if
you are suspected of cheating,
appropriate action will be taken. This
may include invalidation of your
exam results.
The test rules
• You may not write on the erasable

note board until after the exam has
been started. If you need to clean
your note board during the exam,
raise your hand and the test
administrator will assist you.
Practicing for the test
Recommendation:
Take the NMR practice test,

so you are comfortable with
test mechanics
Practicing for the test
the Classic Way
Written Practice Tests
• Pathways of the Pulp, Challenge – A
self assessment exam
• Inflammation, Self tests for each
chapter
• Loma Linda and Einstein Courses -
Review Questions*
• Medical Emergencies n the Dental
Office, Malamed, Post-test Questions
Sit down and take them all together, 3 weeks before

actual exam, time yourself
After exam thoughts……
My thoughts…
• I don’t know if I passed, but I was not

feeling overwhelmed by the exam
• Questions were fair
• If I failed: I’d study the same cards, notes
and old exams
• Additional areas of study: Know “Paget’s
and Von Wildebrand diseases”
• Oral Pathology Diseases: more familiarity
with names, histology and radiographic
descriptions
• How do x-rays work? KVP, grayscale,

maximum annual dosages.
• End Renal disease? Know medical
conditions and drugs used to treat.
• Pharmacology of Drugs. Drug
interactions
• Emergency medical conditions: how
to treat them
• Diagnosis: How do EPT, CO2 and Endo-
ice work physiologically, which is the
best and worst?
• CaOH literature: how much, how long,
how does it work? Is it needed?
• MTA – pH, physical properties, when does
it leak after setting?
• Good to know last Two years of JOE’s.
2004 literature was asked a lot!
• Nerve pathways.
• Mechanisms of Pain
• pKa , what makes anesthetic
“Faster” vs. “Longer Duration”?
• Lipid vs. protein binding?
• Articaine vs. Lidocaine?
• Know traumatic injuries, types and
treatment
• GG ISO size?
I passed!
Assembling your study materials
what you don’t have on disk!
•Textbooks
•Gray’s Anatomy Flash Cards
•Some AAE materials
•Dental Decks
Written part 1 section of DVD
The Case Portfolio
Know the Rules
Table of Contents
•Helpful Hints
•Pet Peeves
•Submission Deadlines
•Portfolio Preparation
•Required Cases for Submission
Narrative
Radiographs & Images
Radiographs
Digital Images
Laboratory and Biopsy Reports
Recall
•The Case History Report Form Instructions and Information
•Instructions for the Case History Report Form
To Create a Case History Report Form
Tool Bar
Tab Button
Select Buttons
Spell Check
Allowed Space
Changes
Addendum Page
Table of Contents-cont’d
•Back Up Copies
•Printing
•Case History Report Form Required Information
•The Case History Report Form
•The Case History Evaluation Form Instructions
Table of Contents - Cont’d
• Category Evaluation
• The Case History Evaluation Form
• How Cases are Graded
• Case Grading Chart
• Case History Portfolio Submission Checklist
Submission of the Portfolio
• Examination Scoring
• Candidate Notification
• Appeal Process for an Adverse Decision
• Certification Process Timeline
Follow the directions!
1. No grammar and spell check!

2. Type up and edit as a WORD
document.
3. Quan’s WORD template is
recommended
4. Adhere to their CHECKLIST
Fifteen Cases
• One year Follow-up
• Types of cases
– Diagnosis (1)
– Emergency (1)
– Medically compromised (1)
– Nonsurgical RCT (5)
– Retreatment (2)
– Surgical RCT (2)
– Other (3)
Case History Peeves
•Acceptable: High technical skill required.

•Excellent: Required the highest level of
knowledge and technical skill.
•Unacceptable: The knowledge and technical
skills required were within the scope of the
general dentist.
•Deficient: Routine diagnostic and technical
difficulty requiring average skills.
Specialist Quality Cases
94% pass rate

