prosthodontic Manual

1

SECTION OF

ADVANCED PROSTHODONTIC EDUCATION

ORIENTATION MANUAL 2007-2008

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TABLE OF CONTENTS

SECTION I INTRODUCTION @ PROGRAM FACULTY . . . 4-5 SECTION II PROGRAM GOAL AND OBJECTIVES 6-7 SECTION III CLINICAL REQUIREMENTS 8-30

a. Patient Care Requirement b. Research Requirements

c. Equipment, Required Textbooks and Responsibilities e. Quarter-by-Quarter Course Schedule ........................................................... f. Emergency Rotation Schedule

SECTION IV PATIENT PROCEDURES AND MANAGEMENT.......................................... 31-34

a. Guidelines and Procedures for Patient Selection................................................................................................

b. Outline of Procedures for Patient Treatment ..........................................................................................................

SECTION V PATIENT EVALUATION AND DOCUMENTATION.................................... 35-40

a. Objectives of Treatment Planning Seminar....................................................... b. Guidelines for Treatment Planning Seminar ..................................................... c. Guidelines for Detailed Session/Case Presentation........................................... d. Requirements for Photographic Documentation ............................................... e. Guidelines for Patient Recall and

Treatment Evaluation ........................................................................................ f. Procedures for Patients Assigned on Recall

and Maintenance ............................................................................................... g. Advanced Prosthodontics Patient Record..........................................................

SECTION VI PATIENT FEES ................................................................................................. 41-58

a. Policy and Guidelines for Patient Fees.............................................................. b. Program Policy.................................................................................................. c. Codes and Fees for Advanced Prosthodontics ..................................................

SECTION VII TREATMENT EVALUATION AND PLANNING........................................... 59-80

a. Guidelines and Procedures for Patient Selection............................................................................................................

b. Essentials of a Treatment Plan .......................................................................... c. Treatment Plan (Example)................................................................................. d. Pretreatment Confirmation Letter...................................................................... e. Essentials of a Letter of Confirmation (and Examples)..................................... f. Oral Rehabilitation Treatment Evaluation......................................................... g. Complete Denture Treatment Evaluation .......................................................... h. Summary of Patient Treatment.......................................................................... i. Summary of Patient Treatment (Example) ........................................................

SECTION VIII RESIDENT and PROGRAM ASSESSMENT .................................................. 81-88

a. Review Evaluations........................................................................................... b. Case Type Inventory ......................................................................................... c. Patient Treatment Inventory.............................................................................. d. Annual Year-End Evaluation ............................................................................ e. Simulated Certifying Examinations .................................................................. f. Course and Faculty Evaluations ........................................................................ SECTION IX THE AMERICAN COLLEGE OF PROSTHODONTISTS............................... 89-90 SECTION X TREATMENT ROOM ORGANIZATION ........................................................ 91-92

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SECTION XI GRADUATE ASSOCIATES ............................................................................. 93-94

a. Introduction ....................................................................................................... b. Requirements..................................................................................................... c. Request for Relief from Teaching Duties ..........................................................

d. Clinic Blockout Request....................................................................................

SECTION XII EMERGENCY PROCEDURES ............................................................. 95-98 a. Medical Emergency Situation ........................................................................... b. Ingested or Aspirated Items............................................................................... c. Needlestick Protocol ......................................................................................... d. CPR Certification and Treatment Protocols ......................................................

Appendix D: Performance Sheets for CPR and Foreign Body Airway Obstruction Management ..............................................

e. TB Testing.........................................................................................................

SECTION XIII INFECTION CONTROL PROCEDURES ............................................99-111 1. Introduction ....................................................................................................... 2. Medical History................................................................................................. 3. Clinical Procedures ........................................................................................... 4. Personal Protective Equipment (PPE) ............................................................... 5. Limiting Contamination .................................................................................... 6. Infection Control Technique ............................................................................. 7. Non-Autoclavable/Disposable Items................................................................. 8. General Guidelines for Prosthetic Materials ..................................................... 9. Standard Operating Procedure in the Dental School

Prosthetic Laboratory ........................................................................................ 10. Summary of Sterilization and Disinfection .......................................................

SECTION XIV MISCELLANEOUS INFORMATION................................................112-128

a. Annual Leave .................................................................................................... b. Sick Leave.........................................................................................................

c. Professional Leave ............................................................................................ d. Slide Film Acquisition and Processing.............................................................. e. Typing and Computer Support .......................................................................... f. Clinic Closings and Open Sessions ................................................................... g. Sexual Harassment Policy ................................................................................. h. Grievances/Due Process .................................................................................... i. Academic Misconduct....................................................................................... j. Unprofessional Misconduct...............................................................................

SECTION XV GUIDE TO THE JOHN A. PRIOR

HEALTH SCIENCES LIBRARY ..........................................................................129

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SECTION I

NOVA SOUTHEASTERN UNIVERSITY COLLEGE OF DENTAL MEDICINE ADVANCED PROSTHODONTIC EDUCATION

Introduction The purpose of this manual is to help the entering student in Advanced Prosthodontic Education become familiar with the program, its goals, administrative procedures, functions, facilities and requirements. The first quarter's curriculum contains time for orientation to ease the introduction of the student to the program. Procedures for satisfying the school's paperwork, insurance forms and other general rules of procedure will be covered. Seminars in photography and patient treatment presentations will be scheduled. A summary of the areas covered during orientation is: An overview of the goals and objectives of this three-year program, the minimum requirements for successful completion, the standard forms employed and the student's responsibilities. A tour of the facilities, this includes a library orientation and a review of its capabilities. Because a considerable amount of time will be spent in literature review, familiarity with this area and its functions is essential. An introduction to the treatment planning seminar and its format. This is a very important part of the advanced training program. Patients requiring extensive and unusual treatment will be reviewed prior to and during therapy. Instruction in management of the patient in need of prosthodontic therapy. This will include the need for and the formatting of the confirmation letter - an essential part of patient management. Initial instruction in tooth preparation concepts advocated in this program. Work on completing laboratory requirements for the fixed prosthodontic course work will be initiated. Introduction to the combined therapy seminar. Inter-disciplinary treatment planning is a basic concept of any specialty and successful prosthodontic therapy requires close liaison with other dental specialty therapists for optimum planning and care. Welcome to the Advanced Prosthodontics Program!

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SECTION I (c) Program Faculty: 1. Director ....................................................................................................Dr. Walter Askinas Co-Director …………………………………………………… Dr. Marie Valentine Lim Assistant Director..................................................................................Dr. Frederick Kohler 2. .Supporting Faculty: Dr. Rafael Castellon Dr. Judy Gartner Dr. Mauricio Hervas Dr. Chiu-Jen Hsu Dr. Elaine Lara 3. Adjunct Faculty Dr. David Herskowich Dr. Robert Selz Dr. Mongi Mikula Dr. David Wessel Dr. Barry Shippman Dr. Daryl Roy Dr. Charles Walowitz Dr. David Sietland

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Section II

PROGRAM GOAL AND OBJECTIVES

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Goal: The primary goal of the Advanced Education Program in Prosthodontics is to prepare competent prosthodontic practitioners by providing an appropriate clinical and didactic education in an environment conducive to learning, culminating in certification by the American Board. Objectives:

• To prepare, by clinical experience and advanced technique, a clinically competent prosthodontist.

• To prepare, by advanced study, an educationally competent prosthodontist.

• To develop, by research experience, a competent student who can evaluate,

design, and complete research in prosthodontic related fields.

• To prepare, by evaluation of the literature using the scientific method, a prosthodontist who can incorporate new ideas, techniques, and advances into his/her future practice.

• To encourage, by active participation, students to share their knowledge and skills

through teaching and interaction with local, state or national organizations.

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Section III

CLINICAL REQUIREMENTS

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Program Requirements for Certificate of Training in Prosthodontics and Master’s Degree a. Successful completion of all clinical requirements b. Maintaining a minimum of 3.0 GPA. c. Recommendation for graduation by program faculty. d. Successful defense of thesis and submission of document OR submission and acceptance of manuscript is required to receive the degree, Master of Science. a. Patient Care Requirements The following are the suggested requirements, which the student should successfully complete to receive a certificate of satisfactory completion. The Program Director may, after consultation with the student and citation of adequate cause, require additional work to ensure competence. Complete Dentures Ten (10) complete maxillary and mandibular denture sets should be fabricated for patients who present a sufficient degree of difficulty. These will be assigned so that several different faculty may demonstrate their philosophy and technique of complete denture therapy. Also, an additional 15 arches should be completed that reflect immediate, interim, overdenture, or conversion of a removable partial denture to complete denture types of prostheses. Implants Students are encouraged to fabricate dentures or fixed partial dentures supported by dental implants as the opportunity presents. Students are required to care for patients who have had implants placed through this program and who require additional care. Participation in continuing education courses in this area is strongly recommended. Clinical requirements may consist of one (1) mandibular or maxillary fixed-detachable prosthesis, one (1) bar and clip prostheses, ten (10) single unit crowns, and twenty (20) implant supported fixed partial denture units.The resident will serve as either primary assistant or primary surgeon for at least 20 implant surgeries. Oral Rehabilitations/Fixed Prosthodontics Four complete mouth rehabilitations which involve the restoration or replacement of 20 or more teeth should be satisfactorily completed. Ideally, two of these patients will be fixed restorations only and two may include removable partial dentures. These usually involve other disciplines, i.e., periodontics, endodontics, orthodontics, etc. The resident should complete 150 fixed prosthodontic units during the three-year residency; these must be definitively cemented. (Pontics are not included.) No units will be seated until they are paid in full OR a payment plan is formally arranged.

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Removable Partial Dentures A total of ten (10) arches requiring the placement of a cast removable partial denture are suggested. Four removable partial dentures should be completed as part of the oral rehabilitation treatment plan. The remainder may be fabricated against natural dentition, opposing RPD or complete denture. These should include designs such as the RPI system, swing locks, rotational path, or attachments. In addition, other patients may be assigned solely for their unique partially edentulous state. The student should be cognizant of the various philosophies accepted today in removable partial denture prostheses. Maxillofacial Prosthetics The student must attend and successfully complete the class in maxillofacial prosthetics. The student will also participate in a clinical rotation where treatment of patients with intraoral and extraoral defects will be provided. Tumor board meetings at various Hospitals and O.R. opportunities with the Head and Neck surgeons may also be part of this experience. Prosthetic restoration of patients treated for severe periodontitis Two of the oral rehabilitations to be completed should be for patients who have completed therapy for severe periodontal disease. These must be patients requiring complex therapy and for whom there is an uncertain prognosis. Other perio patients requiring prostheses will be assigned as they are identified to provide prosthodontic support to the periodontic resident and his/her patient. Maintenance and Recall Each student will be responsible for several patients who require maintenance or reparative care. This includes relines and repairs or re-fabrication of failing restorations. Students will also be assigned to re-evaluate patients of the program at recall visits to the dental hygienist. All residents will be responsible to make arrangements for their patients to received appropriate hygiene treatment during and after the restorative treatment phase.

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Simulated /Definitive Certifying Examination Each student is required to participate in and successfully complete simulated certifying examinations ("mock boards"). This examination may include an oral examination, a written examination, a clinical examination, or any combination of these. Evaluators will be Diplomats of the American Board of Prosthodontics, other faculty from the Section of Restorative and Prosthetic dentistry, and faculty from other disciplines in the College of Dental Medicine. Each third year resident will be required to take Part I of The American Board of Prosthodontics in February of the third year in Chicago. Laboratory Requirements Except for the fabrication of removable partial denture frameworks, each student will perform laboratory work for some of the patients treated. When competency in selected laboratory procedures is demonstrated, some work may be delegated to the Nova Southeastern University College of Dental Medicine Dental Laboratory. In addition, as patient demands dictate, the use of an outside commercial laboratory may be required. Fees and payment procedures will also require review by the Director. Some acrylic resin labwork will be performed by the resident. Patient names will be placed in all removable prostheses. Failure to Complete Clinical Requirements Failure to complete assigned clinical requirements will result in the withholding of the student's certificate of advanced training. The program terminates at the end of the Spring Quarter of the third year. No extension periods for continued treatment will be authorized. See section on Due Process. b. Research Requirements Thesis or Manuscript Development

Each resident is strongly encouraged to: a) identify, develop, and complete a unique research project which will meet the requirements of this University for the awarding of a Master's Degree. The College awards both the Master’s Degree and a certificate of specialty training. For those students not pursuing the Master’s tract an acceptable research project must be completed and a manuscript submitted to an appropriate prosthodontic journal for publication.

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Research Topic Identification

The resident is free to develop a research project in any area of interest in the dental sciences. The Section of Restorative and Prosthetic Dentistry has strength in the areas of materials science and dental implants. Focused clinical research projects are also possible. The resident may provide his/her own topic and review it with the director or faculty member. If a topic idea is needed, the director can discuss the research areas of interest of various Section members that would welcome assistance by a resident.

The Research Advisor and Committee

Each resident must identify an advisor for the research project. This is a faculty member that can best give the resident the required input on all phases of the thesis project. This faculty member MUST have graduate faculty status as noted in the College Graduate School handbook. Not all faculty can serve as an advisor. In addition, the resident must select 2 or 3 other faculty members to serve as committee members. One of these members MUST be from a section outside the resident's field of specialty (Prosthodontics). One member MUST be from the core Advanced Prosthodontic faculty.

Research Timetable

Within the 36-month period of the program, a time line for recommended progress levels is as follows:

Months 1-6 Thorough discussion and personal interest, decide on a

topic for the thesis.

Months 6-12 Select Advisor and Committee members. Begin literature review and develop protocol and grant proposal (if necessary).

Months 12-24 Obtain all materials and develop testing method. Write

introduction, literature review, methods and materials. Start testing.

Months 24-30 Complete testing. Write up results, discussion, conclusion. Months 30-34 Finish writing thesis; obtain individual committee

members’ reviews; develop adequate version for defense of thesis; defend thesis; submit manuscript to Journal decided upon with input from your advisor;

Months 34-36 Following the suggested format requirements, submit final

version to Research Committee and Program Director.

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ADDITIONAL INFORMATION WILL BE PROVIDED AS THE FIRST YEAR

PROGRESSES. Presentations

Each student is encouraged to develop a presentation (table clinic or a projected clinical presentation) to be presented at a professional meeting such as the American College of Prosthodontics, Academy of Fixed Prosthodontics, the American Prosthodontic Society, The Academy of Osseointegration,or the American Academy of Dental Research.

** *

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c. Equipment - Glass rod $9.88 - Porcelain tray $6.35 - Porcelain knife, two per pack, Denerica #1052-1210 $12.99 - Porcelain spatula, #3 handle, Denerica #1052-1300 $18.59 - Brasseler bur kit for provisionals $85.06 - Brasseler denture polishing kit $79.92 - Brasseler porcelain bur kit $75.30 - Hanau torch $90.30 - PKT waxing instruments (set of 5) $72.05 - #7 wax spatula, 7" long $3.02 - Buffalo knife $6.02 - Bard Parker handle for #25 blades $11.93 - Sandpaper disc assortment and mandrel $49.35 - Boley gauge $9.71 - Acrylic resin burs, tapered, SHP, Moore, 84T $6.12 - Bur, round, #10, SHP, pkg of 5, Brasseler $10.50 - Bur, 1/2 round, SHP, pkg of 5, Brasseler $4.25 - Bow dividers, 2 point $8.29 - Die saw $10.66 - Cleoid-discoid, DE, 6C $8.26 - Roach carver $4.47 - Carver, American Dental, 3C 1470, D.E. $8.45 - Jeweler's screwdriver, common, 4 1/8" $5.29 - Occlusal Plane, Trubyte, 2-3/8" square $10.71 - Caliper, metal, Miltex $7.30 - Caliper, wax, Miltex $7.36 - Mark II semi-adjustable arcon articulator $425.00 - Hanau articulator, 96 H - 2 $388.00 - Denar slidematic facebow kit $300.00 - Denar shaft assembly $64.30 - Hanau remount index $39.60 - Hanau mounting stand $39.60 - Surveyor, Dental, Ney, complete with tools $314.50 - Laptop Computer $1600.00 - Camera, Digital $1500.00 - Loupes, Orascoptic 2.5x magnification = $700.00

3.3x magnification = $1180.00 3.8x magnification = $1180.00

- Walkabout Light (optional) $695.00

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REQUIRED CLINIC INSTRUMENTS ADVANCED PROSTHODONTICS PROGRAM High speed hand piece with coupler $560 Low speed hand piece motor, straight, contra, head $693.57 Wyman forceps $122.39 Badees forceps, rubber tip $95.82 Lab coats (2) $35 ea Scrubs $22 ea Burs (3 years) $600 Instrument kit- Basic (2) $239.89 Instrument kit-Restorative Pros (2) $278.23 C&B scissors str $28.40 C&B scissors curved $28.40 Miscellaneous Copy fee $150/100/0

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Required Textbooks Advanced Prosthodontics Education Program

Dawson, Peter E.: Evaluation, Diagnosis, and Treatment of Occlusal Problems. St. Louis: Mosby, 2nd Edition, 1989. Cost: $162.00 Chiche, Gerard and Pinault, Alain: Esthetics of Anterior Fixed Prosthodontics. Chicago: Quintessence Publishing, Co., Inc., 1994. Cost: $98.00 Rosenstiel, Stephen F., Land, Martin F., and Fujimoto, Junhei: Contemporary Fixed Prosthodontics. St. Louis: Mosby, Third Edition, 2001. Cost: $89.00 Wise, Michael D.: Failure in the Restored Dentition: Management and Treatment. Chicago: Quintessence Publishing Co., Inc., 1995. Cost: $240.00 Rahn, Arthur O., and Heartwell, Charles M. Jr.: Textbook of Complete Dentures. Philadelphia: Lea & Febiger, Fifth Edition, 1993. Available from D.C. Decker, Inc., Lewiston, N.Y., Phone: 1-800-568-7281 Cost: $69.95 Krol, Arthur J., Jacobson, Theodore E., Finzen, Frederick C.: Removable Partial Denture Design - Outline Syllabus. San Francisco: University of the Pacific School of Dentistry, Fifth Edition, 1999. Phone: (415)929-6467 Cost: $64.95 Phoenix, Rodney D., Cagna, David R., and DeFreest, Charles F.: Stewart’s Clinical Removable Partial Prosthodontics. Chicago: Quintessence Publishing Co., Inc., January 2003, Phone: 1-800-621-0387 Cost: $89.00 MacEntee, M.I.: The Complete Denture - A Clinical Pathway. Chicago: Quintessence Publishing Co., Inc., 1999. Cost: $48.00 Lundeen, Harry: Introduction to Occlusal Anatomy. L & J Press, 1510 N.W. 68th Terrace, Gainesville, FL 32601, 1969. Cost: $17.50 Okeson, Jeffrey P.: Management of Temporomandibular Disorders and Occlusion. St. Louis: Mosby, Fifth Edition, 2003. Cost: $69.00

Zarb, George A., Bolender, Charles L., Carlsson, Gunnar E.: Boucher's Prosthodontic Treatment for Edentulous Patients. St. Louis: Mosby, 11th Edition, 1997. Cost: $89.00 Craig, Robert G., and Powers, John M.: Restorative Dental Materials. St. Louis: Mosby, 11th Edition, 2002. Cost: $69.00 Suggested Textbooks Spiekermann, Hubertus: Implantology. New York: Thieme, 1995 Tauati, Bernard, Miara, Paul, Nathanson, Dan: Esthetic Dentistry and Ceramic Restorations. New York; Thieme, 1999. Magne, Pascal, Belser, Urs: Bonded Porcelain Restorations In the Anterior Dentition. Chicago: Quintessence, 2002.

