Course Syllabus

EN 521 / 522 Preclinical Endodontics Fall 2019 HENRY M. GOLDMAN SCHOOL OF

DENTAL MEDICINE

Course supports the attainment of competency* in:

Critical Thinking Domain
1 the use of critical thinking and problem-solving, including their use in the comprehensive
care of patients, scientific inquiry and research methodology
2 the application of biomedical science knowledge in the delivery of patient care
3 searching, retrieving, critically appraising, applying, and communicating scientific and lay
literature as it relates to providing evidence-based patient care
Ethics and Professionalism Domain
4 self-assessment, ethical decision making and displaying professionalism in patient care
and interactions with others
Communication and Interpersonal Skills Domain
5 managing a diverse patient population and have the interpersonal and communications
skills to function successfully in a multicultural work environment
6 the application of the fundamental principles of behavioral sciences as they pertain to
patient-centered approaches for promoting, improving and maintaining oral health
Practice Management Domain
7 applying legal and regulatory concepts related to the provision of oral health care services
and risk management
8 applying principles and philosophies of practice management, and models of oral health
care delivery
9 communicating and collaborating with members of the health care team to facilitate
patient oral health care services

Patient Care Domain

10 providing comprehensive oral health care within the scope of general dentistry, as
defined by the School
a. patient assessment, diagnosis, comprehensive treatment planning, prognosis,
and informed consent;
b. screening and risk assessment for head and neck cancer;
c. recognizing the complexity of patient treatment and identifying when referral
is indicated;
d. health promotion and disease prevention;
e. local anesthesia, and pain and anxiety control;
f. restoration of teeth;
g. communicating and managing dental laboratory procedures in support of
patient care;
h. replacement of teeth including fixed, removable and dental implant
prosthodontic therapies;
i. periodontal therapy;
j. pulpal therapy;
k. oral mucosal and osseous disorders;
l. hard and soft tissue surgery;
m. dental emergencies;
n. malocclusion and space management; and
o. evaluation of the outcomes of treatment, recall strategies, and prognosis

*Bold black type = major link to competency; Bold gray type = minor link to competency

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Course name: Preclinical Endodontics
Course number:
EN521: DMD 2 and AS 1 didactic endodontics
EN522: DMD 2 and AS1 Pre-clinical laboratory

Table of contents
Page
1. Contact information 3
2. Description of course 3
3. Purpose of course 3
4. Learning objectives 4
5. Prerequisites 5
6. Pretesting 5
7. Responsibilities of students & faculty 6
8. Study strategies 6
9. Schedule 6
10. Assignments & outside activities 6
11. Formative evaluation & advising 6
12. Summative evaluation & grading 6
13. Student feedback & course changes 8
14. Learning resources & study aids 9

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1. Contact information

Program Director: Dr. Andrew Miller (ajmiller@bu.edu) Room G-607

EN521 & EN522 Course Director: Dr. Andrew Miller
Faculty members: Drs. Louay Abrass, Nauman Chatha and Edward Hsu
Administrative Coordinator: Ms. Sylvia Ruffin sruffin@bu.edu
Location: Robinson Building – 3rd Floor
Pre-doctoral Endodontic Clinic: 6th Floor Patient Treatment Center (#83 & 84)
Dr. Miller/s Office hours M&W 9:00am-6:00 pm and F 9:00 am – 3:30 pm
By appointment or walk-in as available

2. Description of course

This is a basic course in endodontic theory and technique. The student is provided with a
sound basic understanding of modern Endodontics and endodontic concepts, through a
series of lectures which include the following topics:
1. Introduction to endodontics
2. Histology, Physiology & Pathophysiology of the Pulp and Periradicular Tissue
3. Clinical diagnosis and treatment selection of pulpal and periradicular diseases
4. Classification of Pulpal & Periradicular Pathoses and Management of Endodontic
Emergency
5. Tooth morphology and access cavities
6. Cleaning shaping and obturation of root canal system
7. Management of traumatic injuries
8. Endodontic failure and re-treatment
9. Internal bleaching and root resorption
10. Endodontic surgery- an overview
11. Regenerative endodontic procedures

Preclinical course (EN522) gives a thorough grounding in therapy techniques using a series
of structured, carefully supervised, pre-clinical sessions. The laboratory exercise will
emphasize preparation of access cavity, cleaning and shaping and obturation of the root
canal system.