FALL 2009
84% pass rate
Spring 2009
Case History Peeves
Fall
2009
Case History Peeves
Case History Peeves
Case History Peeves Listed
Cases in the portfolio that don‘t meet the

criteria for the category; for example in the
medically compromised category, a case in
which no significant modification of
treatment was done.
• Bespecific with clinical findings – do not

leave anything for the examiner to interpret.
Example: tooth #14 felt different‘. Different

to what stimulus? This may be something
the patient would say and so would be
appropriate only for the chief complaint.
• Make sure it is clear which tooth you are

referring to.
We cannot assume it is the tooth listed in

the case heading, particularly if other teeth
may be contributing to the problem.
•
• Be consistent with terminology. If you

use the term ‗palatal‘ for tooth #3, do not
use the term ‗lingual‘ for tooth #14.
In this example, palatal is a better term
and should be used throughout the
portfolio
•
• • If you do something that differs from your

normal treatment protocol, provide the
rationale.
Example: lidocaine was used singularly for
14 cases in your portfolio, and articaine was
used for 1 case. Why?
•
• Make sure radiographs reveal the entire

periapical lesion and the entire periapical
region of the involved tooth
AAE Endodontic Case
Difficulty Assessment Form
AAE Endodontic Case
LEVELS OF DIFFICULTY
MINIMAL DIFFICULTY Preoperative condition indicates

routine complexity (uncomplicated). These types of cases
would exhibit only those factors listed in the MINIMAL
DIFFICULTY category. Achieving a predictable treatment
outcome should be attainable by a competent practitioner
with limited experience.
AAE Endodontic Case
MODERATE DIFFICULTY Preoperative condition is

complicated, exhibiting one or more patient or treatment
factors listed
in the MODERATE DIFFICULTY category. Achieving a
predictable treatment outcome will be challenging for a
competent, experienced practitioner.
AAE Endodontic Case
HIGH DIFFICULTY Preoperative condition is exceptionally
complicated, exhibiting several factors listed in the
MODERATE DIFFICULTY category or at least one in the
HIGH DIFFICULTY category. Achieving a predictable
treatment outcome will be challenging for even the most
experienced practitioner with an extensive history of
favorable outcomes.
Case Selection Tips
• Show what you can do!

• Moderate to High Difficulty
Cases
Case
Report
Template
With
Spell and
Grammar
check
The
Complete
Set
The Complete Set
Quan’s Case Portfolio
1. The entire, 15 case, portfolio in

digital format
2. Includes the “Routine
Abbreviations and Procedure
Descriptions
3. “Word” template with spell and
grammar check
/www.gradware.com
gradware.com 1-877-333-1676
Case Portfolio Template
Oral Exam
Guidelines
Orals – The Rules
What does this mean?

Case Based Format
Ten Topics- supported by the literature
1. Interpretation of Radiographs
2. Request for Additional Information
3. Differential Diagnosis/Diagnosis
4. Etiology
5. Pathogenesis
2009 ABE
Case Based Format – CONT”D
Ten Topics- supported by the literature
6. Alternate Treatments, Treatment of
Choice
7. Biological Implications
8. Medical History
9. Complications/Management of
Complications
10. Prognosis
2009 ABE
Orals – The Rules
•An oral exam is different than a

written exam
• NOT multiple choice!
•You know THE correct answer or
you DON’T !
Orals – The Rules
• Three sessions, one after another
• They come to you
• 2 against 1
• 30 minute sessions
• Taped
• Paper and pencil provided
• 10 sections of 3 questions each
Orals – The Rules
•Questions are in a specific order

•You start by being given x-rays and
possibly photos
•They were not of high good quality
Orals
96% pass rate

FALL 2009
81% pass rate
SPRING 2009
Orals – Peeves
Use references when indicated or asked for.
References are to be used to justify your

comments.
Unlike the Written Exam, during the Orals

there are almost no instances where we ask
for a specific author.
Orals – Peeves
Failure to use any literature citations to

support an answer or using too many
references from the 60‘s and 70‘s when more
relevant and current literature is available.
Orals – Peeves
A Candidate should be able to quote the

classic literature from our specialty, at a
minimum, to support a position
Orals – Peeves
Trying to control the pace
The Directors must complete all ten
sections of their scripted scenario in the
allotted time. Talking slower doesn‘t help
you
A Candidate that can‘t completely

answer a question should say so and
then move on.
Orals – Peeves
Trying to control the pace
Do not dwell on the question and then try

and answer the question later on. Let it go.
On the other hand, do not filibuster.
Be concise with your answers. Brevity is a

