Download laboratory technician protocol in PDF format

Written Examination 

The Accreditation Written Examination tests the laboratory technician’s foundational knowledge in cosmetic dentistry. Laboratory technicians who are knowledgeable in all phases of cosmetic dentistry are expected to pass the examination. Failure to pass the written examination indicates that a laboratory technician would likely benefit from further education in cosmetic dentistry prior to attempting the submission of clinical cases. 

The written examination is administered at the annual scientific session and at additional dates as directed by the ABCD. The annual scientific session is held in the spring at different locations, and is publicized well in advance of the date.
 

Eligibility for the Written Examination

To be eligible to take the written examination at the next annual scientific session, the following requirements must be met:

• Application completed and fee paid for the written examination

Application and Fees

Applications for the written examination are made through the AACD Executive Office. An application will be mailed upon request, or is available on the AACD Web site at www.aacd.com. A non-refundable written examination fee of $400 member $600 non-member (USD) must accompany the application.

Postponement

If the written examination is postponed in writing at least two months in advance an administrative fee of $75 (USD) must be paid to reschedule. With less than two months notice, an administrative fee of $125 (USD) will be required to reschedule.Failure to appear for a scheduled written examination will result in forfeiture of the entire fee.

Content

Foundational knowledge in cosmetic dentistry includes all disciplines of dentistry with an emphasis on those subjects with a special relevance to aesthetics. Subjects may include, but are not limited to:

• Smile design
• Adhesion
• Materials
• Occlusion
• Porcelain/resin restorations
• Posterior aesthetic restorations
• Bridges and pontics
• Implants
• Color/shade
• Whitening
• Periodontics
• Orthodontics 
• Laboratory communication
• Photography

Some questions will be included that are based on scenarios of clinical cases concerned with cosmetic dentistry.

Type of Examination/Grading

The written examination is a multiple-choice examination. Each question is referenced to a textbook or referred source to ensure its validity. A reference library and sample written examination are available on the AACD Web site at www.aacd.com.

In order to have credibility with the dental community, all steps are followed to ensure that the written examination complies with the established rules of testing. A representative of a testing agency is present when the written examination is compiled. The educational testing and measurement consultant is also responsible for grading the written examination and presents the results to the ABCD. For more information contact the AACD Credentialing Department at 800.543-9220.

Sample Examination

Some questions will be taken from the written examination each year and will be released in the form of sample examinations. The sample examinations may be purchased on the AACD Web site at www.aacd.com.

Time Limit

There is a time limit to complete the entire Accreditation process. The final step in the process, the oral examination, must be taken and passed by the fifth annual scientific session that follows having passed the written examination. In order to be fair to all individuals pursuing Accreditation in the AACD, the ABCD has established policy that no waivers or time extensions will be granted within the Accreditation process.

Clinical Case Submissions/Examination 

The Accreditation Clinical Case Examinations are the core of the Accreditation examination process. Clinical case submissions allow the laboratory technician to demonstrate diagnostic skills and clinical excellence. Three specific types of cosmetic dental treatments have been chosen to cover a variety of techniques. 

Prerequisites for Submission of Clinical Cases 
To submit clinical cases, the following requirements must be met:

• Laboratory technician must have passed the written examination
• Laboratory technician must have attended two workshops: the Accreditation Workshop and the Criteria Workshop. These workshops are offered at the annual scientific session and at additional dates as directed by the ABCD. Verification of attendance must be on record with the AACD Credentialing Department.
• Attended at least half of the annual scientific sessions since passing the written examination
• Submission form completed and fee paid for each clinical case submitted

The Three Required Case Types:

Three case types must be successfully completed. These cases will allow the laboratory technician to demonstrate excellence in a range of disciplines that cover important aspects of cosmetic dentistry. All three cases will be submitted as “Technique” cases.