3. Purpose of course

This course is to provide the student with the basic knowledge and pre-clinical skills to
prepare the new clinician for functional exposure in diagnosing and managing endodontic
emergencies, also treatment of pulpal and periradicular diseases as a comprehensive part of
dental practice. The course teaches how to assess the success and/or failure of endodontic
treatment, using evidence based criteria for conventional re-treatment or surgical
intervention, how to diagnose and treat traumatically affected teeth in accordance with the
W.H.O. Classification. The course also provides the guidance regarding to the decision
making process when to treat and when to refer based on AAE guidelines.

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4. Learning objectives or outcomes

Students completing this course will be able to:

1. Recognize the scope of endodontics.

2. State the ultimate goals of endodontic therapy.
3. Comprehend the importance of preclinical endodontics and its relationship to
clinical endodontics.
4. Complete mandatory exercise in the simulation laboratory.
5. Recognize the subjective and objective signs and symptoms of a patient with normal
and irreversibly damaged pulps.
6. Define reversible and irreversible pulp injury.
7. Identify the pulpal tests that should be performed and discuss the differences
between the normal and pathological findings.
8. Match diagnostic test results to various clinical, pulpal, and periradicular disease
classifications and determine the treatment.
9. Discuss the significance of the chief complaint to the diagnosis.
10. Complete the proper paper work necessary to record a proper endodontic
diagnosis in the clinic.
11. Evaluate cases that are within or beyond the skill level of the beginning clinician.
12. Identify dental emergency situations.
13. Recognize when direct pulp capping, indirect pulp capping, pulpotomy and
pulpectomy are appropriate, and be able to list the sequence of treatment steps.
14. Identify the implications of pulp cap and pulpotomy failure on future patient
treatment.
15. Discuss the advantages and disadvantages of a pulpectomy versus a pulpotomy in
treating emergency patients.
16. Identify the severity and incidence of endodontic pain between
appointments.
17. Recognize when mild and narcotic analgesics are indicated.
18. Recognize when antibiotics are indicated.
19. Determine the number of visits required for treatment.
20. Identify the internal morphology of the pulp chamber, coronal, mid-root, and apical
portions of the root canal systems.
21. Apply the knowledge of topics 20 to access preparations and working length.
22. Recognize correct and incorrect straight-line access to the canals, and the difference
between straight-line access to the canal orifice and the apical portion of the canal.
23. Compare and contrast the access opening needed for anterior, premolar and
molars.
24. List the steps necessary to perform an endodontic access preparation.
25. List the number and types of radiographs required during root canal therapy.
26. Use proper kvp, mA, and exposure times for endodontic therapy.
27. Recognize on radiographs whether a file or obturation material is at the proper
working length.
28. Differentiate the difference between files and other objects placed in multi-
rooted teeth using the angled radiograph technique.
29. Use the cone-image shift principle to identify the relative position of the files placed

in different canals within the same root.

30. Identify the differences in manufacturing and use of hand or rotary files.

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 31. Define the ISO standard and other terminology for instrument specification.
32. Identify the steps involved in cleaning and shaping of endodontic treatment.
33. Explain to a patient what the outcome of a broken instrument might be.
34. Recognize the basic goals of cleaning and shaping root canal systems.
35. Describe the differences between a canal before and after cleaning and shaping.
36. Describe and apply the mechanical principles of cleaning and shaping.
37. Identify the advantages and disadvantages of root canal preparation comparing hand
instruments to rotary instruments.
38. Identify the functions of irrigants and chelating agents used during cleaning
and shaping of root canal systems.
39. Describe how to determine the final file size required cleaning and shaping the
canal at working length.
40. Define recapitulation.
41. Define filing and reaming motion.
42. Describe the use of the Orifice Shaper and Gates Glidden drill.
43. Describe how to prevent dentin mud from obstructing access to working length and
canal patency.
44. Define transporting foramen and strip perforation and describe how to prevent it.
45. Describe the advantages of the crown down technique over the classical step back
technique.
46. List the important points (radiographs) to check during root canal procedure.
47. Recognize the materials commonly used to obturate root canal systems.
48. Recognize the advantages of using Warm Gutta Percha Vertical Condensation
technique over other techniques.
49. List the steps of Warm Gutta Percha Vertical Condensation
50. Describe how sealer is placed in the prepared canal.
51. Recognize the need for apexogenesis or apexification for teeth with open apices.
52. Recognize the necessity for field isolation using the rubber dam.
53. Recognize differences in characteristics and handling properties between
stainless steel and nickel titanium instruments.
54. Recognize the importance of taper and its relation to size of
instruments.
55. Discuss how increasing file sizes influences file flexibility.
56. Identify function of the irrigant used in root canal therapy.
57. Recognize the situations in which intracanal medicaments are necessary
and when they are not.
58. Recognize well and poorly obturated root canals and success or failure of the
endodontic treatment.
59. Recognize the internal or external resorption.
60. Select the cases appropriate for internal bleaching.