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Resident Responsibilities

• After 5:00pm and the assistants are gone, please bring all instruments and materials to the sterilization area.

• Clean any material off computer tops that may harm the surfaces. • Bur blocks are your responsibility to maintain and replace burs when needed. • All material ordered for clinic area need to remain in clinic area, please d not take

any items downstairs unless you notify the assistant(s). • It is your responsibility to let the assistant(s) know if there are any supplies that

need to be ordered for the lab. Try to notify them when the last item that needs to be ordered has been opened.

• Try to get familiar with the clinic area and where all of your supplies are kept. • When there are cases to be sent out to a lab, please notify Ms. Sarah Cruz to have

them shipped. • If you need to order implant parts, fill out the appropriate order form, obtain a

signature from the faculty and forward the form to Ms. Dora Florez. • If you need to order denture teeth, fill out the appropriate order form, obatain a

signature from the faculty and forward the form to Dr. Mark Romer. • At the end of your procedure, please be sure to enter all progress notes in axium and

have the supervising faculty sign-off on the procedures done for the day. • Please be sure that all finances are paid in full prior to the completion of any

restoration. Prior to making the appointment for final cementation of any fixed restoration or insertion of any removable prosthesis, Ms. Sarah Cruz needs to check the patients’ financial record to ascertain payment.

• For any implant cases, payment must be made two weeks prior to any surgical or restorative work. If payment is not made, implant components cannot be ordered.

• All residents’ must be present in the clinic at least 10 minutes prior to your appointment time in order to attend to setting up of the operatories.

• Please notify Sarah when scheduling your patient appointments what your procedure will consist of so that the assistant(s) know what to set up for.

• Please know that we (the assistants) are here to help you as best we can, and if we are with another resident and can’t get to you right away, please be patient or try to do the best you can until we are able to assist you. Remember there are 12 residents and only 3 assistants at this time.

Thank You and Welcome to our Program!

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d. Semester by semester Course Schedule

ADVANCED PROSTHODONTICS RESIDENCY PROGRAM 1st Semester

Course No. Course Title

Credits

Dent Special Problems in Dentistry (Oral Rehabilitation Concepts) Director: Dr. Kohler

02

Dent Dental Materials I Director: Dr. Antonson

02

Dent Advanced Oral Pathology Director: Dr.

02

Dent Orientation and Standardization in Fixed Pros. I Director: Dr. Lim & Lara

04

Dent Fixed Prosthodontic Rehabilitation Technique I Director: Dr. Kohler & Lim

Dent

Introduction to Removable Prosthodontics I (Complete Denture Occlusion) Director: Dr. Kohler

02

Dent Fixed Prosthodontic Literature Review Director: Dr. Hsu / Lim / Askinas

02

Dent Clinical Treatment Planning Seminar Director: Dr. Lim / Askinas

02

Dent Advanced Clinical Practice in Dentistry Fixed Prosthodontics Director: Dr. Lim

03

Dent Advanced Clinical Practice in Dentistry Removable Prosthodontics Director: Dr. Kohler

03

Dent Statistics Directors: Dr. Hardigan

02

Dent Dental Photography Director: Dr. Hervas

01

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ADVANCED PROSTHODONTICS RESIDENCY PROGRAM

2nd Semester


Credits

Dent Group Studies in Clinical Dentistry Periodontal - Prosthodontic Interrelationships Director: Dr. Miller

01

Dent Advanced Oral Pathology Director: Dr.

02

Dent Dent

Oral Rehabilitation/Occlusion Seminar Director: Dr. Lim / Hervas Introduction to Dental Implants Director: Dr. Lim / Hernandez / Hervas

04

02

Dent Dent

Fixed Prosthodontic Literature Review Director: Dr. Hsu Contemporary Journal Club Director: Dr. Hsu

02

02


02


03


03

Dent Research Director: Dr. S. Siegel

02

20


3rd Semester


Credits

Dent Group Studies in Dentistry OMFS-Ortho -Perio-Pros Seminar Director: Dr. Lim / Hernandez

01


02

Dent Specialty Seminars in Dentistry Removable Partial Denture Design Director: Dr. Kohler

02


03


03

Dent Specialty Seminars in Dentistry Implant Literature Review Director: Dr. Hsu

02

Dent Research To Be Arranged Director: Dr. S. Siegel

02

21

ADVANCED PROSTHODONTICS RESIDENCY PROGRAM 4th Semester


Credits

Dent Oro-facial Pain Management Director: Dr.

02

Dent

Clinical Treatment Planning Seminar Directors: Dr. Lim / Askinas

02

Dent Specialty Seminars in Dentistry Implant Literature Review Director: Dr. Hsu

02

Dent

Advanced Clinical Practice in Dentistry Fixed Prosthodontics Director: Dr. Lim

03


03

Dent

Research Director: Dr. S. Siegel

02

22



Credits

Dent Removable Partial Prosthodontic Literature Review Director: Dr. Kohler

02


02


03

Dent Advanced Clinical Practice in Dentistry Removable Prosthodontics Director: Kohler

03


02

23



Credits


02

Dent Dent Dent

Contemporary Literature Review Director: Dr. Hsu

Complete Denture Literature Review Director: Dr. Kohler

01

02

03

Dent

Advanced Clinical Practice in Dentistry Fixed Prosthodontics Director: Dr. Lim

03


02


02

24



Credits


02

Dent Specialty Seminars in Dentistry

02


03


03

Dent Research Design Director: Dr.

03

Dent Advanced Prosthodontics Maxillo-Facial Seminar Director: Dr. Shipman

02

Dent Research To Be Arranged Director: Dr. S. Siegel

02

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Credits

Dent Advanced Prosthodontics Maxillo-Facial Seminar Directors: Dr. Shipman

02

Dent Clinical Treatment Planning Seminar Directors: Dr. Lim / Askinas

02

Dent Specialty Seminar in Dentistry

02


03


03

Dent

Research Director: Dr. S. Siegel

02

26


9th Semester


Credits

Dent Clinical Treatment Planning Seminar

Director: Dr. Lim / Askinas

02

Dent Advanced Clinical Practice in Dentistry Fixed Prosthodontics Director: Dr. Miller

03

Dent

Advanced Clinical Practice in Dentistry Removable Prosthodontics (includes Max/Fac rotation) Director: Dr. Kohler

04

02 Dent Research

Director: Dr. Miller

CALENDAR OF CLASSES (TENTATIVE SCHEDULE)

Calendar of Classes Mon Tue Wed Thu Fri

Summer Semester 1st Yr. RPD laboratory

RPD laboratory

RPD laboratory

RPD laboratory

RPD laboratory

Fall Semester 1st Yr. Core

Courses (All day)

Fixed Pros. Lec. & Lab

(All day)

Seminars; Classes (All day)


(All day)

Fixed Pros. Lab(Half day)

Clinic

Winter Semester 1st Yr. Core

Courses (All day)


(All day)

Seminars; Classes (All day)


(All day)

Fixed Pros. Lab(Half day)

Clinic

Spring Semester 1st Yr. Core

Courses (All day)

Clinic Seminars; Classes (All day)

Clinic Clinic

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EMERGENCY ROTATION SCHEDULE

September 2007 Mon Tue Wed Thu Fri Sat

1

KIM 3 4 5 6 7 8

MASRI 10 11 12 13 14 15

EL SAYED 17 18 19 20 21 22

VILLANUEVA 24 25 26 27 28 29 October 2007 Mon Tue Wed Thu Fri Sat

KIM 1 2 3 4 5 6

MASRI 8 9 10 11 12 13

EL SAYED 15 16 17 18 19 20

VILLANUEVA 22 23 24 25 26 27

KIM 29 30 31

November 2007 Mon Tue Wed Thu Fri Sat

KIM 1 2 3

MASRI 5 6 7 8 9 10

EL SAYED 12 13 14 15 16 17

VILLANUEVA 19 20 21 22 23 24

KIM 26 27 28 29 30

28

EMERGENCY ROTATION SCHEDULE

December 2007 Mon Tue Wed Thu Fri Sat

1

MASRI 3 4 5 6 7 8

EL SAYED 10 11 12 13 14 15

VILLANUEVA 17 18 19 20 21 22

KIM 24 25 26 27 28 29

MASRI 31

January 2008 Mon Tue Wed Thu Fri Sat

MASRI 1 2 3 4 5

EL SAYED 7 8 9 10 11 12

VILLANUEVA 14 15 16 17 18 19

KIM 21 22 23 24 25 26

MASRI 28 29 30 31

February 2008 Mon Tue Wed Thu Fri Sat

MASRI 1 2

EL SAYED 4 5 6 7 8 9

VILLANUEVA 11 12 13 14 15 16

KIM 18 19 20 21 22 23

MASRI 25 26 27 28 29

29

March 2008 Mon Tue Wed Thu Fri Sat

MASRI 1

EL SAYED 3 4 5 6 7 8

VILLANUEVA 10 11 12 13 14 15

KIM 17 18 19 20 21 22

MASRI 24 25 26 27 28 29

EL SAYED 31

April 2008 Mon Tue Wed Thu Fri Sat

EL SAYED 1 2 3 4 5

VILLANUEVA 7 8 9 10 11 12

KIM 14 15 16 17 18 19

MASRI 21 22 23 24 25 26

EL SAYED 28 29 30

May 2008 Mon Tue Wed Thu Fri Sat

EL SAYED 1 2 3


KIM 12 13 14 15 16 17

MASRI 19 20 21 22 23 24

EL SAYED 26 27 28 29 30 31

30

June 2008

Mon Tue Wed Thu Fri Sat


KIM 9 10 11 12 13 14

MASRI 16 17 18 19 20 21

EL SAYED 23 24 25 26 27 28

VILLANUEVA 30

July 2008 Mon Tue Wed Thu Fri Sat

VILLANUEVA 1 2 3 4 5

KIM 7 8 9 10 11 12

MASRI 14 15 16 17 18 19

EL SAYED 21 22 23 24 25 26

VILLANUEVA 28 29 30 31

August 2008 Mon Tue Wed Thu Fri Sat

VILLANUEVA 1 2

KIM 4 5 6 7 8 9

MASRI 11 12 13 14 15 16

EL SAYED 18 19 20 21 22 23

VILLANUEVA 25 26 27 28 29 30

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SECTION IV

PATIENT PROCEDURES AND MANAGEMENT

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a. Guidelines and Procedures for Patient Selection The Advanced Prosthodontic Program at NSU provides an education for graduate dentists to practice the specialty of prosthodontics. This specialty concerns itself with the restoration and maintenance of oral function through the restoration of defective teeth and the replacement of missing teeth and tissues. Patients are evaluated for acceptance for treatment based on the complexity of their restorative needs and the extent to which their treatment will provide a significant educational experience for the student as well as the degree to which the patient will benefit from the therapy. The patient's ability to maintain the completed restoration, as well as their financial responsibility, must be considered. Patients accepted for treatment will be assigned to a student by the Program Director or designated faculty. Upon receiving an assignment, the student in consultation with a member of the attending faculty, will establish a diagnosis, formulate a treatment plan or plans and calculate appropriate fees for therapy. Some restorative treatment plans will be presented at the treatment planning seminar. The prescribed format for these presentations will be outlined during orientation. It is a standard policy of the program that 50% of the fee be paid at the beginning of the treatment, and the remaining 50% prior to impression making. The appointment for the insertion or delivery of the prosthesis cannot be made unless the entire amount is paid. Experience has shown that deviations from this policy create management problems and may result in the student not receiving credit for the restoration when payments are incomplete at the end of treatment. The duration of therapy is dependent upon the complexity of treatment required and frequently is extended by the necessity for care by other specialists. Treatment should be initiated as early in the training period as possible so that the patient will be completed within the term of the program. Patients must be available for at least one half day per week and may expect treatment to extend over a 12-18 month period. Patients receiving complete denture therapy may anticipate a treatment period of approximately 3 months. Patients who desire treatment in the Advanced Education in Prosthodontics Program may request an appointment for screening. The fee for this consultation is $25.00. It is the student's continuing responsibility to render care in a manner befitting that of a specialist and to do so in an expedient, caring and courteous manner. Patients for prosthodontic therapy who are undergoing care in another clinical area should be closely monitored so their care will progress as desired and so that they are returned for prosthodontic care in a timely manner. Dress Code Each student, when seeing a patient in the treatment area, must wear appropriate professional attire (no jeans, shorts, sandals, golf shirts, T shirts, etc) with a green clinic gown worn over them. Note: for the male residents, a tie is optional. The resident is expected to exhibit personal hygiene befitting of a health care professional (i.e. should be well-groomed, clean shaven (if applicable), free from body odors and bad breath.) The clinic gown should be clean and free from odors from the body or from smoking tobacco. This necessitates frequent changes at 1-2 day intervals. Failure to adhere to this policy may result in the resident NOT being allowed to treat the patient and the patient being dismissed from the clinic. Surgical scrubs are acceptable. A green gown MUST still be worn over them when in the dental operatory.

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b. Outline of Procedures for Patient Treatment The Program Director must approve patients to be treated in the Advanced Education in Prosthodontics Program. No patient may be treated without proper documentation of this approval. 1. After a patient has been approved for therapy, the resident must establish the formal

diagnosis, formulate treatment plan(s) and establish fees. Current radiographs and mounted diagnostic casts are essential. It is necessary to obtain photographic documentation.

2. Present patient to a designated instructor or at the Clinical Treatment Planning Seminar for

discussion and finalization of treatment plan and alternatives. 3. Complete patient evaluation and treatment plan forms. One copy is to be submitted to the

Program Director, and one copy is retained by the student in the patient's record. The student will meet with the program's dental assistant and put the treatment plan into the computer.

4. Present treatment plan and fee obligations to the patient. Write a letter of confirmation (as

approved by the director or faculty member) and obtain the patients' signature of acceptance on the original and two copies.

5. Obtain initial fee (50%) from patient. The payment, accompanied by a properly completed

College of Dentistry form, is submitted to the Cashier on the first or second floor of the College of Dentistry. Pre-authorization is mandatory for all dental insurance claims. Patients must obtain the proper insurance forms from their employer, complete and sign them. The department treatment plan must be submitted but the insurance form is not to be completed by the student. When all the necessary documentation has been compiled, the forms will be submitted to the NSU insurance office. The student will be notified if the patient is covered by their insurance policy. In no instance will therapy be initiated before a clear definition of the patient's status with regard to insurance has been made. It is the policy of this program that the patient's obligation is directly to the school and student. The school will aid the patient in obtaining the entitled insurance benefits.

6. Records of patient care must be current, and the sequence of therapy must be legibly

documented (this includes the resident's signature and computer number). Treatment evaluation forms must be kept current. It is the student's responsibility to obtain needed faculty signatures. Upon completion of therapy, the student will complete and submit a summary of patient treatment. One copy of this document will be given to the Program Director and a second copy maintained by the student.

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7. Patient's charts MUST be kept on the premises! Patient’s of record in the University have a chart that will be used for reference purposes regarding past treatments rendered. All current chart entries, notes and records must be entered into axium. The students are requested to complete the progress notes in axium on the day of treatment and obtain a signature from the attending instructor. The resident may keep a chart for a short period, if necessary, to assist in the treatment plan write up, after which it must be returned to the department office. All charts are property of Nova Southeastern University College of Dental Medicine, and may not be taken from the building.

8. All patient care must be rendered as thoroughly and expeditiously as possible. Proper

patient management is an important part of your specialty education. Courteous and competent care is essential.

9. The daily “wrap up sheet” MUST be filled out after each patient visit. It must be filled out

accurately and completely. Information must include: Patient name and computer number if not present ADA code of procedure performed tooth number of procedure and tooth surface(s) if necessary patient disposition (canceled, patient broke, doctor broke, not treated) All procedures performed changes in treatment specifics dealing with unique fees

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SECTION V

PATIENT EVALUATION AND DOCUMENTATION

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a. Objectives of Treatment Planning Seminar Treatment planning seminars are an important means of sharing diagnosis and treatment of patients between residents, as well as a forum for discussing decision-making regarding patient care from an evidence-based foundation. Interesting treatments, including patients with unusual problems in complete dentures, will be presented at this seminar. The objectives of this seminar are: 1. to provide a forum where a student may discuss with the mentors and fellow students,

patients for whom interesting treatment is anticipated. 2. to develop a disciplined, organized, evidence-based approach for decision-making of each

patient. 3. to develop skills needed to lucidly present material to others. 4. to allow students to witness diverse treatment plans beyond those they will organize and

treat themselves. b. Guidelines for Treatment Planning Seminar 1. Selected patients to receive prosthodontic care will be presented at the treatment planning

seminar. Presentations will utilize projected slides with supplemental material consisting of complete mouth radiographs and appropriately mounted casts.

2. Presentations for this general treatment planning should be succinct, well-organized and

delineate: a. chief complaint b. contributory medical and dental history c. pertinent clinical findings d. diagnosis e. tentative treatment plan f. alternatives

3. Presenters should ask questions concerning any aspects of therapy with which they might

be unfamiliar or undecided. It is essential in this forum to obtain clearly defined goals in therapy, a method of obtaining those goals and attempt to foresee and avoid those aspects, which might compromise the final result.