virtue.
My Orals Strategy
Be able to support with

literature citations everything
that I do clinically
Study Aids
3. DIAGNOSIS
4. ETIOLOGY
5. PATHOGENESIS
7. TREATMENT
10. PROGNOSIS
3. DIAGNOSIS
4. ETIOLOGY
5. PATHOGENESIS
7. TREATMENT
10. PROGNOSIS
RADIOGRAPHIC EXAM
SUBJECTIVE AND OBJECTIVE EXAM
Subjective and Objective Exam
Fascial Space Infections
DIAGNOSIS
Differential Diagnosis of Odontalgia
ETIOLOGY
Pulpal Irritants
PATHOGENESIS
Pathogenesis of Apical Periodontitis & Causes of Endodontic Failures
Endodontic Pathogens
Eradication of endodontic infection by instrumentation and irrigation
solutions
3. DIAGNOSIS
4. ETIOLOGY
5. PATHOGENESIS
7. TREATMENT
10. PROGNOSIS
APPLICATION OF BIOLOGIC PRINCIPLES
ChemoMechanical Debridement – Irrigation

Ca(OH)2 - Interappointment
Ca(OH)2
Size of Apical Instrumentation
Dens Evaginitis
Pulp Protection – Current concepts
3. DIAGNOSIS
4. ETIOLOGY
5. PATHOGENESIS
7. TREATMENT
10. PROGNOSIS
TREATMENT
AAE Guide to Clinical Endodontics

AAE Trauma Guidelines
Vital Pulp Therapy
Tooth Morphology
Restoration of the Endodontically Treated Tooth
Management of Traumatic Injuries
Local Anesthetics Injections and Local Anesthetic Pharmacology
Magnification & Illumination
Root End Filling Materials
Flap Design
Root End Instrumentation
Obturation
Adhesive Dentistry and Endodontics (Coronal Leakage)
3. DIAGNOSIS
4. ETIOLOGY
5. PATHOGENESIS
7. TREATMENT
10. PROGNOSIS
COMPLICATIONS TO TREATMENT
Systemic Complications
MEDICAL COMPLICATIONS & MEDICAL

EMERGENCIES
PROGNOSIS
Outcome Studies
Retreatment: - Treatment Options for Negative
Outcomes with NSRCT, NS ReTX, and Surgical RetX.
3. DIAGNOSIS
4. ETIOLOGY
5. PATHOGENESIS
7. TREATMENT
10. PROGNOSIS
What do you do and
why?
What do you do and why?
Creation of Memory Words
Memory Words
Neumonics
Detrails of the study

gfuide and how it is
formatted
My Decks

3. Memory Words
8. Quan’s Endodontic Sequence
Sample Question &
Answers
Sample Question &
Answers
My Practice Questions
FIVE
ABE tolerated but NOT

approved
Practice #1
Practice #1
Practice #1
Practice #2
Practice #2
Practice #2
Practice #3
Practice #3
Practice #4
Practice #4
Practice #5
Practice #5
Practice #5
The Questions
ABE Self Assessment Case Scenario #1
You are looking at a Periapical of #29 and clinical photos of the area.
see PAGE # 1
Describe everything that you see?
Radiograph? Periapical area of #29? Adjacent teeth?
Clinical observations from photos?
21 year old, Asian female, in good health but who reports a prior
allergic reaction to aspirin with rash and dizziness, when she took some
three years ago. Tooth #29 is asymptomatic, non-vital to CO2. The rest
of the quadrant is vital to all tests and is normal on clinical exam.
What other radiographs, test results or clinical findings do you require
to make a diagnosis? See PAGES #2 and #3. Which show #20 also
has dens evaginatus.
#20 is non vital to CO2 and asymptomatic, the rest of lower left
quadrant is vital and normal clinically.
Which population group does Dens Evaginatus occur most frequently ?
What is the prevalence of Dens Evaginatus in this racial group?
Bilaterally?
The Answers
I have the all the

answers and
references!
lesquan@sbcglobal.net
Preparation Hints
• Create your own:

“How I do endo and Why I do it.”
• Create “Short” Oral Reports
• Use Memorize-it Decks
• Factor in Jet Lag affecting your
performance
Orals Folder Part 3
Post Orals
• Histopathology of periapical lesions