I. Six or more indirect restorations, treating upper incisors and canines

II.  One or two indirect restorations (treating upper incisors; adjacent teeth must have no indirect restorations)  

III. Tooth replacement (options: bridge or implant) 

A. Bridge: at least one pontic must be replacing an upper incisor and/or canine

B. Implant: must involve placement of an implant root form into an upper anterior edentulous space. The edentulous space is defined as being devoid of any root structure. (Pre-op x-rays and photographic views must show edentulous space or failing tooth prior to implant placement.) Replacement of a crown on an existing implant is not acceptable for this case type.

All cases will be submitted as “Technique” cases (bench photography) along with all the 12 before and 12 after shots described in the Photographic Documentation and Evaluation in Cosmetic Dentistry – A Guide to Accreditation Photography.

NOTE: ALL required teeth treated must be upper anterior teeth and permanent.  When additional teeth are treated they are judged using the same criteria as the required teeth. Only one case type per patient may be used.

Submission Procedure:

A total of three clinical case submissions must be examined and passed to complete the second part of the Accreditation process. From one to three clinical cases may be submitted at a time by mail, however, only one of each case type may be submitted at a time for evaluation.  

Clinical case submissions must be mailed and received on or prior to the deadline date by the AACD Credentialing Department and must include all of the required materials for the case to be examined at the next available examination session. 

Be sure to follow the protocol exactly. Check and double check that you have included all the required materials. All materials submitted become property of the AACD.

1. Clinical Case Submission Form
The laboratory technician will be sent clinical case submission forms after passing the written examination and all other prerequisites have been completed. All information must be complete and legible. 

2. Fee
The non-refundable submission fee is $200 member / $300 non-member (USD) per clinical case submitted.

3. AACD Photographic Release Form 
This form is to be submitted with each clinical case and signed by the laboratory technician and patient. The form grants permission to the AACD for use of the images submitted for Accreditation. Cases suitable for submission for Accreditation, must be submitted without restrictions or limitations placed on the AACD photographic release form.  

4. Photographic Documentation
The Photographic Documentation and Evaluation in Cosmetic Dentistry - A Guide to Accreditation Photography represents and illustrates the specific photographic documentation required for the clinical case submission portion of the AACD Accreditation Examination. 

The AACD will not define specific equipment requirements, however, the AACD has outlined criteria to produce quality images. The protocol and equipment recommendations are expected to evolve with advances in technology. 

Image Criteria

Digital image quality is contingent upon five distinct factors related to the image itself.  Proper set up and use of your camera and adjunctive photographic equipment maximizes results.  

Correct color
Correct exposure
Depth of field
Good tonal range
Image sharpness

Capture Equipment Criteria

Professional grade digital cameras are recommended

An example of a professional grade camera would be a Single Lens Reflex Digital Camera with a macro lens capable of manual focus and selectable magnification ratio with a lens mounted flash. The digital camera should be capable of capturing at least five megapixels and be able to capture images as RAW files.

Many consumer grade digital cameras capture images that are visibly degraded due to small capture chips and internal firmware. They may also lack the ability to control exposure and depth of field during macro image capture.  

Camera Set Up (Variables are set in the camera menus)

1. Set internal clock to correct time

2. Capture images as RAW files (Required)
Different camera manufactures use different names for this type of file.

3. Select Lens Magnification Ratio as shown in the AACD Photographic 

Documentation and Evaluation in Cosmetic Dentistry - A Guide to Accreditation Photography. Make any necessary magnification conversions to produce an image magnification comparable to the images illustrated in the photography guide.  Typically a conversion is necessary between the ratios dictated for a film camera to produce the same result with a digital camera. Once the ratio has been determined, that ratio or magnification should be consistently maintained throughout the before and after photographic series. The lens magnification conversion that is needed for most digital SLR cameras is 1.5 (Cameras with sensor size of 14 mm x 9.3 mm).