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c. Guidelines for Detailed ‘Completed Treatment’ Session/Case Presentation Each student shall present at least one detailed ‘completed treatment’ on during the Treatment Planning Seminar period. These conferences shall be scheduled by the Course Director, and are obligatory. No capricious changes in the schedule will be allowed. If alterations of the schedule should become necessary, these changes will be permitted only with specific permission from the Course Director. One such session will be given each year. Guidelines for these presentations are: 1. The student shall present a patient for whom complex documentation (see "Photographic

Documentation" sheet) with projections of complete mouth radiographs. The presentation shall be augmented by mounted casts, a diagnostic waxing and written material, including patient history, clinical findings including periodontal charting, diagnosis, treatment plan and prognosis. The written material shall be reproduced and handed out to all course participants and faculty.

2. The presentation shall not take longer than one hour, after which general discussion will be allowed. The student should be prepared to expand upon the material presented and to defend all concepts advanced.

3. a. History and Chief Complaint b. Pre-treatment Radiographs c. Clinical Findings d. Diagnosis e. Treatment Plan f. Treatment g. Instructions to patient - Post-treatment Therapy, and Progress h. Post-Treatment Therapy Staff Conferences Once a year each student will present a formal staff conference. This conference will consist of a projected presentation on a topic of the student's choice. Topics must be approved by the Course Director. The scheduling of such conferences is entirely at the discretion of the Course Director and once scheduled, may not be changed without specific approval by him. This conference is described in Section I under "Research Requirements". The conference must be completely documented with references (which will be disseminated to the group), presented with title slides and appropriate photographs and offer a solid learning experience for those in attendance. One of the two conferences will be written in a manner suitable for publication and copies made available to the class.

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Course Policies Patients to be presented to the treatment planning seminar must be scheduled in advance on the sign up sheet in the laboratory. When it is advantageous to do so, the patient may be scheduled for examination in conjunction with the more formal presentation. All presentations must be given adequate preparation. In those instances where the Program Director feels that there has been inadequate planning or comprehension of the patient presented, he may require a make-up presentation. THE STUDENT SHOULD KEEP IN MIND THAT PRESENTATION OF PATIENTS FOR THE SIMULATED CERTIFYING EXAMINATION AND, ULTIMATELY, TO THE AMERICAN BOARD OF PROSTHODONTICS, IS A GOAL FOR WHICH THESE PRESENTATIONS CONSTITUTE A MAJOR METHOD OF PREPARATION. The general format established by the American Board of Prosthodontics should be referenced in preparation for these seminars. Attendance at treatment planning seminars is mandatory. Two or more absences will result in the grade of Incomplete and require additional work to have such a grade removed. d. Requirement for Photographic Documentation The following photographs are suggested for presentations at Treatment Planning Seminar:

1. Full face 2. Profile 3. Anterior complete mouth with teeth in occlusion 4. Right side with teeth in occlusion 5. Left side with teeth in occlusion 6. Left lateral excursion - working 7. Left lateral excursion - non-working 8. Right lateral excursion - working 9. Right lateral excursion - non-working 10. Anterior protrusion 11. Left side protrusion 12. Right side protrusion 13. Maxillary complete arch occlusal view 14. Mandibular complete arch occlusal view 15. Others as needed for specific situations.

Additionally, close-up photographs showing the patient with the lips in repose and smiling are often desirable.

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e. Guidelines for Patient Recall and Treatment Needs Evaluation 1. Records of patients' treatment and subsequent recall evaluation will be maintained in the

Advanced Prosthodontics Office. 2. Upon completion of treatment, the prosthodontic resident will complete Evaluation

Form 1, and Summary of Patient Treatment Form 1a. On subsequent recall appointments, Form II Recall and Evaluation of Patient Treatment will be completed.

3. Patients to be scheduled for recall care will be assigned by the Program Director. 4. Appointments for recall examinations will be made by the receptionists at the front desk. 5. It is the responsibility of the advanced prosthodontic student to see patients so assigned

within 2 weeks of the date of assignment. 6. Each student will, after completion of the recall examination, submit a treatment plan to a

faculty member for approval and guidance. 7. Each student will be responsible for providing care, for providing maintenance therapy,

or reparative procedures for patients previously treated in this program. Assignments will be made on an alphabetical order as problems arise.

f. Procedures for Patients Assigned on Recall and Maintenance Patients for recall and maintenance will be assigned by the Program Director. The student is responsible for appointing the patient and needed therapy. Documentation must include:

1. Update of medical history 2. Complete mouth radiographic survey (updated as necessary) 3. Photographic survey 4. Periodontal examination and charting 5. Complete soft tissue examination 6. Diagnosis 7. Treatment plan.

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The student must familiarize himself with the patients records to document past therapy. When possible, contact the doctor who rendered the original care. Obtain:

1. Complete summary of all dental treatment. 2. All available radiographs (make slides). 3. If possible, obtain initial pre-treatment slides and casts. 4. Where possible, obtain other documentation of treatment during progress and

upon completion. For presentation during treatment planning seminar, a chronological review of the patient's care and response will be presented. Treatment plan and prognosis will be presented and discussed. A dual screen projection format will be used. g. Patient Assignment Records It is essential for each student to monitor patient care and to render treatment in an expeditious manner. To facilitate records, keeping the attached form will be used to monitor patient assignment and progress in the program. A biannual review with the Program Director will be scheduled. At the time of this review, a completed "Summary of Patient Care" form will be submitted to the Director. Storage of Patient Casts All casts of patient treatment deemed to be usable for future dental care of all patients treated will be stored in a storage box with the following information marked on that box:

1. the patient's name. 2. the patient's social security number. 3. the date of completion.

Such casts would include remount casts with mounting rings in the case of dentures; pre and post casts for full-mouth rehabilitation patients; and pertinent casts for implant patients including diagnostic and surgical splints, if available. All completed casts must be stored properly before departing from the Program.

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SECTION VI

PATIENT FEES

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a. Policy & Guidelines for Patient Fees Fees are required for services provided for patients treated in all programs in the School of Dentistry. Fees in the Advanced Prosthodontics Education Program average 50% of the fees incurred for comparable services in a local private practice of prosthodontics. The revenue obtained is an essential part of the budget, which supports this program. The policy of the school is that fees for services must be paid in full prior to the completion of therapy. This is a sound business practice and is in harmony with private practice policies. IT IS THE STUDENT'S RESPONSIBILITY TO INSURE THAT FEES ARE PROPERLY CHARGED AND COLLECTED FOR ALL TREATMENT WHICH THEY RENDER. Credit will not be given for treatment, which has not been completely paid, and clearance for graduation will not be granted until all accounts are paid in full. Fee Schedule Fee schedules are updated and published annually. Work that has begun is charged at the fee quoted, even though fee changes occur while work is in progress. All other services are charged at the fee schedule in effect at the time the treatment is begun.

Collection Procedures As it was stated above, payment of the first installment must precede the initiation of therapy and all payment must be received before treatment is completed. Although some variables are inevitable, the following guidelines apply to most patient care:

1. A retainer of 50% of the total fee should be paid prior to initiation of treatment.

2. The patient must be informed in writing of the anticipated total fee, the increments of payment and all their financial obligations. This serves as our financial agreement contract with the patient. Likewise, the program administrative assistant must be informed of all financial aspects for each patient.

3. When a payment is due at the next appointment, the patient should be reminded

of that obligation at the appointment previous to the due date.

4. If at any time a patient is having difficulty fulfilling their financial obligation as stated in the letter of confirmation, it is essential that the administrative assistant be notified and the Program Director informed, so appropriate action may be taken. Remember - allowing patients to diverge from the original payment agreement may be legally interpreted as a change in the financial agreement contract.

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Processing of Payments

1. All payments for treatment rendered in Advanced Prosthodontics will be presented to the administrative assistant or can be paid directly to the Cashier on the first or second floor. A payment sheet indicating billed charges should be filled out by the resident and given to the patient to take with them when making a payment. ADA codes must be used to identify treatment.

2. It is a standard policy of the program that 50% of the fee be paid at the beginning

of the treatment, and the remaining 50% prior to impression making. All treatment which involves laboratory work will require full payment before the work may be sent to a laboratory or a precious metal requisition signed.

3. The appointment for the insertion or delivery of the prosthesis cannot be made

unless the entire amount is paid. The resident will not be given credit for any work inserted that is not fully paid. Make sure that payment was made BEFORE seating the patient.

4. The cashier will accept MasterCard, Visa, Discover, personal checks or cash. All

checks are to be made payable to The Nova Southeastern University. The patient's driver’s license number must be on the check and proper identification is required. Second party or payroll checks will not be accepted for payment of patient fees. Checks may not be postdated and must be written for the exact amount of payment. Students will be notified when a check is rejected by the bank. No work is to be done until patients have rectified the error and payment has cleared. Essentially, patients who submit unacceptable checks will be "non-clinical" until their obligations to the school have been met.

5. A large number of workers and their dependents are covered by private dental

insurance.

a. Private Carriers: As with fee-for-service therapy, it is the policy of the school that patients pay for service at the time it is provided. When patients are covered by dental insurance, some additional steps are necessary to assure that the patient will be reimbursed in accordance with their coverage. Most insurance carriers require pre-authorization of claims prior to beginning of treatment. To comply with this requirement, bring the patient, your treatment plan and a completed pre-authorization form to the insurance clerk at the insurance office. Authorization takes from six to eight weeks. Do not begin treatment on the assumption that fees for all services will be paid. When authorization is received, the insurance clerk will contact you to discuss the amount of payment and to adjust your records accordingly.

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6. Under special circumstances, mostly involving discontinuance of treatment, re-

treatment after failure, or changes in treatment plans, it may be necessary to transfer payments or obtain a refund. The policy of the school toward replacement of work done by students is:

Treatment which fails within the first year of service for reasons that are attributable to design or execution will be redone without any charge to the patient. Failures occurring after the first year of service will be judged on an individual basis. Failures occurring because of reasons beyond the doctor's control, such as poor oral hygiene or trauma will not be redone without charge. Charges will be levied on an individual basis and are at the discretion of the Program Director.

7. The school does not make any provision for accepting promissory notes or for

extending payments beyond the period of time during which dental services are rendered. The school will discuss a payment plan arrangement with the patient if it is determined to be warranted.

8. Medicaid or Welfare: The program accepts patients whose sole means for

payment is Welfare. These are usually denture patients. THESE PATIENTS MUST OBTAIN PRE-DETERMINATION BEFORE TREATMENT IS STARTED. A photocopy of their current card must be made and kept in the record. A request for pre-determination form is available in the program's clinical office. This is filled out and taken, along with the record, to the first floor CASHIER's desk. Normal response time is 6 - 8 weeks. Once the dental care is completed, notify Ms. Riley so that the claim is submitted.

9. Agency Sponsored Patients: The treatment will be paid for either partially or

entirely by a state or federal agency. Contact the agency sponsored office prior to initiating treatment for information on how the case will be handled for receiving payment. Patients with dental insurance are NOT agency-sponsored patients.

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b. Program Policy Students in the Advanced Prosthodontic Program must be aware of the following policy. The gravity of this policy cannot be overstated and it is essential that all students acknowledge their understanding of this aspect of patient care.

1. Students are not allowed to use school facilities to treat private patients for a fee or for convenience. The School cannot be and is not liable for such practice. If it is discovered that a student has participated in any such illicit practice that student is subject to immediate dismissal from the program.

2. Students are not allowed to perform any type of private dental practice outside of

the College of Dentistry while enrolled in the program. Discovery of such a practice subjects the resident to immediate dismissal from the program.

3. Students are not allowed to treat any patients beyond the normal clinic hours

unless an authorized faculty member is present.

4. At the conclusion of the 36-month program, to receive a certificate signifying successful completion of the Advanced Program in Prosthodontics from NSU the following requirements must be met:

a. Completion or acceptable transferal of all patients assigned and for whom

therapy has begun.

b. Submission of a complete treatment summary of all patients.

c. Collection of all fees for which patients are responsible.

d. Successful completion of all required courses, patient care and other obligations.

e. For those students not pursuing the Master’s tract an acceptable research project must be completed and a manuscript submitted to an appropriate prosthodontic journal for publication.

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c. Codes and Fees for Prosthodontics (All Fees are Subject to Change)

FEE SCHEDULE 2006-2007

DIAGNOSTIC PROCEDURES

Clinical Oral Evaluation

0120 Periodic Oral Exam $35.00

0140 Emergency Oral Exam - Problem Focused $40.00

0150 Comprehensive Oral Exam $45.00

0160 Detailed and Extensive Specialist Eval $50.00

0170 Re-Evaluation Exam - Problem Focused $40.00

Radiographs

0210 Intraoral Series Include PX, BW’s, PA’s $45.00

0220 Intraoral Periapical First Film $10.00

0230 Intraoral Periapical Each Add. Film $7.00

0240 Intraoral Occlusal Film $16.00

0250 Extraoral First Film $40.00

0260 Extraoral Each Add Film $30.00

0270 Bitewing Single Film $10.00

0272 Bitewings 2 Films $16.00

0274 Bitewing 4 Films $25.00

0277 Bitewings Vertical - 7 to 8 Film

0290 Post-Ant or Lat Skull / Facial Film $46.00

0310 Sialography $95.00

0320 TM Joint Arthrogram Inc. Injection $200.00

0321 Other TMJ Films BR $75.00

0322 Tomographic Survey $50.00

0330 Panoramic Film $45.00

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0340 Cephalometric Film $43.00

0350 Oral/Facial Images (Intra and Extraoral)

Tests and Laboratory Examination

0415 Bacteriologic Studies Determ Path Agent $200.00

0425 Caries Susceptibility Test

0460 Pulp Vitality Tests $20.00

0470 Diagnostic Casts $43.00

0471 Diagnostic Photographs $20.00

0472 A of T Gross, Examination $25.00

0473 A of T Gross, & Microscoptic Examination $50.00

0474 A of T Gross, & Micro Exam, Include margins $80.00

0480 Processing & Interpret of Cytologic Smears $20.00

0501 Histopathologic Exam $105.00

0502 Other Oral Pathology Procedures BR $10.00

Unspecified Diagnostic Procedure BR

0999 Unspecified Diagnostic Procedure BR - Pantograph $375.00

099903 Hand - Wrist X-ray $20.00

Dental Prophylaxis

1110 Prophylaxis Adult $70.00

1120 Prophylaxis Child $45.00

Topical Fluoride Treatment

1203 Topical Appl of Fluoride EXC Prophy - Child $14.00

1204 Topical Appl of Fluoride EXC Prophy - Adult $15.00

Other Preventive Services

1310 Prevention $15.00

1320 Tobacco Counseling for Oral Disease $50.00

1330 Oral Hygiene Instruction Adult, As Needed $10.00

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1351 Sealant Per Tooth $15.00

Space Maintainers (Passive Appliances)

1510 Space Maintainer Fixed Unilateral $130.00

1515 Space Maintainer Fixed Bilateral $150.00

1520 Space Maintainer Remove Unilateral $130.00

1525 Space Maintainer Remove Bilateral $150.00

1550 Recementation of Space Maintainer $20.00

Amalgam Restorations

2110 Amalgam 1 Surface Primary $35.00

2120 Amalgam 2 Surfaces Primary $45.00

2130 Amalgam 3 Surfaces Primary $55.00

2131 Amalgam 4 Surfaces or More Primary $50.00

2140 Amalgam 1 Surface Permanent $55.00

2150 Amalgam 2 Surfaces Permanent $85.00

2160 Amalgam 3 Surfaces Permanent $105.00

2161 Amalgam 4 Surfaces or More Permanent $130.00

Resin Based Composite Restorations

2330 Resin 1 Surface Anterior $45.00

2331 Resin 2 Surfaces Anterior $55.00

2332 Resin 3 Surfaces Anterior $65.00

2335 Resin 4+ Surfaces or Incisal Angle $120.00

2336 Resin Crown Anterior Primary $100.00

2337 Resin Crown Anterior Permanent $70.00

2380 Resin 1 Surface Posterior Primary $45.00

2381 Resin 2 Surface Posterior Primary $55.00

2382 Resin 3 Surfaces Posterior Primary $65.00

2385 Resin 1 Surface Posterior Permanent $45.00

2386 Resin 2 Surfaces Posterior Permanent $75.00

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2387 Resin 3 Surfaces Posterior Permanent $150.00

2388 Resin 4+ Surfaces Posterior Permanent $90.00

Gold Foil Restorations

2410 Gold Foil 1 Surface $80.00

Inlay/Onlay Restorations

2510 Inlay Metallic 1 Surface $400.00

2520 Inlay Metallic 2 Surface $500.00

2530 Inlay Metallic 3 Surfaces $500.00

2542 Onlay Metallic 2 Surfaces $500.00

2543 Onlay Metallic 3 Surfaces $500.00

2544 Onlay Metallic 4 or More Surfaces $500.00

2610 Inlay Porcelain / Ceramic 1 Surface $500.00

2620 Inlay Porcelain / Ceramic 2 Surface $600.00

2630 Inlay Porcelain / Ceramic 3 Surfaces $600.00

2642 Onlay Porcelain / Ceramic 2 Surfaces $600.00

2643 Onlay Porcelain / Ceramic 3 Surfaces $600.00

2644 Onlay Porcelain / Ceramic 4 or More Surfaces $600.00

2650 Inlay Composite / Resin 1 Surface (LAB) $400.00

2651 Inlay Composite / Resin 2 Surfaces (LAB) $400.00

2652 Inlay Composite / Resin 3 Surfaces (LAB) $400.00

2662 Onlay Composite / Resin 2 Surfaces (LAB) $300.00

2663 Onlay Composite / Resin 3 Surfaces (LAB) $400.00

2664 Onlay Composite / Resin 4 Surfaces $400.00

Crowns - Single Restorations Only

2710 Crown Resin (LAB) $200.00

2720 Crown Resin with High Noble Metal $450.00

2721 Crown Resin with Base Metal $425.00

2722 Crown Resin with Noble Metal $600.00

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2740 Crown Porcelain Ceramic Substrate $690.00

2750 Crown Porcelain Fused HI NBL Metal $690.00

2751 Crown Porcelain Fused Based Metal $650.00

2752 Crown Porcelain Fused NBL Metal $690.00

2780 Crown - 3/4 Cast High Noble Metal $495.00

2781 Crown - 3/4 Cast Predominately Base Metal $425.00

2782 Crown - 3/4 Cast Noble Metal $450.00

2783 Crown - 3/4 Porcelain / Ceramic $450.00

2790 Crown Full Cast High NBL Metal $690.00

2791 Crown Full Cast Predom. Base Metal $600.00

2792 Crown Full Cast NBL Metal $690.00

2799 Provisional Crown $100.00

2810 Crown 3/4 Cast NBL Metal $650.00

Other Restorative Services

2910 Recement Inlay $50.00

2920 Recement Crown $50.00

2930 Prefabricated SS Crown Primary Tooth $68.00

2931 Prefabricated SS Crown Permanent Tooth $68.00

2932 Prefabricated Resin Crown $50.00

2933 Prefabricated SS Crown Resin Facing $50.00

2940 Excavation Sedative Filling $20.00

2950 Crown Buildup, Including Any Pins $175.00

2951 Pin Retention Per Tooth IN Add. To Rest. $20.00

2952 Cast P&C $300.00

2953 Each Additional Cast Post - Same Tooth

2954 Prefab. Post & Core in Add. To Crown $200.00

2957 Each Additional Prefabricated Post - Same Tooth

2960 Composite Laminate Veneer, Chairside $120.00

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2961 Composite Laminate Veneer, LAB $300.00

