Over the weekend I received an email from a reader asking for advice regarding the WREB CTP exam as she has failed the examination twice. I have decided to post my edited response here as other dental students may find it useful.
There’s not much info about this exam online. However, a good place to start is a blog post I published after passing the exam: http://oneloosetooth.com/wreb-ctp-exam/
The WREB CTP exam is a free response section of the WREB taken at a standardized testing center that requires a student to formulate three treatment plans for three separate clinical cases – where one case is a child.
Honestly, free response treatment planning exams are subjective and often frustrating.
If I can offer advice to students taking this exam, this would be it. Treatment plan in 5 phases and keep your explanations brief.
Phase 1 = systemic (does the pt. require a medical consult prior to starting dental treatment?).
Review what to ask for in a medical consult…the 6 big ones are probably, uncontrolled hypertension, diabetes, anticoagulant therapy, liver failure, history of infective endocarditis, and joint replacement.
Phase 2 = acute. If something hurts, treat that here. This is extractions and RCTs. If the case description does not mention the results of vitality testing, remember to mention vitality tests…so if a tooth has a deep lesion on the radiograph don’t say endo, say “RCT pending vitality test results”.
As you move to disease control, remember to address the patient’s chief complaint early.
Phase 3 = disease control. Take care of the perio and decay. If a tooth needs a crown, treatment plan a core build up here and move tooth by tooth. For example if the radiographs show 3 lesions in the UR quadrant the student would say:
#3 MOD resin
#4 DO resin
#5 MO resin
If scaling and root planing was indicated, do not forget to plan an evaluation of initial therapy 4-8 weeks after completion of initial, non-surgical periodontal therapy. Plan SRPs before completing operative, unless it’s a large lesion.
If a tooth from phase 1 needed endo, plan the build up during disease control.
Phase 4: definitive. Time to plan fixed or removable prosthetics. For removable, you’ll have to draw the design of the cast metal framework on the lab slip. Keep RPDs simple; the rest, proximal plate, I-bar (RPI) method is the way to go. Mesial rest seats on teeth serving as abutments for distal extensions, proximal plate on the distal, I-bar engaging MB surface with 0.01-0.02″ retention.
Phase 5: maintenance. Remember to recommend an appropriate recall schedule.
Some other notes:
Always provide options. Single missing tooth usually = FPD, RPD, and an implant. 2 missing teeth adjacent to one another..lean towards just an RPD. Avoid long bridges and implant supported FPDs and overdentures as I believe the examiners will think that this type of treatment plan is above and beyond the student’s scope of practice at this point in her career (even though that may not be the case).
For single until crowns plan full gold (FGC) or porcelain fused to metal (PFM); avoid eMax, Lava, and Bruxir crowns for this exam. Same goes for bridges. I say this because most of the evaluators will be in the later stages of their careers (maybe even retired); when they practiced, they placed FGC and PFM crowns. No inlays, no onlays, no endo crowns. Don’t be cute, don’t be fancy. Keep the plans simple and to the point.
Review appropriate prescriptions for analgesics. No aspirin for children, and don’t prescribe narcotic analgesics during the exam – 600 mg of ibuprofen PO q6h PRN for pain relief should be all that’s needed for adults. Review appropriate prescriptions for antibiotic prophylaxis and bacterial infections. Remember to dispense the correct number of tablets, no refills, and use standard abbreviations.
One last thing…when it comes antibiotic prophylaxis, use the most current guidelines. BUT if you have any doubts – just write a medical consult in the systemic phase. That’s an easy way to play it safe.