• What cell types are present in any
given clinical situation?
• Vertical cracks
• Most frequent causes?
• Microbiology in cracks
• External Resorption
Post Orals – Cont’d
• Heathersay 2004
• Intermediate cementum
• Incidence of oral cancers
• Inflammation and Immunology
Classes of Immunoglobulins
Types of Immune responses
• Classes of Hypertension
Normal
Pre-hypertension
Stage I
Stage 2
• Review immunology and
inflammation basics
• Pulpal anatomy
• Tooth anatomy - layers
• Tooth development
• Each case had Medical Issues
Post orals – Cont’d
If there is a next time……
• Relearn prior flashcard lists - subject selection was good.
• Some subjects I just did not study at all.
• It is a question and answer by memory test. It was a fairly

relaxed conversation with my peers (5 of 6 examiners)
Memorize your support research so you can respond
flawlessly under stress.
• Try not to get flustered if you don’t know every answer, you
are not supposed to! They are trying to quickly determine
the depth and breadth of your knowledge, so they keep
asking questions until you run out of answers.
The Resource Disk
Practice questions and answers (111 Pages)
Personal Memorize flash cards (Six Inch Stack)
–Endodontic Glossary
–Immunology Questions
–SBE regimens & Antibiotics
–Space Abscesses
–Miscellaneous
PowerPoint Lectures (32) individual
Website List (43) individual
Medical Emergencies (9 pages) home study
course
Reprints in PDF (9) Miscellaneous Important
articles
Resource Disk – Cont’d
Differential Dx. and Histology of Periradicular
Lesions (7 pages)
New Developments in Instrumentation (80 pages)
Index Card Literature Review (2 Inch tall stack)
QuickHitLit – Quan Literature Review
Navy Literature Review
San Antonio Guide
OHSU Literature review
Quan’s Orals Study Guide (filed in “ABE Part 3 Oral
Exam” folder)
Assembling your study materials
1. Order 3”X 5” index cards – Avery

5388
2. 5” X 7” Blank Index Cards
3. Print Hardcopy of “Resource Disk”
4. Acquire recommended texts
Les (Quando) Quan
―Appointed‖
Ambassador to China
The first and only
Ambassador of the
American Board of
Endodontics
Good Luck!

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Les Quan’s ABE Study and

Diplomate, American Board of Endodontics - 2006

• No additional formal training

• The 2 endodontists who I admired most

• I was totally occupied with building a

• Board Certification is the process by

Ghosts One More

Know all the rules!

1. The Written Examination contains 200

My older age wasn’t held

1. What are the rules?

I went to them all, and got a

• Many identical topics to study

What I studied first

Free PowerPoint Lectures

ALVEOLAR BONE CEMENTUM

Service tissue keeping its Odontoblasts alive

Providing antimicrobial defense for the

Providing sensory feedback from the dentine,

ALVEOLAR BONE CEMENTUM

Service tissue keeping its Odontoblasts alive for slow

CORONAL PULP HORN

Nerves: sensory (V) to

& Denticles & Fibrosis with aging

Both may show layering/lamellar patterns

P 1 FREE - in the pulp

DENTAL ORGAN DENTAL LAMINA

DENTAL LAMINA TOOTH

DENTAL ORGAN ENAMEL

DENTAL PAPILLA DENTINE

DENTAL LAMINA TOOTH

DENTAL ORGAN ENAMEL

DENTAL PAPILLA DENTINE

DENTAL SAC/FOLLICLE CEMENTUM

Epithelial diaphragm Odontoblast recruitment site

2. Dental Pulp, Hargreave/Goodis

3. Pathways of the Pulp, 8th Edition, Cohen/Burns

4. Endodontics, 5th edition, Ingle/Bakland

5. Dental Management of the Medically

I didn‘t read every chapter!

Important text. The whole

• The BEST of the Bunch!

Grey pages – Dental Management

• Malamed & Darby Home Study

• Dental Management of the

Physical/Emotional Dental Procedure

Many of these events are preventable, or at least the chances

– If not, proceed with treatment in the usual

• How do I need to modify treatment

• How do I need to modify treatment to avoid those problems?

• Are there any oral manifestations

Getting the information

The whole idea of learning is centered around

The more you practice something, the better you

1. ABE Glossary of Endodontic Terms

Other information sources

•Advances in Endodontic Surgery and Contemporary Endodontic Treatment

The AAE has published nearly 20

1. ABE Glossary of Endodontic Terms

Exam questions cited both

• San Antonio Guide

*Included on Resource Disk