1. Magnification of (1.5) x (the setting on the lens barrel)

2. 1:2 views set the lens on a digital camera to 1:3

3. 1:1 views set the lens on a digital camera to 1:1.5 

4.  Maximize depth of field using high f-stops (minimized aperture)

Managing Images on a Computer 

1.  Set internal clock to correct time

2. Transfer the RAW camera image files from the camera directly to your computer hard drive.  

3. Create a compressed JPEG image file by copying the RAW image file

*Choose a software tool to make compressed JPEG files of all the RAW files. Either use software from the camera manufacturer or an after-market software tool of your own choice. (i.e. PhotoShop, ThumbsPlus, acdsee)  

A. Open the RAW image with the software.  Go to: file> save as> JPEG compressed> Quality> Maximum (100%, best quality, Minimum Compression).  Image quality must be more than adequate to judge the dentistry; free of saliva and debris, properly exposed, framed and focused. (See the Photographic Documentation and Evaluation in Cosmetic Dentistry -A Guide to Accreditation Photography for additional recommendations.) 

B.  Some cameras have settings that create both a RAW and a high-quality JPEG at the same time. Make sure the camera is set to the highest JPEG setting when using this feature. 

NOTE:   Scanned images will not be accepted for submission

(Instructions are a guide and not intended as a substitute for continuing education in digital photography and use of computer hardware and software.)

Image Editing 

No global, focal, fixed point or spot editing is allowed

Global, focal, fixed point or spot editing is strictly prohibited and considered fraudulent.  This means even innocent changes such as cleaning up dust spots, cropping, rotating, resizing or eliminating red eye is not allowed. 

Case Submission

Laboratory technicians will need to submit two separate disks or inexpensive memory stick(s) with pre-op and post-op images in their respective folders with the required RAW images, RAW technique views, x-rays, case title and treatment listing and a second folder of these images in JPEG format. All materials become property of the AACD. 

Two separate compact disks or inexpensive memory stick(s) must be submitted for each case.  Each disk/memory stick should be marked with the laboratory technician’s AACD ID number and case type. All images submitted for examination must be PC compatible. All materials become property of the AACD. 
 

Disk/Memory Stick #1	Folder One:	-12 required views pre-op RAW images
		-Case title listing from AACD web site
		-RAW technique views when applicable
		-Case Type III- periapical radiograph/pre-op images showing edentulous space or failing tooth prior to implant placement
	Folder Two:	-12 required pre-op JPEG images converted from the RAW  images in folder one
Disk/Memory Stick #1	Folder One:	-12 required post-op RAW images
		-Treatment listing from the AACD web site
		-Post Treatment periapical radiographs
	Folder Two:	-12 required post-op JPEG images converted from the RAW  images in folder one

 

Please open and review both pre-op and post-op disks/memory stick(s) to ensure all correct views and images are viewable.  If your submission is incomplete, it cannot be evaluated.

Accreditation Examination

Examiners will evaluate cases with appropriate media for image viewing and evaluating.

Additional Photographic Documentation for all Cases 

Additional documentation is required to demonstrate the technique that was utilized to complete all cases. The following RAW images must be included on disk 1/memory stick, folder 1 (pre-op) and are to be documented in the written report. 

These photos are to be taken at 1:2 magnification or digital equivalent.

1. Frontal view of prep model in occlusion with opposing model
2. Occlusal view of prep model
3. Frontal view of lab manipulated tissue site for Case Type III only
4. Frontal view of bridge framework or coping design before application of veneering material
5. Frontal view of completed build-up before firing or processing
6. Frontal view of contoured bisque bake (including tissue adaptation on Case Type III)
7. Frontal view of finished case on model

Verification of Authenticity for Each Case

AACD upholds the highest standards of ethical behavior applicable to the profession of cosmetic dentistry and expects its members to do the same. Violation of these ethical standards in the Accreditation process is a matter that is taken seriously by the AACD and can result in permanent disqualification from the Accreditation process.

As technology continually evolves, increasing opportunities exist for fraud. Although the AACD knows that few would resort to such unethical behavior, the AACD is committed to ensuring the integrity of the Accreditation process through proactive measures to verify supporting documentation for clinical case submissions. Such measures are designed to maintain the integrity of the credential without imposing an undue hardship on laboratory technicians.  

Examiners are trained in specialized software tools to detect manipulation of the digital image in violation of this protocol including spot editing. Any alteration of images, falsification of information or attempt to mislead the examiners is grounds for immediate termination of the Accreditation process and permanent disqualification from obtaining Accreditation in the future.