2962 Labial Veneer Porcelain Laminate (LAB) $690.00

2970 Temporary Crown Fractured Tooth $120.00

2980 Crown Repair by Report $150.00

2999 Unspecified Restorative Procedure BR $150.00

Complete Dentures

5110 Complete Upper $850.00

5120 Complete Lower $850.00

5130 Complete Immediate Denture, Maxillary $850.00

5140 Complete Immediate Denture, Mandibular $850.00

Partial Dentures

5211 Upper Partial, Resin Base, Clasp / Rest $425.00

5212 Lower Partial, Resin Base, Clasp / Rest $425.00

5213 Upper Partial, Cast Metal Acry. Sad Inc. C/R $900.00

5214 Lower Partial, Cast Metal Acry. Sad Inc. C/R $900.00

Adjustments to Removable Prostheses

5410 Adjust Complete Denture Upper (non NSU) $50.00

5411 Adjust Complete Denture Lower (non NSU) $50.00

5421 Adjust Partial Denture Upper (non NSU) $50.00

5422 Adjust Partial Denture Lower (non NSU) $50.00

Repairs to Complete Dentures

5510 Repair Broken Complete Denture Base $75.00

5520 Replace Missing/Broken Teeth, Ea. Com DTR $75.00

Repairs to Partial Dentures

5610 Repair Resin Saddle or Base, RPD $100.00

5620 Repair Cast Framework RPD $150.00

5630 Repair or Replace Broken Clasp $80.00

5640 Replace Broken Teeth, per Tooth $50.00

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5650 Add Tooth to Existing RPD $100.00

5660 Add Clasp to existing RPD $100.00

Denture Rebase Procedures

5710 Rebase Complete Upper Denture, LAB $250.00

5711 Rebase complete Lower Denture, LAB $250.00

5720 Rebase Upper Partial Denture, LAB $250.00

5721 Rebase Lower Partial Denture, LAB $250.00

Denture Reline Procedures

5730 Reline Complete Upper Denture, Chair $250.00

5731 Reline Complete Lower Denture, Chair $250.00

5740 Reline Upper Partial Denture, Chair $200.00

5741 Reline Lower Partial Denture, Chair $200.00

5750 Reline Complete Lower Denture, LAB $250.00

5751 Reline Complete Lower Denture, LAB $250.00

5760 Reline Upper Partial Denture, LAB $200.00

5761 Reline Lower Partial Denture, LAB $200.00

Interim Prosthesis

5810 Interim Complete Denture, Upper $450.00

5811 Interim Complete Denture, Lower $450.00

5820 Interim Partial Denture, Upper $450.00

5821 Interim Partial Denture, Lower $450.00

Other Removable Prosthetic Services

5850 Tissue Condition Upper per Denture Unit $50.00

5851 Tissue Condition Lower Per Denture Unit $60.00

5860 Overdenture - Complete BR $1000.00

5861 Overdenture - Partial BR $1000.00

5862 Precision Attachment BR, each $450.00

5867 Replacement Semi or Precision Attachment

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5875 Modification REM Pros Follow Implant Surg

5899 Unspecified REM Pros Procedure BR $450.00

589901 Remount and Refine Occlusion $125.00

589902 Reset Anterior Teeth $100.00

589903 Reset Posterior Teeth $100.00

589904 Chrome Cobalt Base Complete Denture $900.00

589905 Gold Base Complete Denture $1200.00

589906 Gold Occlusal per Tooth $250.00

589909 Imitation 3/4 Crown on Tooth $250.00

589910 Imitation Masel Crown on Tooth $225.00

589911 Hardy Cutters: per arch $75.00

589912 Gold Base Partial Denture $1250.00

Maxillofacial Prosthethics

5911 Facial Moulage Sectional $150.00

5912 Facial Moulage Complete $250.00

5913 Nasal Prosthesis $750.00

5914 Auricular Prosthesis $750.00

5915 Orbital Prosthesis $850.00

5916 Ocular Prosthesis $450.00

5919 Facial Prosthesis $950.00

5923 Ocular Prosthesis Interim $250.00

5924 Cranial Prosthesis $500.00

5925 Facial Augmentation Implant Prosthesis $500.00

5926 Nasal Prosthesis Replacment $450.00

5927 Auricular Prosthesis Replacement $450.00

5928 Orbital Prosthesis Replacement $550.00

5929 Facial Prosthesis Replacement $700.00

5931 Obturator Prosthesis, Surgical $200.00

54

5932 Obturator Prosthesis, Definitive $700.00

5933 Obturator Prosthesis Modification $75.00

5934 Mand Resection Pros with Guide Flange $600.00

5935 Mand Resection Pros without Guide Flange $500.00

5936 Obturator Prosthesis, Interim $350.00

5937 Trismus Appliance Not TMD TX $350.00

5951 Feeding Aid $150.00

5952 Speech Aid Prosthesis Pediatric $250.00

5953 Speech Aid Prosthesis Adult $500.00

5954 Palatal Augmentation Prosthesis $450.00

5955 Palatal Lift Prosthesis Definite $350.00

5958 Palatal Lift Prosthesis Interim $200.00

5959 Palatal Lift Prosthesis Modification $75.00

5960 Speech Aid Prosthesis Modification $75.00

5982 Surgical Stent $60.00

5983 Radiation Carrier $250.00

5984 Radiation Shield $250.00

5985 Radiation Cone Locator $250.00

5986 Fluoride Gel Carrier $75.00

5987 Commissure Splint $200.00

5988 Surgical Template $125.00

5999 Unspecificed Maxillofacial Prosthesis BR $1100.00

Implant Services

6010 Endosteal Implant Body Inc. 2 Stage/CAP $825.00

6040 Eposteal Implant Body Inc. 2 Stage/CAP $600.00

6050 Transosteal Implant Body Inc. 2 Stage/CAP $600.00

Implant Supported Prosthetics

6055 Implant Connection Bar $2000.00

55

6056 Prefabricated Abutment $450.00

6057 Custom Abutment $450.00

6058 A/S Porcelain/Ceramic Crown $740.00

6059 A/S Porcelain Fused Crown HI Noble Metal $740.00

6060 A/S Porcelain Fused Crown Base Metal $650.00

6061 A/S Porcelain Fused Crown Noble Metal $740.00

6062 A/S Crown HI Noble Metal $740.00

6063 A/S Crown Base Metal $650.00

6064 A/S Crown Noble Metal $650.00

6065 I/S Porcelain/Ceramic Crown $650.00

6066 I/S Porcelain Fused Crown T, TA, HI Noble $650.00

6067 I/S Crown T, T Alloy, HI Noble $625.00

6068 A/S Retainer for Porcelain/Ceramic FPD $625.00

6069 A/S Retainer Porcelain Fused HI Noble Metal $740.00

6070 A/S Retainer Porcelain Fused Base Metal $625.00

6071 A/S Retainer Porcelain Fused Noble Metal $740.00

6072 A/S Retainer Metal FPD HI Noble Metal $625.00

6073 A/S Retainer Metal Base Metal $625.00

6074 A/S Retainer Metal Noble Metal $625.00

6075 I/S Retainer for Ceramic FPD $625.00

6076 I/S Retainer Porcelain Fused T, TA, HI Noble $625.00

6077 I/S Retainer Cast Metal T, TA, HI Noble Metal $625.00

6078 I/A/S Fixed Denture Completely Edentulous $7200.00

6079 I/A/S Fixed Denture Partially Edentulous $4000.00

Other Implant Services

6080 Implant Maintenance Procedures $250.00

6090 Repair Implant Prosthesis BR $250.00

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6095 Repair Implant Abutment BR $250.00

6100 Implant Removal BR $150.00

6199 Unspecified Implant Procedure BR $2750.00

Fixed Partial Denture Pontics (FPD)

6210 Pontic, Cast HI Noble Metal $690.00

6211 Pontic, Cast Base Metal $650.00

6240 Pontic, Porcelain Fused HI NBL Metal $690.00

6241 Pontic, Porcelain Fused Base Metal $650.00

6242 Pontic, Porcelain Fused Noble Metal $690.00

6245 Pontic, Porcelain/Ceramic $550.00

6250 Pontic, Resin with HI Noble Metal $650.00

6251 Pontic, Resin with Base Metal $400.00

6252 Pontic, Resin with Noble Metal $600.00

Fixed Partial Denture Retainers - Inlay/Onlay (FPD)

6519 Inlay/Onlay - Porcelain/Ceramic $390.00

6520 Inlay Metallic, Retainer 2 Surfaces $600.00

6530 Inlay Metallic, Retainer 3+ Surfaces $600.00

6543 Onlay Retainer Metallic 3 Surfaces $600.00

6544 Onlay Retainer Metallic 4+ Surfaces $600.00

6545 Retainer Cast Metal for Acid Etch $350.00

6548 Retainer - Porcelain/Ceramic Resin Bonded

Fixed Partial Denture Retainer - Crowns (FPD)

6720 Crown Retainer, Resin/High Noble Metal $650.00

6721 Crown Retainer, Resin/Base Metal $400.00

6722 Crown Retainer, Resin/Noble Metal $650.00

57

6740 Crown Retainer Porcelain/Ceramic $550.00

6750 Crown Retainer, Porcelain Fused HI NBL $690.00

6751 Crown Retainer, Porcelain Fused Base Metal $650.00

6752 Crown Retainer, Porcelain Fused Noble $690.00

6780 Crown Retainer, 3/4 Cast HI NBL $650.00

6781 Crown Retainer 3/4 Cast Base Metal $425.00

6782 Crown Retainer 3/4 Case Noble Metal $450.00

6783 Crown Retainer 3/4 Porcelain/Ceramic $550.00

6790 Crown Retainer Full Cast HI NBL $690.00

6791 Crown Retainer Full Cast Base Metal $425.00

6792 Crown Retainer Full Cast NBL $690.00

Other Fixed Partial Denture Services

6920 Connector Bar $350.00

6930 Recement Bridge $50.00

6940 Stress Breaker $200.00

6950 Precision Attachment $450.00

6970 Cast P&C $250.00

6972 Prebabricated Post/Core in Add to FPD Retainer $125.00

6973 Core Buildup fo Retain Incl Any Pins 250.00

6975 Coping, Metal , Cast $400.00

6976 Each Additional Cast Post - Same tooth

6977 Each Additional Prefab Post - Same tooth

6980 FPD Repair BR $200.00

6999 Unspecified Fixed Prosthesis Procedure BR $500.00

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Oral and Maxillofacial Surgery

Extractions

7110 Single Tooth Extraction $92.00

7120 Each Additional Tooth $92.00

7130 Root Removal Exposed Roots $92.00

Misc Services

9930 Post-op Care BR $250.00

9940 Occlusal Guards-Bite PI INC. 2 Adjust $175.00

9941 Fabrication of Athletic Mouthguards $75.00

9950 Occlusion Analysis Mounted Case $50.00

9951 Occlusal Adjustment Limited $50.00

9952 Occlusal Adjustment Complete $200.00

9970 Enamel Microabrasion $30.00

9971 Odontoplasty 1-2 teeth; Enamel Projections $30.00

9972 External Bleaching - Per Arch $225.00

9973 External Bleaching - Per Tooth $30.00

9974 Internal Bleaching - Per Tooth $75.00

9999 Unspecified Adjunctive Procedure BR $100.00

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SECTION VII

TREATMENT EVALUATION AND PLANNING

60

a. Guidelines and Procedures for Patient Selection The Advanced Prosthodontic Program at NSU is involved in the education of graduate dentists for practice in the specialty of prosthodontics. This specialty pertains to the restoration and maintenance of oral function by the repair of defective teeth and the replacement of missing teeth and tissues. Patients are evaluated for acceptance for treatment based on the complexity of their restorative needs and the extent to which their treatment will provide a significant educational experience for the student, as well as the degree to which the patient will benefit from the therapy. The patient's ability to maintain the completed restoration, as well as their financial responsibility, must be considered. Patients accepted for treatment will be assigned to a student by the Program Director or designated faculty. Upon receiving an assignment, the student, in consultation with a member of the attending faculty, will establish a diagnosis, formulate a treatment plan, or plans, and calculate appropriate fees for therapy. All restorative treatment plans must be presented at the treatment planning seminar. The prescribed format for these presentations will be outlined during orientation. It is a standard policy of the program that 50% of the fee be paid at the beginning of the treatment, and the remainder in appropriate increments to insure that the entire amount is paid prior to making final impressions. Experience has shown that deviations from this policy create management problems and may result in the student not receiving credit for the restoration when payments are incomplete at the end of treatment. The duration of therapy is dependent upon the complexity of treatment required and frequently is extended by the necessity for care by other specialists. Treatment should be initiated as early in the training period as possible to insure that the patient will be completed within the term of the program. Patients must be available for at least one half day per week and may expect treatment to extend over a 12 to 18 month period. Patients receiving complete denture therapy may anticipate a treatment period of approximately three months. Patients who desire treatment in the Advanced Education in Prosthodontics Program may request an appointment for screening. The fee for this consultation is $25.00. It is the student's continuing responsibility to render care in a manner befitting that of a specialist and to do so in an expedient, caring, and courteous manner. Patients for prostho-dontic therapy who are undergoing care in another service should be closely monitored to insure their care is progressing as desired and that they are returned for their restorative care in a timely manner.

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b. Essentials of a Treatment Plan The following outline will serve as a guide in the formulation of a treatment plan for patients undergoing care in the Advanced Education in Prosthodontics Program: I. Chief Complaint II. Summary of Medical History III. Dental History IV. Initial Data

a. extraoral examination b. intraoral examination c. radiographs d. diagnostic casts and mounting

V. Diagnosis VI. Prognosis VII. Sequential Treatment Plan VIII. Restorative Goals IX. Fee X. Presentation of Treatment Plan to Patient XI. Confirmation Letter to Patient c. Treatment Plan, (Example) Patient: Mrs. Ethyl Jones Age: 58 Personal Status: Divorced, mother of four grown children. Employment: Buyer for furniture company Chief Complaint: Progressive loss of teeth, "can't chew as well as I used to", poor esthetics

"I hate to smile anymore" gums bleed when brushed.

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Pertinent Medical History: Usual childhood diseases, appendectomy, childbirth X 5 (one child died in infancy), partial hysterectomy at age of 52. Patient has acceptable BP (125/80), is moderately overweight. Smokes occasionally (less than ½ pack/day) social consumption of alcohol. Medications: thyroid, estrogen. Last physical examination: January 1984. Dental History: Patient tells of intermittent, symptomatic tooth loss, admits to diminished

oral care during child rearing period. She tells of pain in jaws at end of day and bleeding upon brushing. Patient has forced look on smiling, trying not to reveal teeth. She relates a dental care history of palliative dental care and acknowledges need for definitive restorative work. The patient speaks easily and rationally, and seems realistic in her discussion and anticipation of restorative results.

Examination: Palpation of the muscles of mastication reveal tenderness in right and left masseter at their origin, and tenderness in the lateral pterygoid muscles, especially the right. There are no palpable nodes or masses, the TMJ is free of joint sounds and there is a maximum opening of 38 millimeters with no deviation on opening. Saliva, tongue, and throat are within normal limits. The lips are slightly flaccid with some cracking at the commissure. Periodontal examination (see charting) revealed slight to moderate periodontitis with pocket depths ranging from 2 to 6 mm. There were no inadequate zones of attached tissue. Teeth #2, 3, 14 and 18 had class II furcation involvement. Mobility of all teeth was within normal limits. Teeth #1, 4, 5, 13, 15, 16, 17, 19, 30, 31 and 32 were missing. The patient stated that most had been lost to caries and the financial inability to consider restorative procedures advocated. Carious lesions were present in #2, 3, 7, 8, 9, 22 and 29 (see charting). Vitality testing revealed all teeth WNL. Silver amalgam restorations were present in #2, 3, 6, 12, 14, 18, and 28. Composite restorations were present in #7, 8, 9, 10, 23, and 24. All restorations were considered in need of replacement (see charting). The mandible was not easily placed into the retruded position, and extruded teeth #14 and #3 were the primary contacts which prevented the intercuspal position. The anterior teeth exhibit moderate to severe wear and facets of wear are present on many posterior teeth. Radiographic examination employing complete mouth periapical and panoramic radiographs confirmed clinical observation. No further pathosis was observed. Photographic documentation was completed and impressions made for diagnostic casts. A tentative jaw relationship record was made and casts transferred to a simple axis instrument (i.e., Hanau H2).

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Diagnosis:

Partially edentulous and loss of function Caries Moderate periodontitis Altered vertical dimension, extrusion and occlusal malposition Compromised esthetics

Prognosis: Patient attitude, good residual supporting bone, adequate tooth structure and adequate number of remaining teeth make prognosis excellent. The prognosis will be compromised if patient enthusiasm for improved oral care wanes, and recall maintenance will be essential. Treatment Plan: Preliminary: 1. Refer to Periodontics for definitive care. 2. Hinge axis location and tattoo, intraoral tattoo, pantographic tracings, 3 centric jaw

relationship records and duplicate mounted casts. 3. Mount casts on fully adjustable gnathologic instrument. Set instrument and verify centric

jaw relationship records. 4. Trial preparations and diagnostic waxing at arbitrary altered vertical dimension. Diagnostic

waxing will address improved esthetics, corrected occlusion and restored function. Distal extension removable partial denture design to be incorporated.

5. Place “bite plane” at altered vertical dimension, verify patient tolerance. 6. Make matrices for all sextants. Definitive: 1. Prepare #2, 3, 6 place provisional restoration. 2. Prepare #12, 14 place provisional restoration. 3. Prepare #18, 20, 21, 22 place provisional restoration. 4. Prepare #27, 28, 29 place provisional restoration. 5. Prepare #7, 8, 9, 10, 11 place provisional restoration. 6. Replace all provisional restorations with new provisional units made at altered vertical

dimension of occlusion and restoring function. 7. After patient accepts vertical dimension of occlusion, mandibular position and esthetics,

refine all preparations and make final impressions, and mount in a fully adjustable instrument.