5. Prerequisites

The student should be in good standing in the DMD II or AS I class.

6. Pretesting
No pretesting administered for this course.

7. Responsibilities of students & faculty

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The course schedule will be reviewed at the first meeting of the class, which provides the key
information regarding all of the courses. The handouts will be available on the website (course info)
for review. The instructors will be accessible all the time through email or in person by appointment
outside the class room. The didactic and lab courses will be introduced in a logical sequence to
facilitate the learning process. Faculty members will respect and treat students as a colleague at all
times. In return, you will be held to the same standards of conduct that befits a professional.
Deceptive or disruptive behavior will be considered unprofessional and will not be tolerated.
1) Students are allowed to miss two sessions only with written permission from the
Associate Dean of Academic Affairs for genuine sick or compassionate leave.
2) If a third session is missed, the final grade will be marked down, or in extreme cases
where more than three sessions were missed the student may be asked to repeat the
course, at the Course Director’s discretion.
3) Attendance may be taken during every lecture and at every lab session.
4) Set-Up and Clean-Up Detail: All students are required to fulfill their responsibilities
regarding setting up at the beginning of the lab session and clearing up at the end
thereof.

8. Study strategies

1. Pre-view the handouts before the lecture.

2. Take notes where the details might help you to understand the
concept.
3. Review the handouts and notes before taking web-based quizzes.
4. Review the objectives of the course listed in syllabus.
5. Study the self-assessment questions at the back of the textbook,
PATHWAYS OF THE PULP.

9. Schedule (posted on BB8 for each class)

10. Assignments or outside activities

Web based quizzes and possible online search/article review for related topics

11. Formative evaluation & improvement

Evaluation of pre-clinical lab exercises is formative. Where the standard of the work handed in is
deemed unacceptable, or sub-standard, students may be afforded the option of repeating the
exercise for re-grading; a grade reduction may be incurred.

12. Summative evaluation & grading

EN 521 (Didactic course) 1. Web-based Quizzes 10%

2. Class Quizzes 10%
3. Video Assignment 20%
4. Didactic Midterm Written Exam 20%
5. Didactic Final Written Exam 40%

EN 522 (Pre-clinical lab) 1. Mandatory In-Lab Exercises 10%

2. Mandatory Extracted Teeth Exercises 40%
3. SLC Quizzes 10%

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 4. Attendance 5%
5. Practical Summative Final Exam 35%

1). Web-based Quizzes and attendance

Web-based quizzes are accessible on Blackboard. It is intended that the learning proceed as a
continuous assimilation rather than cramming for the final at the end of the course. A missed lecture
has to be accompanied by express written permission from the office of the Dean for academic
affairs. One unexcused absence may result in forfeit of that lecture quiz, three or more unexcused
absences will mandate repeating the course.

2.) Class Quizzes will be unannounced and given randomly during a few lectures. Therefore, you
will need to be present during the lecture to take the quiz. Only excused absences approved through
the office of academic affairs will be provided the opportunity to make up any missed quiz.

3.) Video Assignment. The class will be assigned to groups who may select an available topic from
the course text book and will be required to create a short video teaching the concepts in the
selected topic/section.

4). Didactic Midterm Written Exam

This will be given after the first semester didactic lectures of the course; it will be 50+ multiple
choice questions, which will be derived from lectures, endodontic manual and suggested text books
and readings.

5). Didactic Final Written Exam

This will be given at the end of the course; it will be 50+ multiple choice questions, which will be
cumulative and derived from lectures, endodontic manual and suggested text books and readings.

1). Mandatory In-Lab Exercises:

There will be five in-lab exercises including access cavities, cleaning and shaping as well as
obturation that will have grading sheets provided on the day of the lab.
Grades will be given with regard to how well the assignment meets certain readily identifiable,
objective criteria.
Late assignments will have points deducted. Assignments that are incomplete will get a score of
zero. Where the standard of the work handed in is deemed unacceptable, or sub-standard, students
may be afforded the option of repeating the exercise for re-grading; a grade reduction may be
incurred.