Radiographic Documentation 

Post-op periapical radiographs are required for all cases. An implant must also include a pre-op radiograph prior to implant placement. Radiographs must be of diagnostic quality. Use as many radiographs as needed to show all required treated teeth. Additional treated teeth do not require radiographic documentation. In the event that the radiographic images submitted by the laboratory technician suggest that there has been manipulation or editing of the image in violation of this protocol, it is grounds for immediate termination of the Accreditation process and permanent disqualification from obtaining Accreditation in the future. When submitting radiographic images, please be sure to seperate them.  

Radiographs are to be included on disk 2/memory stick, folder 1 (post-op). Radiographs may be in one of three formats:
1. Digital x-ray image file
2. Photo image file (JPEG) of x-ray
3. Scanned x-ray image file (JPEG)  

4x6 Photographic Prints

A pre-op and post-op of each of the following four views (8 prints total) must be included with each of the three written reports. They must be mounted as shown in diagram 4 below: 

View #1, Full face (1:10 magnification)

View #2, Full smile, frontal (1:2 magnification)

View #5, Retracted view, frontal (1:2 magnification)

View #8, Retracted view, frontal (1:1 magnification)

 

These prints must match the digital images submitted with the case. 

Written Report

The written report is to be submitted in the AACD template format, typed and bound.  Reports are expected to be well organized, original, accurate, and complete. Include the following information in the written report:

Title page (as directed in template)

Description of preparation design

Copy of lab prescription including shade diagram

Description of framework or porcelain coping (when applicable)

Description of application and layering of porcelain including: opaques, tints, modifiers to final build-up

Description of handling of bisque stage to ready for glaze

Description of glaze handling to completion

Eight photographic prints

*Submit three separate copies of the written report.  

Under no circumstances should names, acknowledgements (including partnering dentist, ceramist or specialists that may have been involved in the case) or any type of personal information be included in the written report.

WRITTEN REPORT TEMPLATE

 [Page 1 to include:]

Title Page

Case Type #___ 

Case Description - _______(per Protocol)

Member #___ 

Treatment List (include tooth numbers and types of restorations, as well as any adjunctive treatment)

• (List in bullet point format)

Restorative Material (include brand of porcelain/composite)

• (List in bullet point format)

Type of Adhesive System and Luting Agents (when applicable)

• (List in bullet point format)

[Additional pages to include:]

Introduction and chief complaint

History (medical and dental)

Diagnosis and treatment plan

Description of treatment including rationale for choice of restorative material

References (pertinent literature supporting the treatment performed)

Eight print photographs

Grading/Evaluation

Each case is judged anonymously by a panel of five examiners. A majority of “pass” votes are required to pass a case. The laboratory technician may resubmit clinical cases until all three have received a passing score. When all three clinical cases have received a passing score, the laboratory technician is eligible to continue to phase three, the oral examination. 

The format for the clinical cases must be followed exactly. Poorly produced or incomplete written reports and/or poor photographic or radiographic documentation could result in failure. Each case will be examined based on the Accreditation examination criteria. Diagnosis and Treatment Evaluation in Cosmetic Dentistry - A Guide to Accreditation Criteria uses examples of previously presented cases to further clarify and identify criteria points being evaluated.

Resubmission Information

A candidate in the process that does not successfully complete the Accreditation process in their allotted five-year time frame may be eligible for a one time roll-forward of successfully passed clinical case(s) to a new five-year time period.  The requirements for eligibility are as follows:

• The written examination must be taken no later the next annual scientific session following term expiration to initiate a new five year time frame. 

• The case being submitted for roll-forward has not been previously transitioned

• The candidate feels that he or she can comfortably and thoroughly explain and defend treatment decisions at the oral examination

• A roll-forward form is completed and submitted to the credentialing department for each passed case being requested

• A fee of $200 member / $300 non-member (USD) will be required with each case roll-forward and submitted with the required form

NOTE: All materials submitted become property of the AACD.