8. Make casts and dies, complete laboratory phase. 9. Try-in metal work. 10. Fabricate porcelain veneers. 11. Place restorations with soft set luting agent.

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12. Fabricate precision retained removable partial denture framework. 13. Altered cast impression for RPD. 14. Place removable partial denture. 15. Finalize cementation after patient comfort is assured. 16. Reinforce oral hygiene and maintenance procedures. 17. Recall every 3 months for 1 year. Fee: The fee for the diagnostic procedures, fixed restorations, and precision retained removable partial denture will be $_________. Patient Presentation Letter of Confirmation Initiation and completion of treatment as outlined. Estimated time of therapy including initial periodontal care: 11 months. d. Pretreatment Confirmation Letter The pretreatment confirmation letter is a very important part of establishing a clear and direct understanding with your patient the extent, intent, limitation and fee for services to be rendered. The letter must be direct and personal and explain in simple terms the considerations of the therapy anticipated. A statement is made of what treatment is anticipated and the limitations which the patient's dental, physical, emotional or financial circumstances place on that treatment. A "no guarantee" paragraph is included along with a statement of the dentist's (and the school's) limited obligation to the patient. The fee for the service must be stated clearly and specify what is included and excluded. A clear cut agreement is an essential basis for resolving any potential future misunderstandings. The payment sequence for the fee must be specific, must clearly state that no treatment can be initiated without the first 50% of the fee, and that work cannot be completed without complete payment. The remaining balance of 50% should be paid prior to the final impression appointment. This letter should end with an optimistic expression of encouragement and an assumption of cooperation between the parties involved. It should invite questions and insure resolution of differences prior to therapy. The pretreatment letter must be completed, approved by the Program Director, finalized and submitted to the patient prior to definitive therapy. It must be signed by the patient and, if possible, the spouse, to insure assumption of the obligations incurred. Please remember that the pretreatment confirmation letter must precede treatment of any type and serves as a financial obligation contract.

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e. Essentials of a Letter of Confirmation1 1. Explain why you are writing. 2. Refer in general terms to the "explanations session". 3. Point out all problems which are unusual in the "no guarantee" paragraph. 4. Define your treatment objective and give your prognosis based on the limitations mentioned

above. 5. State the fee and the agreed payment plan. 6. Place a time limit on your responsibility for this treatment. 7. Conclude on a hopeful aspect of the situation, if there is one.

1 Designed by Alex Koper, D.D.S., The University of Southern California School of

Dentistry

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May 6, 2005 Mary L. Windle Address Dear Mrs. Windle: It is our custom to confirm our agreement regarding the dental restorative procedures that have planned for you. I shall follow the plan of treatment I outlined to you on 5/4/05, when we discussed aspects of this matter in moderate detail. As you know, considerable professional skill, time and effort is involved in these procedures. Your understanding and cooperation as a patient is essential and is gratefully acknowledged. I estimate the treatment period to last approximately 3 months. After this, routine follow-up adjustments and care will be provided as indicated for an additional three month period. Your surgical treatment needs are as follows: Surgical extractions of 3 root tips (upper arch) $210.00 (3x7) Extraction of ALL remaining teeth $512.00 (16x32) Your prosthetic treatment needs are as follows: Exam + Consult $25.00 Panoramic x-ray $34.00 Upper and Lower immediate complete dentures $1200.00 (2x600) Upper and Lower rebase (post insertion) $400.00 (2x200) An estimate of the total fee for your Restorative services will be $2,381.00. A retainer of $1,000.00 is to be paid before treatment commences, and the remainder can be paid in increments and in full prior to the final impression appointment.

RE: REMOVABLE

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Any additional treatment, for example, removal of your wisdom teeth, if indicated will be carried out by the oral surgery department and you will be billed for theses services separately. The separate account must be settled before any prosthetic treatment commences. Once treatment begins, if due to unforeseen circumstances the treatment plan were to change, the change will be discussed with you and the fee adjusted accordingly before the treatment continued. Naturally, with all the variables presented by human begins, no guarantees are possible. Occasionally situations arise which require additional treatment. In your case due to continued resorption (shrinkage) of your jaw bone and gums following the extractions, the dentures will lose their retention and will most likely need to be rebased to maintain an adequate fit 3-6 months following initinal construction. In addition, if any portion of the restoration, such as the teeth or the plastic base fails within one year period beginning from the time the restoration is placed, we will be responsible for the fabrication of a new prosthesis without any additional cost to you. Following the delivery of your dentures, we will be glad to see you for any minor adjustments if need be. The first four of such visits will be of no cost to you, however there will be a minimal fee for further visits. Your signing and returning two of the enclosed copies, will indicate your accord and agreement to proceed. Please enclose your preferred starting date, current work and home telephone number. Please do not hesitate to contact me via telephone or in person if you wish to discuss any uncertainties you may have, regarding your treament. It is my intention to offer you my best efforts, and with a feel of optimism about the results we can achieve for you, I welcome this opportunity to help you. Very sincerely yours, Mehran Sanei, B.D.S. My signature indicates that I have read, understand and consent to the above treatment and its terms. ____________________________ ____________________ Mrs. Mary L. Windle Date

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May 6, 2005 Mrs. Sally Close Address Dear Mrs. Close: It is our custom at The Nova Southeastern University to confirm our agreement regarding the dental treatment to be performed for you. I shall follow the plan of treatment I outlined to you during your last visit when we discussed all aspects of this matter in detail. As you know, considerable professional skill, time and effort are involved in these procedures. Your cooperation and understanding as a patient are gratefully appreciated. I estimate the treatment period to last approximately three months. After this, routine follow-up adjustments and care will be provided as indicated for four additional visits. A charge of $50 per visit will be assessed for appointments beyond these four. As with any dental procedure, potential risks and complications may arise. Although these are rare, it is important for you to be aware of them. Problems may include sore spots, uneven bite, tooth debonding, plastic resin cracking, and difficulty with speech modification, difficulty on eating or looseness of the prosthesis. Solutions for these situations exist. We will do all we can to resolve such problems and bring the prosthesis to an acceptable level of performance. You must realize, however, that the progressive denture wear, the abuse the tissue bears causes further bone resorption, which in turn compromises future results. Therefore, the only guarantee we offer covers the materials employed for the fabrication of the denture. Modifications to accommodate other problems must be performed at the patient’s expense (this includes relines when indicated). This guarantee is good for one year following prosthesis insertion. The total fee for these services is $1,109. As we agreed, a retainer of $500 is to be paid at the beginning of treatment and the remainder can be paid in increments and in full prior to the final impression appointment.

College Of Dental Medicine

RE: COMPLETE DENTURES

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Your signature at the bottom of the enclosed copy of this letter will indicate your accord and agreement to proceed. It is my intention to offer my best efforts for you and I welcome this opportunity to help with your dental needs. Very sincerely yours, Nicolas F. AbuJamra, D.D.S. _______________________________ Mrs. Sally Close

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June 23, 2005 Miley B. Hellyer Address Dear Mr. Hellyer: It is our custom to confirm our agreement regarding the dental restorative procedures that I have planned for you. I shall follow the plant of treatment I outlined for you on 6/14/05, when we discussed aspects of this matter in moderate detail. As you know, considerable professional skill, time and effort is involved in these procedures. Your understanding and cooperation as a patient is essential and is gratefully acknowledged. I estimate the treatment period to last approximately 9-12 months (including restoring the implants). After this, routine follow-up adjustments and care will be provided as indicated for an additional six-month period. Your prosthetic treatment needs are as follows: Exam + Consult $25.00 Intraoral series of X-Rays $45.00 Diagnostic casts $50.00 Surgical stent $150.00 Diagnostic photographs $20.00 Amalgam filling $40.00 White filling $35.00 Amalgam core build-ups $375.00 (5x75) Gold crowns $1875.00 (5x375) Gold onlay $370.00 Implanted supported crowns $1200.00 (2x600)

RE: IMPLANTS

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An estimate of the total fee for your Restorative services will be $4,185.00. A retainer of $2,100.00 is to be paid before treatment commences, and the remainder can be paid in increments and in full prior to the final impression appointment. Any Periodontal, Surgical or Endodontic treatment (if indicated), will be carried out by these separate departments and you will be billed separately. In your case surgical placement of two implants by Grad Peiro (approx. $1,000.00), and a root canal treatment by Grad Endo. These bills must be settled with the relevant department separately and completely before prosthodontic treatment commences. Once treatment begins, if due to unforeseen circumstances the treatment plan were to change, the change will be discussed with you and the fee adjusted accordingly before the treatment continued. Naturally, with all the variables presented by human beings, no guarantees are possible. Occasionally situations arise which require additional treatment. In the unfortunate event that after completion of your treatment a tooth or root fractures, new decay occurs, or a nerve of a tooth dies, you must understand that you will be financially responsible for any necessary treatment at that time. Additionally, you must be responsible for using daily fluoride as prescribed. However, if any portion of a restoration, such as porcelain, plastic or metal fails within a one-year period beginning from the time the restoration is places, we will be responsible for the fabrication of a new prosthesis without any additional cost to you. Dental implants are a relatively new procedure and technique, and as any such procedure the probability of failure over the long-term is not currently known. In our experience eat Nova Southeastern University State they usually last for many years, but no guarantee for a specific amount of time will be given. Should the implant fail, there will be no refund of fees, but you will be given the opportunity to replace it with another after a short period of bony healing. Your signing and returning two of the enclosed copies will indicate your accord and agreement to proceed. Please enclose your preferred starting date, current work and home telephone number. Please do not hesitate to contact me via telephone or in person if you wish to discuss any uncertainties you may have, regarding your treatment. It is my intention to offer you my best efforts, and with a feel of optimism about the results we can achieve for you, I welcome this opportunity to help you. Very sincerely yours, Mehran Sanei, B.D.S. My signature indicates that I have read, understand and consent to the above treatment and its terms. _________________________________ ________________ Mr. Miley Hellyer Date

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March 27, 2005 Mr. Farris J. Davis Address Dear Mr. Davis: It is our custom at The Nova Southeastern University to review treatment plans recommended to our patients. This letter will serve as a written record of the proposed plan. Your signature on the bottom will indicated your understanding of the plan, its costs, time requirements as well as your willingness to proceed with treatment. As we discussed during your last visit, your treatment will include three phases: Surgical, Periodontal and Restorative. The first phase will require extraction of two upper teeth and three upper roots. Placement of a temporary partial will occur on the same day the extractions are performed. Crown lengthening of one root we are planning on retaining will be performed on the same day. Following extractions, a bone graft is planned for the lower right area to allow implant placement at a subsequent date. Periodontal cleaning will also be performed to give us a sound foundation to build your prosthesis on. The cost for the proposed surgery is $2,435. This includes $1,500 for the placement of three implants. These will be placed, however after the graft has had a chance to heal (about 6 months). In the meantime, the restorative phase of treatment can be started. This includes three crowns on the upper teeth to be retained and a special cap for the retained tooth (i.e.: coping and attachment). A new bridge will be made for the lower teeth (lower left). Finally, a partial can be made for the upper arch. Once the implants are integrated, a bridge will be placed in the lower right area. The cost for this phase of treatment is $5,715. As you can tell, a significant financial commitment on your part will be required, as well as some time commitment. The total cost of your treatment will be $8.150. It is the graduate program’s

RE: COMPLEX TREATMENT

73

policy to request that half of the treatment cost be paid at the beginning of treatment. We are asking that you make a down payment of $2,892 to indicate your desire to proceed with treatment. This half does not take into account any fees for the implant bridge, the fee for which can be paid when we being making that bridge later. The remainder can be paid in increments and in full prior to the final impression appointment. The above-mentioned fees do not include any endodontic (root canals) treatment, which may become necessary later. It also represents my estimation of periodontal fees. These will be finalized by Dr. Bounds and will be discussed by him at length. Finally, let me make a mention of the guarantees we offer. Since we are dealing with human subjects who bring to us a variety of problems unique to each of them, we can only make generalizations on prognosis, with limited confidence on any one specific case. Therefore, it is not customary for decay or us to guarantee that teeth will not fracture. However, if failure of any restorative material (metal, porcelain, amalgam….) is prematurely noted (within the first year of service), we will repair such problems at no financial cost to you. It is important to note here that oral hygiene will be pivotal to the long-term success of your restorations, both implant and tooth supported. This includes regular professional visits as well as a high level of home care, which will include brushing, flossing, and the application of fluoride. I will be giving you specific instructions on what to do as we progress. I am happy to have this opportunity to participate in the management of your dental needs, Mr. Davis. Your case is challenging and will require significant investment of time and resources. The result will be gratifying to both of us. I believe that you will find this treatment plan to be worth the effort in the end. If I can be of any further assistance to you, please do not hesitate to call on me. I will be more than happy to answer any questions you have. Sincerely, Nicolas F. AbuJamara, D.D.S. ____________________________________ Mr. Farris J. Davis

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f. Oral Rehabilitation Treatment Evaluation NSU Advanced Prosthodontics Fixed Prosthodontics Patient Treatment Record

Patient’s Name____________________________ Date Started______/_____/_____ Resident’s Name__________________________ Primary Faculty __________________________ __/__/__ 1. Diagnostic Casts / Mounting / Photographs Sig.____________ Articulator Settings Articulator Model_________________________ __/__/__ 2. Splint Therapy Sig.____________ __/__/__ 3. Diagnostic Tracing (Pantograph, Stereograph) Sig.____________ __/__/__ 4. Diagnostic Wax-up Sig.____________ __/__/__ 5. Case Presentation Sig.____________ Treatment Plan finalized and entered in computer. Confirmation Letter completed and signed. All Diagnostic Phase procedures billed and paid for. __/__/__ 6. Preparations and Provisionals Sig.____________ Teeth Number(s)________________________________ Margin type by tooth_____________________________ _____________________________________________ _____________________________________________ _____________________________________________ __/__/__ 7. Impressions (identify by tooth number each impression) Sig.____________ Patient has paid 50% of treatment cost __/__/__ 8. Master casts / pindexing / die work (margin and spacer) Sig.____________

Each of the following procedures MUST be evaluated by the primary faculty member assigned to work with this patient. If the assigned faculty member is not available and treatment must proceed, check with that faculty member or the program director on which other faculty should be involved. The procedures listed are considered essential monitoring points and must be signed off before proceeding to the next point. It is expected that the faculty will work closely with the resident during all phases of treatment.

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__/__/__ 9. Interocclusal records (record bases if needed) Sig._____________ __/__/__ 10. Mounted master cast(s) and opposing cast Sig._____________ __/__/__ 11. Full contour wax-up (indicated if sent out to commerical laboratory)

Case will not be sent to lab or gold will not be issued until 50% payment has been made and units are billed out on the computer.

Sig.____________ __/__/__ 12. Cutback for porcelain (as above) Sig.____________ __/__/__ 13. Sprued units Sig.____________ __/__/__ 14. Retrieved castings Sig.____________ __/__/__ 15. Finished castings Sig.____________ __/__/__ 16. Metal finish prior to porcelain (sufficient thinning of metal, .3-.5mm) Metal to be checked at least 24 hours before appoinment Sig.____________ __/__/__ 17. Metal try in Sig.____________ __/__/__ 18. Porcelain application Sig.____________ __/__/__ 19. Porcelain try-in / recontouring Sig.____________ Porcelain to be checked at least 24 hours before appointment __/__/__ 20. Cementation (trial or final) Sig.____________ __/__/__ 21. Post treatment splint Sig.____________ __/__/__ 22. Post cementation full mouth series of radiographs Post cementation photographs Sig.____________ __/__/__ 23. TREATMENT COMPLETE Faculty Signature _____________________________

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g. Complete Denture Treatment Evaluation Dr. _______________________________ Date ________________ Patient ___________________________ Assigned Faculty __________________ The procedures listed are considered essential monitoring points. It is expected that the faculty will work closely with the advanced student during all phases of treatment. 1. DIAGNOSTIC RECORDS, PROGNOSIS AND TREATMENT PLAN: 2. FINAL IMPRESSIONS:

Maxillary:

Mandibular: 3. VERTICAL DIMENSION, CENTRIC AND ECCENTRIC JAW RELATION RECORDS: 4. CASTS MOUNTED, ARTICULATOR SETTINGS:

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5. SELECTION AND ARRANGEMENT OF TEETH:

Anterior Mold Posterior Mold Maxillary _______ Maxillary _______ Mandibular _____ Mandibular _____ Anterior Shade _______ Posterior Shade _______

Selected Posterior Occlusal Scheme _____________________________

6. FINAL TRY-IN OF WAXED DENTURE: 7. CORRECTION OF PROCESSING ERRORS BY SELECTIVE GRINDING: 8. DENTURE PLACEMENT, INITIAL ADJUSTMENTS, REMOUNT RECORDS AND

ADJUSTMENTS, ON THE ARTICULATOR: 9. COMPLETED DENTURES: 10. POST-INSERTION CARE AND ADJUSTMENTS: h. Summary of Patient Treatment to guide preparation for Treatment Planning Seminar Dr. _______________________________ Date __________________ Patient ___________________________ Date Therapy Initiated ____________ Date Therapy Completed _____ 1. Patient's Pretreatment Problems: 2. Diagnostic Procedures:

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3. Treatment Procedures: 4. Evaluation and Progress: 5. Recommended Recall Interval: __________________ Months _______________________________________ ____________________ Signature of Doctor Rendering Treatment Date i. Summary of Patient Treatment (Example) Dr. _______________________________ Date ____________________ Patient ___________________________ Date Therapy Initiated_____________ Completed ______________ Patient's Pretreatment Problems:

The patient had numerous missing anterior and posterior teeth, advanced periodontal disease with furcation involvements, inadequate zones of attached tissue and horizontal bone loss. Endodontic therapy was needed on the maxillary right first molar and numerous defective restorations were present. Occlusal interferences resulted in mandibular displacement.

Diagnostic Procedure:

1. Complete medical and dental history.

2. Complete mouth radiographs, diagnostic casts and photographic series.

3. Hinge axis location and pantograph. Duplicate mounted casts, diagnostic waxing.

4. Patient presentation, fee quotation, confirmation letter.

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Treatment Procedures: 1. Periodontic and endodontic therapy to restore tissue to acceptable health.

2. Removal of restorations and placement of foundation restorations.

3. Sequential preparation of maxillary and mandibular teeth, placement of provisional

restoration at original vertical dimension of occlusion.

4. Replacement of all provisionals. New provisional restoration formed from diagnostic waxing at decreased vertical dimension to improve crown/root ratio.