2). Mandatory Extracted Teeth Exercises:

Letter grades will be given with regard to how well the assignment meets certain readily
identifiable, objective criteria.
Late assignments will have points deducted. Assignments that are incomplete will get a score of
zero. Where the standard of the work handed in is deemed unacceptable, or sub-standard, students
may be afforded the option of repeating the exercise for re-grading; a grade reduction may be
incurred.
.

3). SLC Quizzes

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Quizzes along with the topic will be based on assigned readings and/or lectures and will be
announced the week before. Quizzes will be given depending on the classes’ progress and
development. Only excused absences approved through the office of academic affairs will be
provided the opportunity to make up any missed quiz.

4). SLC Attendance:

Students are expected to be in lab and working on endodontic related exercises unless given explicit
permission by the course director to leave early or work on another subject. Students will be
assigned to their work stations and if they are not present and working on endodontic related
exercises during the assigned scheduled Preclinical Endodontics SLC lab time then they will not
receive credit for attendance during that lab session.
A missed lab has to be accompanied by express written permission from the office of the Dean for
academic affairs before the SLC lab session. One unexcused absence may result in forfeit of that
lecture quiz, three or more unexcused absences could mandate repeating the course.

5). Practical Summative Final Exam

This will be a Summative examination; the student will be assessed for independent competency
while performing endodontic therapy, unsupervised, on a relatively uncomplicated single-rooted
tooth, and a complete set of radiographs, accompanying the case.

6.) Attendance is mandatory. Any unapproved absences may lower your final course grade.

UNEXCUSED ABSENCE FROM EITHER OF THE FINAL EXAMS WILL RESULT IN A

SCORE OF ZERO.

Absolute standard will be used in either written or summative examination. The following
distribution will be applied to the letter grades.
93-100 A
90-92 A-
87-89 B+
83-86 B
80-82 B-
77-79 C+
73-76 C
70-72 C-
60-69 D
< 59 F

The grade "D" or “F” in either Didactic Examination or the Final Summative will result in a re-
taking of the exam and the highest grade you can earn is “C”.

13. Student feedback & course changes

Based on previous years student feed back, the course director has made following changes.

1. The total number of radiographs needed has been reduced by using some plastic teeth
(clear roots) for the lab exercise
2. An additional two radiograph stations were added for a total of five
3. Videos have been added to the SLC sessions
4. Additional lectures have been added to the SLC course
5. Comparing Warm Vertical Compaction to Continuous techniques

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 6. Students are able to access the digital radiographs from their laptop computers which
should further reduce the time spent on the digital radiographic units
7. TA’s have been added to the course
8. The number of SLC lab sessions have been increased, while each session time has been
decreased
9. A midterm examination has been added to decrease the volume of material covered on
the final exam
10. The weight of the final summative exam has been decreased so there is less overall
effect on the final grade for a single endodontic exercise
11. All exercise radiographs submitted must be of a mounted extracted tooth to reduce
confusion
12. A patency file radiograph is required to ensure all students are following correct
mounting protocols and none have an unfair advantage
13. Conefit with sealer radiograph is required to ensure all students use sealer during
obturation
14. SLC lab exercises and summative exam will be required to be performed mounted in the
mannequin with rubber dam isolation to better prepare students for working on live
patients and licensure exams where it is required
15. An additional exercise of a molar extracted tooth is required with all canals graded
16. SLC attendance has its own grade
17. An updated objective grading format for exercises and summative exam has been
created along with a grading rubric which is made available for students to understand
exactly what is expected in order to receive each grade
18. In-lab quizzes focusing on endodontic diagnosis of clinical cases were added to practice
using the correct diagnostic terms in preparation for clinic and board exams
19. A student self-evaluation of their submitted exercises were added to better understand
how to assess their own work compared to the updated objective grading criteria and
rubric
20. An AAE Difficulty Assessment must be submitted along with each submitted exercise
and summative exam to reinforce the areas to review preoperatively for an endodontic
case

14. Learning resources

1. Pre-doctoral endodontic manual
2. “Pathways to the Pulp” Burns & Cohen
3. Speaker’s notes and hand-outs for each individual lecture, wherever appropriate
4. AAE Newsletters, videos, recent articles/journals
5. EN 521 and EN 522 course material