This year, the Western Regional Board Exam (WREB) – the exam dentists need to take to practice in California and other states – released a new written exam.
The creators of the WREB are calling this new exam the “Comprehensive Treatment Planning Exam” or CTP. Students graduating after 2014, are required to take this exam in its new format, and as a student who will graduate in 2015, I took this exam about 1 month ago.
The exam is 3 hours long, and consists of 3 separate cases (one of which is always a pediatric case). Each case begins with a chief complaint and brief social history. A complete medical history is provided for your reference along with clinical photos, a periodontal chart, an odontogram, and a full mouth series.
Unfortunately, the x-ray quality is poor (I heard the same was true of previous exams and the NERB). While you are able to “enlarge” an x-ray, the magnification is minimal and the clarity of the x-ray will most likely be dependent on the monitor’s resolution.
After you have reviewed a case, you are tasked with formulating a treatment plan in a blank text box.
Treatment follows this order (Making sure to address the CC early):
Modification (Medical consult/Prophylaxis/Allergies)
Acute
Disease Control
Definitive
Maintenance
Each case is followed by 5-8 free response questions. You may be required to elaborate or justify your treatment of choice for a particular tooth or write a prescription for an antibiotic or an analgesic or you may need to write a lab order.
The WREB is offering a tutorial here.
You can read the 2015 CTP exam guide here.
how would lab orders be written?? Just a major connector and rests? Specifying which type crown?
The way I interpreted the lab order portion of the exam was that I was required to provide all of the information necessary for any dentist or lab tech to know exactly how to make the device without the need for a drawing (because you can’t draw on the lab form).
Here are some examples:
If the exam asks you to write a lab order for a single unit crown, you may want include:
What type of crown? All ceramic or PFM. If you choose all ceramic, what type of ceramic? If you choose a PFM, what type of metal (base, noble, high noble)?
If you chose a ceramic crown write down the shade and if you’d like occlusal staining and you’re done.
If you chose a PFM crown, do you want a metal collar (if so, where?).
Here’s an example of what I’d write for a PFM for #3:
Please fabricate a high noble PFM crown for #3.
Facial metal collar: Yes
Shade: A3 gingival third, A2 middle and occlusal thirds.
Occlusal staining: No
My guess is that I provided more information here than what’s needed to pass the exam, but I think this it’s clear that if I sent a lab these instructions, they would would pour the dies, trim the dies, fabricate a coping, and send me back a high noble PFM crown with a metal collar on the buccal surface. The shade of the crown would be A3 in the gingival third and A2 in the middle and occlusal thirds.
If the exam asks you to design an RPD you should include the major connector, rests, proximal plates, lattice/tube teeth (if indicated), and what type of clasps you’re using (circumferential , iBar or wrought wire). While you do not have casts on hand to survey, I believe you’ll want to include where and how much retention you’d like.
For example, if you’re going to put an iBar on #28, and you’d like .010" retention on the MB, you should write that down.
Hope this helps and good luck on the exam.
Thanks for taking the time to answer the question. My main question was about how to design an rpd without cast to survey. I guess if we did it as you suggested "iBar on #28, and you’d like .010" retention on the MB" it would work. All hypothetical (when it comes to retention), but just justifying how it would be done. I feel like the candidate guide should have specified what they wanted from us. Regardless thanks for the info. Much appreciated.
Not a problem, and thanks for commenting on the article. Hopefully next year they’ll update the candidate guide to include some more specifics about what they want written in the lab orders.