5. Final impressions.

6. Laboratory procedures fabricating 14 units of fixed restorations on the maxillae

and 5 units on the mandible. Maxillary posterior fixed partial dentures were inte-grated to the anterior six-unit splint with precision attachments. Mandibular units surveyed for extracoronally retained removable partial denture.

7. Try-in of metal work, remount.

8. Porcelain fabrication.

9. Intraoral try-in and modification, characterization and glazing.

10. Trial placement of all restorations.

11. Impressions for mandibular Kennedy Class I partial denture framework.

12. Framework try-in and altered cast impressions.

13. Jaw relationship records.

14. Set teeth and try-in.

15. Process and finish RPD.

16. Place RPD, adjust, remount.

17. Fabricate gold occlusal surfaces.

18. Place RPD, adjust.

19. Place all restorations with ZnPO4 cement.

20. Recall and maintenance instructions.

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Evaluation and Progress: The patient tolerated the procedures well, was pleased with the esthetic result and was impressed with the improved function and comfort. Oral hygiene has been superb and the motivation achieved was most encouraging. Care of this patient was an excellent learning procedure and the esthetic concepts employed were most rewarding. Patient functions with an anterior guided occlusion with planned posterior integration should wear be a factor. Patient is being observed for post-operative problems and has been informed that a night guard may be needed if any wear is observed. Recommended Recall Interval: 3 months for the first year, 6 months thereafter in so long as adequate oral hygiene procedures are observed. __________________________________________ ______________ Signature of Doctor Rendering Treatment Date

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SECTION VIII

RESIDENT and PROGRAM ASSESSMENT

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a. Review Evaluations The program faculty at least twice per year evaluates each resident. The frequency depends upon the student’s progress. Students in difficulty or probation are reviewed each quarter. This evaluation is scheduled individually with each resident and is an opportunity for the faculty to express their perception of the resident's performance during the preceding quarter. The resident is also given the chance to discuss any concerns he/she may have about the program, patients, treatment modality, individual, etc. A composite evaluation form is given to each resident identifying the resident's performance (see Resident Performance Review example). Poor evaluations may require additional instruction of varying types in order to overcome indicated deficiencies. Consistent poor evaluations can lead to academic or program probation. Extended probationary periods, without improvement, can lead to dismissal from the program. b. Case Type Inventory Each resident will be asked to keep a quarter-by-quarter record of the clinical procedures they have performed. This record is reviewed at each Review session (see Case Type Inventory example). c. Patient Treatment Inventory Each resident will maintain an ongoing record of each patient he/she is assigned during the program. This record provides an assessment of patient load, type of patients in treatment, progress on each patient, identification of non-cooperative patients, and completion of treatment. d. Annual Year-End Evaluation One of the resident review sessions is scheduled at the close of each academic year. e. Simulated Certifying Examinations Simulated certifying examinations ("mock boards") are given to third-year residents in April or May and can incorporate one or more of the following: a written examination over the broad aspect of prosthodontics, an oral examination covering information presented in the program to date of exam, and/or a clinical examination. The oral examination may be accompanied by the presentation of a summary of care rendered for a patient.

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f. Course and Faculty Evaluations All residents are asked to complete clinical faculty evaluation forms at the conclusion of each year. Feed back of this nature is used to identify areas where faculty improvement is needed. These forms are anonymous and the resident should complete them as honestly and as fully as possible. Course instructors are provided quarterly evaluation forms that are distributed to students for purposes of course evaluations. There are standard forms formulated by The Nova Southeastern University. As changes in prosthodontic procedures, materials, program requirements, College faculty, patient load, etc. occur, expected changes in curriculum must also occur. Evaluations of this nature are the only feedback the Program faculty has to evaluate how the resident perceives things. Therefore, resident support with honest responses is extremely necessary and beneficial to all. Note: See forms on the following pages.

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THE NOVA SOUTHEASTERN UNIVERSITY

ADVANCED PROSTHODONTIC RESIDENCY PROGRAM

Resident Performance Review Resident’s Name___________________ Review Period ______________________ The core faculty reviews the following areas periodically in order to afford the resident with a concise and clear idea of how the faculty perceives his/her performance during the review period. This review is performed to identify to the resident those areas in which he/she is performing at or above the levels expected in the Program and those areas where performance is identified as being substandard. The areas are rated as follows:

5-Excellent, 4-Good, 3-Satisfactory, 2-Needs Improvement, 0-Unsatisfactory The resident is expected to maintain a rating of 50 or above. PERFORMANCE AREA RATING Overall Academic Performance _____________________ Professionalism _____________________ Cleanliness (Lab Station & Operatory) _____________________ Personal Appearance _____________________ Punctuality (Attendance & Requirements) _____________________ Patient Management _____________________ Attention to Detail _____________________ Utilization of Time _____________________ Interpersonal Relations _____________________ Follows Instructions _____________________ Research Progress _____________________ Paperwork _____________________ Quantity & Quality of Tx (Fixed) _____________________ Quantity & Quality of Tx (Removable) _____________________ TOTAL _____________________ Additional Comments: ______________________________ Walter S. Askinas D.D.S,M.S. Director, Advanced Prosthodontics

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NSU ADVANCED PROSTHODONTIC EDUCATION CASE TYPE INVENTORY

Resident's Name_________________________________ Date_________________

TYPE OF CASE NEEDED STARTED COMPLETED

I. OCCLUSAL RESTORATION

A. Hinge-axis location

B. Pantograph

C. Stereograph

D. Use of a semi-adjustable articulator

E. Use of a fully-adjustable articulator

F. Alteration of vertical dimension

II. TMJ-MPD RELATED PROCEDURES

A. Differential diagnosis

B. Occlusal repositioning prosthesis

C. Occlusal equilibration

III. FIXED-REMOVABLE COMBINATION

A. Partial veneer crowns

1. Anterior

2. Posterior

B. Complete veneer crowns

C. Metal-ceramic crowns

1. Anterior

2. Posterior

D. All porcelain crowns

E. Fixed partial dentures

F. Resin-bonded, etched retainer FPDS

G. Non-rigid connectors (key & keyway)

H. Fixed splints

I. Telescopic crowns

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J. Provisional coverage

1. Preformed or made direct

2. Heat processed; indirect pressure pot

TYPE OF CASE

K. Removable partial dentures

1. Tooth-borne

2. Tooth and tissue borne

3. Precision attachments

4. Transitional

IV. COMPLETE DENTURES

A. Overdenture

B. Immediate

C. Transitional

V. MAXILLOFACIAL PROSTHETICS

A. Obturators

B. Mandibular resection prostheses

C. Extra-oral prostheses

D. Surgical prostheses

E. Other

VI. ENDODONTIC-RESTORATIVE COMBINATION

A. Pin retained cores

B. Preformed posts

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C. Cast post and cores

VII. PERIODONTAL-RESTORATIVE COMBINATION

A. Crown lengthening

B. Periodontal Split

C. Hemisected OR Root amputated teeth

D. Electrosurgery

VIII. ORTHODONTIC-RESTORATIVE COMBINATION

IX. GERIATRIC/HANDICAPPED-RESTORATIVE COMBINATION

X. IMPLANT SUPPORTED PROSTHESES

A. Removable

B. Fixed

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PATIENT TREATMENT INVENTORY

RESIDENT NAME_______________________________________ DATE OF UPDATE_________________

PATIENT NAME

RESIDENT

TYPE

DATE ASSIGNED

CASE PRESENTATION

LETTER OF CONFIRM

Tx TOTAL COST

DOWN PAYMENT

IMPLANT TYPE

AND NO. ATTCHM.

TYPE AND NO.

STATUS

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SECTION IX

THE AMERICAN COLLEGE OF PROSTHODONTISTS

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This is the only organization in the United States made up solely of Prosthodontists, and as such, it is unique. Other prosthodontic organizations have let untrained practitioners join their membership. The ACP has a very strong commitment to furthering the specialty of prosthodontics. One major component of that commitment is supporting the educational advancement of the resident toward Board Certification. Current membership stands at about 2000 with approximately 700-800 Boarded members. Each resident will be required to join this organization as an Affiliate Member at an annual fee of $40.00. This facilitates your attendance to the meeting during all 3 years of the residency, if you so choose, but more specifically, in the second and third year when a table clinic or projected clinic will be presented. Membership benefits as a student are significant. Besides the ability to attend the meetings without further registration payment, the resident also receives The Journal of Prosthodontics. Once student status is over, the College no longer provides the Journal.

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SECTION X

TREATMENT ROOM ORGANIZATION

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Reasonable modification of treatment rooms or equipment is allowed without specific permission from the Program Director and, when applicable, the Director of facilities. Please report all deficiencies or defects in equipment promptly. If service is not accomplished the same day, resubmit the following day and inform the administrative assistant. Resident responsibilities for operatory cleanliness are:

1. Disposal of all waste (cotton rolls, gauze, used articulating paper, cups, saliva ejectors, patient drapes, paper towels, brown paper on counter tops, etc).

2. Sweeping floor should excessive debris be present. This is especially true for dental

compound trimmings.

3. Returning special instrumentation to appropriate place. This would include implant screwdrivers and parts, facebows, pantagraphs, porcelain staining kit, casts, prostheses, etc.

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SECTION XI

GRADUATE STUDENT TEACHING

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All students in the Advanced Prosthodontic Program at Nova Southeastern University College of Dental Medicine are required to teach the equivalent of one half day per week. The assignments will be in Restorative Dentistry (usually fixed prosthodontics or occlusion) or Removable Prosthodontics. There is some latitude to give a student his or her preference. Teaching is a requirement of this and all accredited programs in Advanced Prosthodontics as outlined in the American Dental Association Council for Accreditation. Students will teach regardless of whether they receive a stipend. Stipends are scholarships or grants for those not receiving outside financial support. They are available only to a select limited number of students. As Graduate Associates (GAs), when you wish to request to be relieved from your teaching duties to attend a continuing education course or professional meeting, you MUST apply for permission from the Program Director by completing an Application for Leave. This must be done in duplicate, submitted to the Director for his authorization and signature. THIS FORMS MUST BE COMPLETED AT LEAST 4-6 WEEKS IN ADVANCE of the date you are requesting absence. This is to insure that students will not be assigned to you on those half-days. Application in the above manner does not guarantee you will be given permission to block-out those half-days. However, every effort will be made to honor your request. Every resident must obtain a teaching and patient treatment license to be enrolled in the program. Paperwork for obtaining this license is in the Office of the Associate Dean for Clinical Affairs.

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SECTION XII

EMERGENCY PROCEDURES

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a. Medical Emergency Situation If a medical emergency arises while treating a patient do the following: a. Stay with the patient. Send someone to get the supervising clinical faculty member. b. Initiate emergency help for the patient.

1) Chair position 2) Airway, breathing, circulation support if indicated. 3) Obtain vital signs.

c. Send someone for the nearest oxygen equipment. d. If further assistance is needed - send someone to call the OMFS clinic at . OMFS personnel will

respond with ACLS equipment. If further assistance is needed call 911. Emergency Resuscitation Equipment

Emergency oxygen and resuscitation equipment are located in the central hallway. This is not to be used for practice in the clinic. There is equipment available in OMFS clinic for practice. You are encouraged to use this equipment.

b. Ingested or Aspirated Items Listed below are precautions to minimize these occurrences:

a. Appropriate chair position b. Rubber dam c. Gauze pack d. Length of floss attached to instrument, item, prosthesis, etc.

Whenever suspicion that an object has been ingested or aspirated:

a. Institute any emergency assistance that is indicated. b. Advise faculty of occurrence. c. Contact OMFS emergency assistance - . d. Finish planned treatment if it does not compromise the patient. e. Fill out incident report before discharging the patient. Patient and their record must be taken to

OMFS to fill out paperwork and to follow-up with further evaluation.

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c. Needlestick Protocol Any wound made with an object that is contaminated with another individual's (source patient) body fluid (saliva or blood) is considered contaminated with infectious material. a. IMMEDIATE WOUND CARE

- encourage bleeding - wash with antiseptic - cover with sterile bandage

b. Make sure patient's planned dental care is completed or temporized. c. The injured individual, the source patient, and the patient's record should be taken to OMFS.

1) THE INJURED INDIVIDUAL

The wound will be evaluated and treated or referred for treatment.

Basic information about the short and long term concerns because of having a contaminated wound will be outlined.

The injured individual will be referred to: Student - Student Health Clinic Faculty/Staff - Occupational Medicine Clinic

2) THE SOURCE PATIENT

The patient's record will be reviewed and he/she will be advised of any concern for the injured individual. Written consent will be obtained for bloodwork (Hepatitis B antigen and HIV antibodies). The consenting patient will be escorted to Out-Patient Laboratories (1st floor, University Hospitals Clinic Building) to have blood drawn. The College will pay all charges.

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3) FOLLOW-UP

The injured individual will be followed by Student Health/Occupational Medicine.

The source patient's blood work results will be reported to the OMFS Clinic Director. The Director will advise the health service of these results. Results will also be made available to source patient.

If the source patient's lab work indicates positive for hepatitis B or HIV reactive, the OMFS Clinical Director will consult with:

Dr. Steve Kaltman OMFS

for further counseling/evaluation of the source patient.

4) REPORTING

Either the Director or nurse will complete university and College of Dental Medicine incident reports in OMFS. When the reports are completed they will be sent to Director of Clinics of the College. Copies will be kept in OMFS. A formal note will be put on the source patient's record indicating treatment and injury.

The business office will be advised of the expected bill to cover the source patient's testing.

5) BILLING

All billing for testing will be forwarded to the OMFS Clinic Director. He will forward to College of Dentistry Director of Clinics for payment.

d. CPR Certification and Treatment Protocol Each resident will receive training in Basic Life Support (BLS) through the College of Dentistry. Such training is good for two years. Recertification will be available as needed. e. TB Testing Each resident will be required to receive a TB test conducted at employee health located in the University’s Hospital.

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SECTION XIII

INFECTION CONTROL PROCEDURES

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INFECTION CONTROL GUIDELINES 1. INTRODUCTION

Because all infected patients cannot be identified by history, physical examination or readily available laboratory tests, each patient must be considered as potentially infectious and the same infection control procedures (Universal Precautions) will be used for all patients.

Dental personnel are exposed to a wide variety of microorganisms in the blood and saliva of patients. The use of effective infection control procedures will prevent cross-contamination.

2. MEDICAL HISTORY

A thorough medical history will be obtained from each patient and it should be reviewed and updated at EVERY subsequent visit. Specific questions will be asked regarding: care being given by a physician, medications, allergies, recent illnesses, exposure to infections, with all information appropriately recorded in the patient's record.

3. CLINICAL PROCEDURES

a. INFECTION CONTROL PROTOCOLS APPLY TO ALL PATIENTS.

b. Constantly consider the potential for cross contamination.

c. Take the time to plan your procedure and set up your operatory accordingly. It will save you time and preserve the integrity of your operatory.

d. Secure long hair and loose fitting clothing as appropriate.

e. Always create a proper barrier by wearing:

GLOVES MASK PROTECTIVE EYEWEAR OR FACE SHIELD FASTENED CLINIC ATTIRE

f. Always wash your hands with soap before gloving and always place gloves on as the last step before entering the mouth.

g. NEVER leave the operatory with just your exam gloves on. Overglove or remove your gloves

and wash hands if you find it necessary to leave the operatory area.

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h. "Clean and disinfect" using one of these methods:

SOAK IN DISINFECTANT FOR 10-30 MINUTES WIPE WITH DISINFECTANT AND A 10-MINUTE AIR DRY WRAP IN DISINFECTANT-SOAKED GAUZE FOR 10 MINUTES

i. Be extremely careful with used injection needles. Only recap needles using the one hand scoop

method. This makes it available for possible reuse on the same patient and facilitates safe disposal.

j. Any impression or intraoral record made during a planned procedure must be cleaned and

handled in the manner stipulated in this outline. (See 8, A.)

k. Any denture or appliance removed for work during a planned procedure must be cleaned and handled in the manner stipulated in this outline. (See 8, A.)

4. PERSONAL PROTECTIVE EQUIPMENT (PPE)

a. GLOVES

Gloves will be worn to prevent skin contact with blood, saliva or mucous membranes. Gloves will also be worn when touching items or surfaces that may be contaminated with blood, body fluids or secretions.

After each patient contact, gloves will be removed and hands washed and regloved with new gloves before treating the next patient. Repeated use of a single pair of gloves by disinfecting them between patients is not acceptable. Exposure to soap and/or disinfectants often causes defects in the glove material, thereby diminishing their value as an effective barrier. Furthermore, this method of disinfection may not be adequate to prevent cross contamination between patients.

Overgloves are to be used when writing in charts or handling instruments or equipment which is difficult to disinfect such as X-ray units, amalgamators, light curing units, etc.

b. GOWNS

Clinic gowns will be worn to cover street clothes. Gowns are to be worn when providing patient care - not in the laboratory area. Gowns are not worn outside the building.

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c. MASKS

Surgical masks will be worn to protect the oral mucosa and the nasal mucosa from spatter and aerosols of blood and saliva.

d. PROTECTIVE EYEWEAR

Protective eyewear with side shields or a plastic face shield will be worn to protect the operator's eyes from spatter and aerosols of blood and saliva.

e. WORKING SURFACES

Surfaces that may be contaminated by blood or saliva, e.g., light handles or X-ray unit heads, must be wrapped with clear plastic. Use gloves to remove and discard the covering. These surfaces will be recovered with clean material.

Surfaces and equipment that cannot be covered or removed for cleaning and sterilization should be thoroughly cleaned (rough surfaces scrubbed) and disinfected. A disinfectant should then be applied and left moist on the surface to air dry.

5. LIMITING CONTAMINATION

All procedures should be performed in a way that minimizes the formation of droplets, spatter and aerosols. This can be accomplished by using high-speed evacuators, proper patient positioning, and the use of a rubber dam, whenever appropriate.

Dental personnel must not contaminate the treatment field by contacting objects such as charts, telephones, and instrument cabinets during patient treatment procedures.

Be mindful that once intraoral procedures have begun, touching anything outside the treatment field will result in contamination. Being prepared with all necessary instruments and materials before the patient is seated will eliminate many of the potential sources of contamination.

a. LABORATORY INSTRUMENT CASE

No non-clinical items will be brought to the operatory except for diagnostic casts and specific laboratory equipment needed for the patient you are treating during the current clinical appointment.

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b. HAND WASHING

Hands will be washed thoroughly with an antimicrobial or antiseptic handwash solution before gloving. Remove gloves and wash hands between patients and after touching inanimate objects.