Oral Examination

Purpose

The purpose of the Accreditation Oral Examination is two-fold. The first purpose is to provide the laboratory technician an opportunity to verify and authenticate passed casework. The laboratory technician may be asked questions about case selection, diagnosis and treatment planning, or materials and techniques on any of their passed clinical case submissions. The laboratory technician’s knowledge should clearly demonstrate a familiarity and understanding of these cases.  Additional questions may be asked that cover related topics considered relevant by the examiners. 

The second purpose of the oral examination is to provide the laboratory technician with an opportunity to demonstrate their treatment planning abilities. The laboratory technician will be presented with information regarding a pre-selected case. Adequate time will be allowed for the laboratory technician to formulate a treatment plan, which will then be shared and discussed.

Eligibility for Appearance at the Oral Examination

To take the oral examination at the next given date, the following requirements must be met:

The laboratory technician must have passed all three required clinical cases

Attended at least half of the annual scientific sessions, starting with the session that the laboratory technician took and passed the written examination

Application completed and fee paid for the oral examination

Application and Fees

The application for the oral examination will be sent to a laboratory technician once the three clinical cases have been passed. The application and fee must be received at the AACD Executive Office by the date specified by the ABCD. The fee is $500 member / $725 non-member (USD) and is non-refundable. 

Postponement

The laboratory technician may defer appearance for the oral examination as long as all three phases of the Accreditation process are completed within the time limit. If the oral examination is postponed in writing at least two months in advance an administrative fee of $125 (USD) must be paid to reschedule. If the oral examination is postponed with less than two months notice, the fee will be forfeited. 

Guidelines for Appearance at the Oral Examination

Dress professionally and be on time. You should be completely familiar with the three cases. Laboratory technicians will be required to bring one written report from each case passed.

For any Cases that were Completed with Digital Documentation: Bring pre-op and post-op images on two separate disks, or two separate memory sticks or two separate USB external removable devices. Each disk or device will have two folders: one folder with the required RAW images, RAW technique views, x-rays, case title and treatment listing and a second folder of these images converted to JPEG files. 

For any Cases that were Completed with 35 mm Slide Documentation Prior to the Deadline: You will need to bring two 80 count slide carousels loaded with your original (or duplicate depending on what you submitted for your passed clinical case submissions) of pre-op and post-op slides of your passed cases. This should include all required technique views and pre-op and post-op radiographs.

Grading: Pass/Fail 

Pass

With the successful completion of the oral examination, a laboratory technician becomes an Accredited member in the AACD. 

Fail

A laboratory technician may retake the oral examination one time immediately following the expiration of their five-year time period and must successfully pass the next time the oral examination is administered. A second failure at the oral examination terminates the Accreditation process. Submission of a new written examination application is required to begin the Accreditation process again.

Accreditation Award Ceremony

With the successful completion of the oral examination, a laboratory technician becomes an Accredited member in the AACD. The recognition ceremony and presentation of the Accreditation award will be held at the next annual scientific session. 

Maintaining Accredited/Accredited Fellow Member Status

To maintain Accredited or Accredited Fellow status, Accredited Members and Accredited Fellow members must maintain active membership in the AACD. It is important for individuals who are Accredited or Accredited Fellow member dentists and laboratory technicians to stay abreast of advances in cosmetic dentistry. (An Accredited Fellow member is an Accredited member of the AACD who has met additional requirements established by the ABCD; Accredited Fellows must maintain Accredited status to remain an Accredited Fellow.)

One of the following is required once every three years: 

1. Attend the annual scientific session    
2.  Serve as an editor, editorial reviewer or contributing editor in a cosmetic dentistry publication
3.  Author a published article in a cosmetic dentistry publication
4. Participate as a coordinator or lecturer in a cosmetic dentistry continuum
5.   Attend the Criteria Workshop or lecture portion of the Advanced Accreditation Workshop
6. Serve as a board or committee member in the AACD
7. Examiners only – Attend Examiner Calibration

Forms for verification on requirements are available at the AACD Executive Office. Submission of these forms are the responsibility of each individual who is Accredited. Five percent will be randomly reviewed and proof of verification will be required. 

Version: August 2010