Precautions should be taken to avoid hand injuries during procedures. When gloves are torn, cut, or punctured, remove them as soon as it is compatible with the patient's safety. Wash hands thoroughly and reglove before completing the dental procedure.

c. USE CARE, IN DISPOSAL OF SHARP INSTRUMENTS AND NEEDLES

A sterile syringe, a new disposable needle, and new local anesthetic solutions will be used for each patient. Needles, scalpel blades, and other sharp instruments should be handled carefully to prevent unintentional injuries.

Since an individual patient may require multiple injections of anesthetic, recap after each injection using the one hand scoop method.

Disposable needles will not be bent or broken after use. Discard needles, carpules, scalpel blades, and other sharp items into the sharps container at the Clinic Supply Desk. NEVER discard any sharp in any other manner.

6. INFECTION CONTROL TECHNIQUE

a. Prior to seating the patient:

1). Turn the wall and unit switches on.

2). Wash hands and put on overgloves.

3). The following items will be carefully sponged (not sprayed) with Disinfectant, wiped clean with a paper towel, sponged again with Disinfectant and left to air dry:

a). Bracket table

b). Handpiece and holders

c). Air/Water Syringe, including handle and holder

d). Saliva ejector, suction tip holders

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e). Light handles, switch and intensity control if applicable (Do not wipe the surface--front

or back-- of the light. This can damage the surface).

f). Chair adjustment switches

g). Chair

h). Stool

i). Counter top

4). Remove overgloves and dispose of properly.

5). At the beginning of each operating day, the water syringe and the highspeed handpiece will be flushed for 30-60 seconds.

6). Place a plastic cover over:

a). the headrest

b). each light handle

c). Handpiece-hose connectors d). The air/water syringe

e). The suction tip holder

7). Place clean, brown paper on the counter top.

b. After the patient is seated:

1). Adjust the chair, including headrest.

2). Place patient napkin.

3). Update medical history, discuss treatment, do necessary paperwork, payments, schedule next

appointment.

4). Have the patient rinse thoroughly with an antiseptic mouthwash just prior to any patient care.

5). Put on gown, mask and glasses.

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6). WASH HANDS THOROUGHLY USING A 45 SECOND HAND SCRUB TECHNIQUE (remove jewelry before hand washing).

7). Put on gloves.

8). Rinse gloves (no soap).

9). Open sterilized instrument packs and use blue wrapping as a barrier on the bracket table.

10). Do not handle patient charts or radiographs with contaminated gloves. Remove and wash

hands or use overgloves.

11). Remove gloves and wash hands before leaving the treatment area.

c. Between patients:

1). Wear overgloves to clean all contaminated instruments. Place all paper, disposable items and debris from the bracket table and counter top into the used headrest cover and then into the appropriate waste receptacle.

2). Flush water syringe and highspeed handpiece for 30 seconds to flush out any aspirated

materials or organisms.

3). Wipe down unit and all components with Disinfectant solution. Repeat a second time and allow to air dry.

4). Flush the saliva ejector system with several cups of warm water (the more the better).

d. At the end of the treatment period:

1). Repeat steps described in c. ("Between patients"), but allow second wipe to air dry.

2). Raise chair 3/4 of maximum height.

3). Turn off the unit switches.

4). Place foot control on the chair base.

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5). Wearing mask, eyewear protection, and overgloves, carefully clean all contaminated instruments and equipment with a brush, soap and water to remove saliva and debris. All instruments must be cleaned before returning for sterilization. Be sure to flush suction tips, etc., as part of this cleaning process. Place the instruments into a plastic bag. Heavy gloves are available in sterilization area for students to use.

7. a. NON-AUTOCLAVABLE ITEMS:

Items such as plastic rulers, measuring items, shade guide buttons, etc., must be thoroughly cleaned with soap and water, dried and then disinfected.

b. DISPOSABLE ITEMS:

Items such as wooden or plastic wedges, rubber prophy cups, plastic saliva ejectors, prophy brushes, sandpaper disks, mylar strips, etc., are considered disposable and are to be disposed of after use.

8. GENERAL GUIDELINES FOR PROSTHETIC MATERIALS

a. Impressions, interocclusal records and facebow transfer:

Impressions, interocclusal records and facebow impressions will be washed thoroughly under running tap water to remove saliva, blood or debris. Remove excess water, spray with Disinfectant solution, and place on a clean paper towel to air dry. Alginate impressions should be kept under a damp towel to reduce drying distortion. After a minimum 10 minute period, overglove and wash again. Items may now be taken to the laboratory for pouring or mounting procedures.

Note: Record bases must be treated as above before replacing them on their cast.

Note: Articulators should be disinfected with the spray and wipe, spray and air dry process.

b. Check-out and return of items from central clinic supply:

When checking out items such as pin kits, amalgam, electrosurgery units, shade guides, porcelain stain kits, etc., hands must be degloved and washed or overgloved. When returning to the operatory, place these items on an uncontaminated surface. Anticipate how the item will be used and make preparation for it prior to contaminating your hands again. Disinfect all items before returning them.

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c. Use of clinical area laboratory facilities:

A common area such as this is particularly susceptible to contamination and cross-infection. Disinfect all items, which have had patient exposure before bringing them into the laboratory. Hands should be overgloved or thoroughly washed. Use eye protection, mask, and ventilation when grinding or polishing. Put down fresh paper each time a procedure is performed. Clean up after yourself to minimize the accumulation of contaminating debris.

1). Lathes

Any item to be ground or polished must be disinfected. Sterilized rag wheels or stones will be used for each patient as well as a disposable tray and new individual sized quantities of pumice, rouge, or polishing compounds. Mask, protective eyewear and proper ventilation must be used. Do not use pumice from a pan or a wheel that has been left on the lathe.

2). Ultrasonic cleaners

New containers (with covers), and fresh cleaning solutions will be used for every patient. Items brought into the lab from the operatory will have been disinfected and hands will have been degloved and washed, or overgloved. After use the container and solution must be properly disposed.

3). Air abrasion units

Castings must be disinfected before entry in the air abrader and before returning to the patient.

9. STANDARD OPERATING PROCEDURE IN THE DENTAL SCHOOL PROSTHETIC

LABORATORY

1). All materials submitted to the laboratory must be clearly identified as to the state of disinfection.

Any item submitted to the laboratory that is not clearly identified as being disinfected will be treated as follows:

a. Alginate Impressions - household bleach diluted to l to 4 parts H20 for 3 minutes.

b. Polysulfide Impressions - alkaline glutaraldehyde or 1% sodium hypochlorite for 10 minutes.

c. Polyvinyl or Silicone Impressions - alkaline glutaraldehyde for 10 minutes.

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d. Materials that have been contaminated by try-in or wearing: Acrylics, acrylics and metals, metal/ceramics; sodium hypochlorite, household bleach, 20% solution for 10 minutes.

e. Gypsum Products - iodophors soak or spray 10 minutes, then wash.

2). The laboratory will have an area for acceptance of materials that will be treated with Disinfectant

the same as in a patient treatment area. The laboratory will also have an area for discharge of finished materials separate and distinct from the acceptance area and will be treated the same as the acceptance area.

a. Sprayed and wiped after each acceptance of submitted materials.

b. Sprayed and wiped and sprayed and air dried at the beginning and end of each day.

3). All in-coming materials will be handled using barrier protection until proper disinfection

processing has been completed.

4). Two polishing or finishing lathes will be maintained in the laboratory: one for uncontaminated materials and one for contaminated materials.

a. For uncontaminated materials or those being fabricated and "untried in", the pumice will be

changed weekly and a solution of iodophor disinfect will be used as the wetting agent.

b. For contaminated materials or those that have been worn or "tried in", a fresh paper plate and sterilized pumice and sterilized rag wheels and/or brushes will be utilized and properly disposed of for each individual piece of submitted material.

After each use, the paper plate containing pumice will be placed in a container that can be autoclaved. Autoclaving will be done daily and disposition made following clinic guidelines. The equipment will be cleaned and sprayed with iodophors. Rag wheels and other instrumentation will be re-bagged and autoclaved for additional use. This apparatus will be treated the same as a patient treatment area.

5). All items dispensed from the laboratory will be disinfected, rinsed, and delivered in a plastic bag

either dry or in water.

6). Every effort must be made to prevent cross-contamination by disrupting the infectious chain of all materials reaching the laboratory.

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10. SUMMARY OF STERILIZATION AND DISINFECTION ITEM TO BE STERILIZED OR DISINFECTED STERILIZATION OR DISINFECTION

AGENT PROCEDURE

1.) Surface Disinfection

Sodium Hypochlorite 1:10 Spray and spread with cloth, or wipe on; repeat; leave 10 minutes; wipe dry.

Wexcide Spray and spread with cloth, or wipe on; repeat; leave on 3 to 10 minutes.

2.) Holding solution for instruments

Cidex Place instruments in holding solution if they cannot be cleaned immediately.

3.) Instrument disinfection

Wexcide Wash off blood, or use Ultrasonic Cleaner; soak for 10-30 minutes.

Cidex Wash off blood, saliva, and debris or use Ultrasonic Cleaner; soak for 10-30 minutes.

4.) Instrument sterilization: a. Cassettes Steam Autoclave Harvey Chemiclave Clean instruments in Ultrasonic Cleaner

before wrapping and sterilizing.

b. Operative cutting hand instruments Harvey Chemiclave Wash off blood, saliva, and derbis or use Ultrasonic Cleaner before bagging and sterilizing.

c. Endo files, kits Ethylene Oxide Gas Wipe off derbis from files and reamers with alcohol-dampened gauze; wrap; sterilize.

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d. Burs, diamonds, stones Ethylene Oxide Gas Wipe off blood, saliva, and debris with alcohol dampened gauze; bag; sterilize

e. Oral surgery instruments Steam Autoclave Wash off blood, saliva, debris, or use Ultrasonic Cleaner before bagging or wrapping and sterilizing.

5.) Non-Autoclavable items Ethylene Oxide Gas, Cidex, Wexcide, or Sodium Hypochlorite

Choice of agent and procedure will depend on the material the item is made of.

6.) Impression: silicone, rubber base, compound

Sodium Hypochlorite or Wexcide Thoroughly rinse under running water to remove blood and saliva. Soak for 10 minutes. Rinse.

7.) Impression: alginate, ZOE, polyether Wexcide Thoroughly rinse under running water to remove blood and saliva. Spray impression. Cover with Wexcide dampened gauze. Leave for 10 minutes. Rinse.

8.) Gypsum casts Wexcide Spray to dampen surface after separating from impression.

9.) Complete dentures, partial dentures with processed acrylic

Wexcide

Wash denture with antimicrobial soap and rinse. Soak in Wexcide for 15 minutes, rinse thoroughly. To be done before taking denture into laboratory.

10.) Partial denture frameworks, Maryland bridges, crowns, bridges.

Steam Autoclave Wash item with antimicrobial soap and rinse; bag and steam autoclave before sending to the laboratory for further work.

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Wexcide Wash item with antimicrobial soap and

rinse. Soak for 15 minutes and rinse before taking item into laboratory.

11.) Handpieces (High-speed and Slow-speed) Wexcide Wipe off blood, saliva, debris with Wexcide dampened gauze and wrap with a new dampened gauze after each patient.

Steam Autoclave Wipe off blood, saliva, and debris with Wexcide dampened gauze. Lubricate handpiece following manufacturer’s instructions. Bag, steam autoclave, re-lubricate handpiece before using. To be done at noon and at the end of the day or after any patient with an infectious disease or at high risk.

12.) Wax recoreds, denture and partial denture wax set-up.

Wexcide Rinse thoroughly under running water to remove saliva. Soak item for 15 minutes. Rinse.

13.) Air/Water Syringe Steam Autoclave (tip only) Wipe off saliva, debris with Wexcide dampened gauze. Remove tip, bag, and steam autoclave. (To be done after each patient.)

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SECTION XIV

MISCELLANEOUS INFORMATION

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a. Annual Leave The residents in the Advanced Prosthodontics Program are not granted any annual leave or vacation time since they are considered full-time students in the University. However, since Graduate School schedules do not incorporate the long seasonal "breaks" that the undergraduate schools utilize routinely, some mechanism of annual leave is warranted. Therefore, each resident is eligible for two weeks of annual leave per year, to use at his/her discretion. A written request for leave must be submitted to the Program Director at least 1 month before the requested leave dates. Arrangements with fellow residents must be made to cover any potential emergency visits patients of the leave requestor may find necessary during the absence. Restrictions do exist. Annual leave will not be granted during the first four months of the Program or during the last month of the Program unless for extreme hardship circumstances. It is strongly urged that annual leave be used during the normal holiday or "break" times to reduce the absences from seminars, courses, and clinic. Leave days will not be carried over from year to year. The resident is responsible for fulfilling the requirements of the program and this should be considered when leave requests are submitted. b. Sick Leave Residents are not given a finite number of sick days per academic year. The resident is expected to be in attendance at the courses as the schedule dictates unless illness prevents it. In which case the resident is expected to contact the Program Director at the earliest possible moment and explain the situation. It is also the resident's responsibility to contact the front desk (262-7217) and inform them of the situation so they can reschedule any patient appointments affected by the illness. Illnesses of over three days duration may require a physician's explanation. Please call the Program Director's office at 262-4345 (or Sarah Cruz 262-7217) and leave a message indicating illness so he will know as well. c. Professional Leave Residents are allowed professional leave to attend specific prosthodontic related dental meetings. These are: The American College of Prosthodontists Annual Session, The Academy of Fixed Prosthodontics meeting in Chicago in February, the IADR and AADR meetings, and the Academy of Osseointegration meeting. If the resident wished to present a table clinic or a projected clinic at any dental meeting other than the IADR or AADR, the program may not provide travel support. Submission to present must be discussed with the Program Director prior to submission.

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d. Digital Image Acquisition and Processing The Program will receive a copy of each image the resident makes. It is recommended the resident shoot at least two exposures of every view he/she elects to take. It is hoped that each patient treated in the Program will have an adequate photographic file. MANDATORY PICTURES INCLUDE:

A. Full pre-treatment series including all radiographs. B. Full post-treatment series including post-treatment radiographs. C. Intra-oral photos of preparations, castings, try-ins, implant frameworks, etc. D. Lab steps as requested by faculty.

This Image Library will be available for faculty and residents to use in order to enhance any presentation that he/she may be asked to present. e. Typing and Computer Support Residents are responsible for constructing letters to patients, treatment plans, other letters of communication for program purposes. Each resident will purchase his or her own laptop computer for this usage. f. Clinic Closings and Open Sessions Clinic is closed for this program, not necessarily the rest of the College, during the Christmas/Hanukah holiday week. Residents who are in town may be asked to take care of emergency patients. Clinics are also closed during the last two weeks of June. Again residents will be asked to cover emergency needs of program patients. Residents will be required to set up a call schedule for carrying the emergency beeper during these times. The beeper number is 954-730-3843. The "free" week between the end of one quarter and the beginning of the next, other than Christmas/Hanukah and June, are usually open clinic sessions. Limitations during these weeks are faculty availability and operatory availability. Therefore, not all clinic sessions may be available or "open" even though the week is an open clinic week.

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g. Sexual Harassment Policy Applies to University faculty, staff and students:

Policy The University Administration, faculty, staff and students are responsible for assuring that the University Maintains an environment for work and study free from sexual harassment. Sexual harassment impedes the realization of the University's mission of distinction in education, scholarship, and service and will not be tolerated. The University Administration seeks to eliminate sexual harassment through education and by encouraging faculty, staff and students to report concerns or complaints. Prompt corrective measures will be taken to stop sexual harassment whenever it occurs. A. Definition Sexual harassment is any unwelcome sexual advance, request for sexual favor, offensive reference to gender or sexual orientation, or other conduct of sexual nature when: 1. Submission to or rejection of such conduct is used either explicitly or implicitly as a basis for any

decision affecting terms or conditions of an individual's employment, participation in any program or activity, or status in an academic course;

2. Such conduct has the purpose or effect of unreasonably interfering with an individual's work

performance or educational experience, or creates an intimidating, hostile or offensive environment for working, learning or living on campus.

Sexual harassment can occur between an employee and a supervisor, or co-worker or customer; or between a student and a faculty member or another student. B. Regulations 1. Consensual Relationships

Consenting romantic and sexual relationships between supervisor and employee or between faculty and student are strongly discouraged. In the event of an allegation of sexual harassment, the University will be less sympathetic to a defense based upon consent when the facts establish that a professional power differential existed within the relationship. Consensual relationships are prohibited where the supervisor has direct responsibility for evaluation and direction of the employee or where the faculty member has primary responsibility for academic evaluation or direction of the student. These relationships may be subject to concerns about the validity of consent, conflicts of interest, and unfair treatment of other students or employees. Further, such relationships can undermine the atmosphere of trust essential to the educational process and the employment relationship.

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2. Confidentiality and Non-retaliation

University administrators will make every reasonable effort to conduct all proceedings in a manner, which will protect the confidentiality of all parties. It is expected that parties to a complaint will observe the same standard of confidentiality. This practice is in the best interest of all parties.

University policy and state and federal law prohibit retaliation against an individual for reporting sexual harassment or for participating in an investigation. Retaliation is a serious violation, which can subject the offender to sanctions independent of the merits of the sexual harassment allegation.

3. Sanctions

When it has been determined that sexual harassment has occurred, steps will be taken to ensure the harassment is stopped immediately. Corrective measures consistent with the severity of the offense will be imposed. Sanctions may range from a verbal reprimand up to and including dismissal from the University and, with prior notice to the harasser, a record of such sanctions will become part of the harasser's personnel records. Sanctions may also be imposed when an administrative official or supervisor fails to respond to a complaint of sexual harassment.

It is also a violation of this policy for anyone to make false accusations of sexual harassment.

C. Responsibilities 1. The Office of Human Resources is responsible for the administration of this Policy and the

associated procedures. 2. Each vice president, dean, department chair, administrative official or supervisor shall be

responsible for assuring compliance with this policy. NOTE:

See Procedures for Addressing Complaints Under the Sexual Harassment Policy on the following pages.

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Procedures for Addressing Complaints Under the Sexual Harassment Policy I. PREVENTION AND EDUCATION Educational efforts are essential to the establishment of a campus environment as free as possible of sexual harassment. The primary goals to be achieved through education include:

. ensuring persons are aware of their rights;

. notifying persons of prohibited conduct;

. informing parties of the proper way to address complaints of violations; and

. informing the community about the problems of sexual harassment. The Office of Human Resources will coordinate these educational programs. The Sexual Harassment Policy and Procedures will be published in pamphlet form and disseminated to the University community on a regular basis. The pamphlets will be included in orientation materials for new students, faculty and staff. II. EXAMPLES OF SEXUAL HARASSMENT Sexual harassment encompasses any sexual attention that is unwanted. Verbal or physical conduct prohibited by the University’s Sexual Harassment Policy includes, but are not limited to:

(A) Physical assault;

(B) Direct or implied threats that submission to sexual advances will be a condition of employment, work status, promotion, grades, or letters of recommendation;

(C) Direct propositions of a sexual nature;

(D) Subtle pressure for sexual activity;

(E) A pattern of conduct (not legitimately related to the subject matter of a course) intended to cause

discomfort or humiliate, that includes: (1) comments of a sexual nature; (2) sexually explicit statements, questions, jokes or anecdotes; (3) touching, patting, hugging, brushing against a person's body, or repeated or unwanted staring; or (4) remarks about sexual activity, experience or orientation.

III. PARTIES Under the University Sexual Harassment Policy, any student, staff or faculty member may bring a complaint against any member of the University community believed to have violated the Policy.

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Sexual harassment concerns are most appropriately resolved at the lowest possible level of responsibility. When such resolution is not possible, the procedures outlined below are available. Prompt and thorough investigation of all claims is essential. IV. PERSONS AUTHORIZED TO RECEIVE COMPLAINTS A complaint alleging a violation of the University's Sexual Harassment Policy may be brought to the following officials: A. any academic or administrative official of the University (e.g. dean, chairperson, vice president,

director, supervisor, department head); B. Dispute Resolution Services in the Office of Human Resources; and C. any person designated as the Human Resources Representative within a department or unit. A Human Resources Advisor from Dispute Resolution Services is available to assist any person with a sexual harassment complaint. Likewise, the Human Resources Advisor is available to assist any administrative officer in handling a complaint. All above officials are expected to participate in training related to handling sexual harassment complaints provided by the Office of Human Resources. V. AVAILABLE OPTIONS A person bringing a complaint will be advised of all options under the Policy by the official taking the complaint. These options are described below. A. Informal resolution of the complaint

1. by the complainant directly with the alleged harasser;

2. with the assistance of the Human Resources Advisor; or

3. with the assistance of any official designated in Part IV above. B. Filing a formal complaint with the Office of Dispute Resolution Services. C. Filing a grievance under the nondiscrimination clause of the appropriate collective bargaining

agreement. D. Filing an action outside the University; i.e. Equal Employment Opportunity Commission, Florida

Civil Rights Commission, Department of Education.

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The complainant should be informed that:

• A decision to proceed informal does not preclude the filing of a formal complaint at some later time.

• The filing of an informal complaint is not a prerequisite to a formal complaint.

• A complainant should not simultaneously process complaints arising from the same

occurrence with more than one office. • Internal actions do not extend filing deadlines relating to actions outside the University.

VI. PROCEDURES FOR INITIAL INTAKE OF COMPLAINTS A. Discussion of relevant considerations. The official to whom the complaint is initially brought will discuss with the complainant the following relevant considerations:

1. The complaint process to include the available options (described in Part V above);

2. The issues involved in the complaint;

3. Possible resolutions;

4. Protection of the complaint's interests (e.g., confidentiality; need for truthfulness by both parties; keeping complainant fully informed of steps taken during the process; protection of complainant and witnesses against retaliatory action); and

5. Protection of the interests of the alleged harasser (e.g., confidentiality; need for truthfulness by

both parties; right to be notified of existence of any formal complaint; opportunity to respond to the complainant's allegations).

6. The complainant shall be given a copy of the Sexual Harassment Policy and these procedures.

B. Determination as to further action. Once all of the above information has been discussed, the complainant determines which process to use to resolve the complaint. VII. INFORMAL COMPLAINTS

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A. Referral If the complainant wishes to pursue informal resolution of the complaint, he or she may do so either with the assistance of the official to whom the complaint was initially brought or with another official as authorized in Part IV. The official or department selected by the complainant to process the complaint will follow the procedures below. If the complainant elects to file a formal complaint, the official to whom the complaint was initially brought will refer the complainant to the Office of Dispute Resolution Services for that purpose. B. Procedures for informal complaints.

1. Notice of complaint to Office of Dispute Resolutions Services.

Upon receiving an informal complaint, the official handling the complaint will notify the Office of Dispute Resolution Services in writing of the complaint and will provide a summary of the allegations. (A summary form is available for this purpose.) If the complainant has requested anonymity, or that no action is taken or that the alleged harasser not be informed of the complaint, such complaints should be reported without disclosing information, which would identify the parties. The Office of Dispute Resolution Services will treat the information reported confidentially.

This information is for data collection purposes and will be used to monitor complaints to assure claims are adequately addressed.

2. Investigation of complaint.

The official handling the informal complaint should follow the procedures for investigation of complaints set forth in Section VIII(B) on page 5.

3. Notice to the alleged harasser.

In the context of an informal complaint, the complainant's consent for informing the alleged harasser of that complaint should be obtained. In situations when the alleged harasser is not apprized of the complaint, the complainant should be informed that the ability to impose formal sanctions is limited.

4. Time period for investigating complaint.

Informal complaints should be concluded within thirty (30) calendar days of their inception. Where this is not reasonably possible, the official processing the complaint should notify the complaint in writing of the delay and the reasons for such delay.

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5. Notice of conclusion of investigation.

Within ten (10) workdays of concluding the investigation of an informal complaint, the official will notify the Office of Dispute Resolution Services in writing that the complaint has been concluded and the resulting outcome or resolution.

6. Other options.

If the complainant is not satisfied with the informal resolution, she/he again should be advised of the option of filing a formal complaint with the Office of Dispute Resolution Services and the existence of options outside the University.

VIII. FORMAL COMPLAINTS A. Referral to the Office of Human Resources Dispute Resolution Services. When the complainant elects to file a formal complaint, the complainant should file the complaint in writing with Dispute Resolution Services in the Office of Human Resources. (A complaint form is available for this purpose.) B. Procedures for formal complaints.

1. Method of formal investigation.

The Office of Dispute Resolution Services will be responsible for the investigation of the complaint, with the cooperation of the department or unit involved, and will keep the administrative officer informed.

2. Notice to the alleged harasser.

The alleged harasser will be informed of the allegations and identity of the complainant at the commencement of the process.

3. Investigation of formal complaint.

a. Purpose of investigation.

The purpose of the investigation is to determine whether a reasonable basis exists for the alleged violation(s) of the Sexual Harassment Policy.

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b. Persons to be interviewed.

The official conducting the investigation will interview the complainant, the alleged harasser, and any other persons believed to have knowledge of the allegations. The alleged harasser will be afforded full opportunity to respond to the allegations. Throughout the investigation, steps to preserve the confidentiality of all persons involved will be taken by the investigating official.

c. Matters to be investigated include:

I. Whether the specific conduct constitutes sexual harassment, including the type(s) of

conduct; frequency of occurrence; date(s) or time period over which the conduct occurred; location of alleged occurrence(s); whether similar others; and all factual circumstances have made complaints upon which the complaint is based.

ii. The specific relationship of the alleged harasser to the complainant (e.g., professor-

student, supervisor-employee, etc.) iii. The effect of the alleged harasser's conduct on the complainant, including any

consequences that may be attributed to the conduct and whether the alleged harasser was aware of the complainant's concern.

iv. Whether the department head or supervisor was aware of the complainant's concern,

and if so, how he/she became aware of the concern. v. Whether any prior steps were taken to resolve the complaint.

vi. Whether the complainant is aware of appropriate support services available.

4. Possible outcomes of investigation.

a. The possible outcomes of the investigation are:

I. a finding that there is a reasonable basis supporting the alleged violation;

ii. a finding that there is no reasonable basis supporting the alleged violation; or

iii. a negotiated settlement of the complaint.

5. Time period for investigating complaint.

Investigations of formal complaints should be concluded within thirty (30) calendar days of their inception. Where it is not reasonably possible to conclude the complaint within that amount of time, the Office of Dispute Resolution Services will notify the complainant in writing of the delay and reasons therefore.

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6. Notice to parties.

At the conclusion of the investigation, the Office of Dispute Resolution Services will promptly inform both the complainant and the alleged harasser of the outcome and the factual findings. If the investigation reveals no reasonable basis for supporting sexual harassment, the investigator will advise the complainant of options outside the University and the time limits for filing such actions.

7. Written report of findings.

Upon conclusion of the investigation of a formal complaint, the Office of Dispute Resolution Services will prepare a written summary of the findings. If the investigation supports a claim of harassment, recommendations will be made to take prompt and effective action, consistent with the severity of the offense. This report will be provided to the appropriate administrative official (as described in Subsection 9(B) below) for implementation.

8. Formal sanctions/resolutions.

a. Sanctions.

When there is a finding of sexual harassment, if negotiated settlement of the complaint has not occurred, formal sanctions will be imposed by the appropriate administrative official.

Where sexual harassment is found, steps will be taken to ensure the harassment is stopped immediately. Appropriate corrective measures may range from verbal reprimand up to and including dismissal, in accordance with established University Rules and Procedures. The Office of Dispute Resolution Services will monitor sanctions to ensure compliance with the Policy.

b. Person responsible.

The following administrators in consultation with Dispute Resolution Services will impose formal sanctions.

I. In cases involving a faculty member, graduate assistant, or other instructional

personnel, by the Dean in consultation with the Senior Vice President for Academic Affairs and Provost;

ii. In cases involving a staff person as the alleged harasser, by the department

administrator in consultation with the Vice President responsible for the unit; and

iii. In cases involving a student, the appropriate office in the office of the Vice President for the Student Affairs.

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c. Governing provisions.

Sanctions for violations of the Sexual Harassment Policy imposed are governed by the following procedures:

I. In cases involving faculty members, by the Rules of the University Faculty.

ii. In cases involving graduate assistants, by the Student Code of Conduct.

iii. In cases involving staff members, appeals from any formal disciplinary action taken

are governed by the following:

a) for administrative and professional employees, by Section 8.15 of the Operating Manual;

b) for classified civil service employees not included in the bargaining unit by Rules for

Classified Civil Service; c) for bargaining unit employees by procedures available under the collective bargaining agreement; and

iv. In cases involving students, by The Student Code of Conduct.

IX. PRESENCE OF SUPPORT PERSONS The complainant or alleged harasser may be accompanied at the initial interview (and subsequently as appropriate) by a friend, family member, or other individual of the complainant's or alleged harasser's choice whose presence is necessary to provide support and/or clarification of the facts related to the complaint. X. CONFIDENTIALITY The Office of Human Resources (Dispute Resolution Services) treats as confidential all information received in connection with the filing, investigation, and resolution of complaints except to the extent it is necessary to disclose particulars in the course of the investigation. Parties to a complaint will observe the same standard of strict confidentiality. This practice is in the best interests of all parties. Failure to respect confidentiality may result in sanctions. XI. RECORD KEEPING Any person conducting an investigation, whether formal or informal shall maintain a written record of all witness interviews, consent provided, evidence gathered, and the outcome of the investigation.

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h. Grievances/Due Process Should a resident disagree with an evaluation or given grade, to the extent that the disagreement is based on substantive information, the resident should first seek clarification and /or adjustment with the person assigning the disputed evaluation or mark. If the issue cannot be resolved the order of hierarchy to reach agreement is as follows: instructor or course director, program director, section chair (who will assign a review of the matter to an ad hoc committee) and finally, without resolve, to the Committee on Academic Misconduct.

Alteration of Marks:

a. A mark filed in the office of the university registrar is a part of the official records of the

university. It is subject to change only when a procedural error has been discovered in evaluation or recording of a grade. Action to change a grade must be initiated before the end of the second succeeding quarter. In no case will a grade be revised in accordance with criteria other than those applied to all students in the class. If the instructor agrees that an error in the mark was made, the mark will be changed upon written authorization of :

(a) The instructor of the course, (b) The instructor’s department chairperson, (c) The director of the instructor’s school, if applicable, (d) The dean of the instructor’s college, and (e) The authorized representative of the dean or director to the student’s enrollment

unit.

If a student believes that a procedural error in grading was made, the student should meet with the instructor. If the instructor does not agree that a procedural error was made, the student may meet with the department chairperson to discuss the grade grievance. The chairperson shall respond to the student no later than thirty days after the student has requested a review by the chairperson. Upon receipt of the chairperson’s response, if the issue is not resolved to the satisfaction of the student, the student may within two weeks request in writing by duplicate submission to the dean or director of the instruction unit and the department chairperson the procedures in paragraph (B) of this rule. Unresolved cases of grade grievance due to grading procedures are subject to paragraph (B) of this rule; unresolved cases of grade grievance due to other causes are not subject to paragraph (B) of this rule.

b. A faculty departmental committee appointed by the department chairperson shall review

unresolved cases of grade grievance due to grading procedures.

(a) In cases of instructors still affiliated with the university, the review committee shall consult both the student and the instructor and shall determine the validity of the grade grievance due to grading procedures. The review committee shall makes its findings known in writing to both the student and the instructor within thirty days of the student’s request to the chairperson.

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(b) If the committee finds that a procedural error has occurred and if the instructor declines to accept the findings of the review committee, the committee shall consider the reasons for not authorizing a grade change given by the instructor and may, upon consideration of these reasons, authorize in writing a grade change to be instituted by the department chairperson.

(c) In cases of instructors no longer affiliated with the university, the findings of the

committee shall be reported to both the student and the instructor. If the instructor chooses not to respond, the judgment of the committee shall prevail. If the instructor responds and declines to accept the findings of the committee that a procedural error has occurred, the committee shall consider the reasons for not authorizing a change given by the instructor. In either case, the committee may, upon due consideration, authorize in writing a grade change (if such can be determined) to be instituted by the department chairperson.

If a department committee can find no academic basis upon which to recommend an appropriate grade for the course, the student shall be given the option of having the course stricken from the student’s record and, if so desired, to retake that course without prejudice or penalty.

c. If charges of grave academic misconduct against an instructor are made and substantiated under

rule 3335-5-04 of the Administrative Code, the department chairperson shall be authorized to appoint a department grade grievance committee to consider grading errors that are alleged to be related to the misconduct. The committee shall consider all evidence and present, in writing, a report to the chairperson indicating any recommended grade changes. The department chairperson shall be authorized to institute grade changes in accordance with the recommendations to the committee.

If a department committee can find no academic basis upon which to recommend an appropriate grade for the course, the student shall be given the option of having the course stricken from the student’s record and, if so desired, to retake that course without prejudice or penalty.

d. The graduate school and graduate professional colleges may formulate appropriate

modifications of this rule, subject to the approval of the council on academic affairs, and publish this rule in their bulletins.

3335-7-231 Retention or disposal of materials submitted to meet course requirements.

A. Materials submitted by a student to satisfy course requirements shall either be returned to the student or made available for the student’s inspection, after they have been marked or otherwise evaluated, before the end of the quarter, semester, session, or term in which the work is performed or, in the case of final projects and final examinations, no later than the fourteenth day of instruction of the following quarter, semester, session, or term.

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B. Materials of this kind which have not been returned to the student shall be retained by the academic unit or the individual instructor until the last day on which a grade change may be initiated as provided for in paragraph (A) or rule 3335-7-23 of the Administrative Code. An exception to this rule may be made in the case of materials that are impracticable to store if the need for such exception is clearly communicated in writing and distributed to the students at the beginning of the course. (B/T/6/5/87)

i. Academic Misconduct:

1. Whenever academic misconduct by a student is suspected, the instructor should inform

the student of the allegation and obtain a statement in writing from the student either denying or admitting guilt, the statement furnished by the student should be made a part of the instructor’s report of the incident. The presence of a colleague with the instructor at any subsequent meeting with the student is recommended.

2. If the accused student admits his guilt, the instructor may recommend in his report that

hearing of the case by the Committee be waived. In such a case the instructor’s report should indicate the recommended academic penalty that will be imposed. Whether the student admits his guilt or not, the instructor in consultation with his or her appropriate chairperson, may request that the case be heard. The student may also request a Committee hearing. The final decision on a waiver is the prerogative of the Committee.

3. The instructor shall prepare a written report on the alleged academic misconduct. The

report should be as complete as possible, and should have all relevant evidence attached. Whenever possible, original documents, such as the alleged plagiarized paper, test, computer printouts, etc. should be submitted and sources of plagiarized material should also be provided, with the passages plagiarized clearly marked.

i. If hearing by the Committee is waived, the report must be filed in the Dean’s

Office and the student is still subject to whatever academic penalty the instructor, in consultation with his/her section chairperson, considers appropriate, e.g., reduction of grade or failure of the course.

ii. When a hearing is waived, the Dean’s Office shall notify the student that the

offense has been recorded in its files.

iii. The Committee on Professionalism will only have access to student’s records if guilt is determined.

4. The report prepared by the instructor will be reviewed by the chairperson of the academic

unit and transmitted within three working days to the Chairperson of the Professionalism Committee. If possible, the report should be hand-carried and marked “Confidential”.

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5. Students suspected of academic misconduct, whether acknowledging involvement or not, should be allowed to continue in the course without prejudice pending action by the Committee. If the course ends before the Committee has acted, the instructor should assign the student the grade of Incomplete in accord with Rule 3335-7-21. The alternative grade for the Incomplete should be that which would be given if the student were not found in violation of the Code of Student Conduct.

j. Unprofessional Misconduct:

1. Whenever unprofessional conduct by a student is suspected, the instructor should inform the student of the allegation and obtain a statement in writing from the student either denying or admitting guilt, the statement furnished by the student should be made a part of the instructor’s report of the incident. The presence of a colleague with the instructor at any subsequent meeting with the student is recommended.

2. The instructor shall prepare a written report on the alleged unprofessional conduct. The

report should be as complete as possible, and should have all relevant evidence attached.

3. The report prepared by the instructor will be reviewed by the chairperson of the academic unit and transmitted within three working days to the Dean of the College of Dental Medicine who will take action which may include:

a. resolution of the matter, or b. referral to an appropriate College committee, or c. referral to the University Coordinator of Judicial Affairs.

If possible, the report should be hand carried and marked “Confidential”.

1. Students suspected of unprofessional conduct, whether acknowledging involvement or not, should be allowed to continue in the course without prejudice pending action by the Committee. If the course ends before the Committee has acted, the instructor should assign the student the grade of Incomplete in accord with Rule 3335-7-21. The alternative grade for the Incomplete should be that which would be given if the student were not found in violation of the Code of Student Conduct.

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SECTION XV

GUIDE TO THE NSU HEALTH SCIENCES LIBRARY

Documents

prosthodontic Manual