American Board

The American Board of Orthodontics
Clinical Examination Guide
Fifth Edition April 2010 March 2011 Updated 3-15-2011 See Major Revisions History on last page
Case Report Forms, Instructions and Examples are found at www.americanboardortho.com This Guide is a reproduction of the clinical examination webpages on the ABO website. There are no hyperlinks in this Guide. Use the ABO website for hyperlink capability.
The American Board of Orthodontics 401 North Lindbergh Blvd. Suite 308 St. Louis, MO 63141 Telephone: 314.432.6130 FAX: 314.432.8170 Email: info@americanboardortho.com Website: www.americanboardortho.com
CLINICAL EXAMINATION
Any orthodontic question not covered on these web pages can be answered by the ABO Director of your constituent organization.
Examination Process
Pg-4 Pg-5 Pg-6 Exam Components Overview Explanation of the Board Case Oral Exam Types of Clinical Examinations and Requirements Which exam will I take? Initial Certification Examination Beginning Certification Examination Gateway Certification Examination Recertification Examinations Voluntary Recertification Examination Traditional Option I and II (limited) Testing Protocol What to Expect Exam Assignment and Day of Exam Completion and Non-Completion of Exam or Recertification Information Request and Appeal Process
Pg-37 Pg-38 Pg-13
Presentation of Case Reports

Pg-17 Pg-18 Pg-19 Clinical Exam Whats New? Selecting Cases for Presentation Proof of Treatment Case Report Preparation Pg-20 Patient Records Dental Casts Photographs Radiographs Tracings Record Requirements and Identification Digital Record Requirements Case Report Forms Title Page Written Case Report Measurement Instruments (DI, C-R Eval, CMF) Assembly of Case Report Notebook Case Report Assembly Electronic Submission of Case Report Forms Electronic Submission Information Log into Clinical Exam Electronic Submission Example Case Presentation (pdf, 4.0mb, 24pgs) Pg-35 Pg-35 Pg-36 Download and Print: Case Report Forms and Instructions Download and Print: Guides and References Suggestions for the Examinee
(A11) Pg-28
Pg-33 Pg-34
Appendix of Exhibits
Referenced as in the clinical narrative
A-2
Exam Components Board Case Oral Exam Worksheet
A-3
Options I and II Case Category Specifications for Option I Case Selection by DI for Option I
A-6 A-7
Option for One Case by Mail Case Report Preparation Class II Molar Relationships Construction of Mandibular Plane Supplies Needed for ONE Case Report Notebook
A-11
Records Record Requirements and Identification Dental Cast Guide Example Photo Collage Photo Mount Sheet Example 1 Cephalometric Tracing Reference Example 2 Cephalometric Tracing Example of Composite Tracings
EXAMINATION PROCESS
Exam Components Overview Explanation of the Board Case Oral Exam Types of Clinical Exams and Requirements Testing Protocol
Exam Components Overview

Background
The Clinical Examination is an assessment of an examinees orthodontic therapeutic knowledge and skills. There are several components of the Clinical Examination, and there are different types of clinical examinations that are utilized in the certification and recertification process. Specific components of an exam may differ depending on the reason for the examination. In other words, different formats will be used depending upon whether the examinee is being certified for the first time, recertified, etc.
Components of the Clinical Examination A. CASE REPORTS PRESENTED BY THE EXAMINEE

1. Case Report Examination (CRE) A comprehensive evaluation of case reports for patients treated solely by the examinee. The number of reports is dependent on the type of Clinical Examination for the particular stage in the certification/recertification process. Case Report Oral Examination (CROE) An assessment of the examinees knowledge about the case reports that they have presented.
2.
B.
BOARD CASES PRESENTED TO THE EXAMINEE

1. Board Case Examination (for Voluntary Recertification only) An examinee review of case records on the ABO website with a response concerning the treatment decision needed for the case. Board Case Oral Examination (BCOE) An assessment of the examinees explanation of treatment decisions for one case provided by the ABO.
2.
Explanation of the Board Case Oral Exam

The Board Case Oral Exam is that portion of the Clinical Examination that involves one set of case records presented to the examinee to evaluate and treatment plan. The examinee cannot specifically prepare for this portion of the Clinical Examination. The clinical practice of orthodontics where treatment decisions are made on a daily basis should be sufficient preparation for this exam. This will be the first portion of the Clinical Examination and the examinee will appear at the appointed time. Complete records via computer format provide all required information to develop appropriate treatment decisions. An Examinee Worksheet (pdf) will be provided for the case and contains four major areas that will be discussed by the examiners. Be reminded that treatment objectives are not the mechanotherapy used to accomplish these objectives.
Sample Board Case Oral Exam - enter here
Pathways to Certification/Recertification
EXAMINATION PROCESS
Types of Clinical Examinations
Note: No case may be presented to the Board more than one time Initial Certification Exam Beginning Certification Exam Gateway Certification Exam Recertification Exams Voluntary Recertification Exam Traditional Option I and II (limited)
INITIAL CERTIFICATION EXAMINATION

This Clinical Examination is offered to orthodontists following completion of their orthodontic education. The orthodontist must be a graduate of a CODA (Commission on Dental Accreditation) accredited orthodontic program and have successfully passed the ABO Written Exam. The examinee must present for this examination within twenty-four (24) months following graduation. The time-limited certificate will expire ten (10) years from the completion of the Initial Certification Exam. 1. Patient Source
Of the six cases required, a minimum of three cases must be presented. All cases presented must have been entirely treated, from appliance placement through appliance removal, by the examinee under direct supervision of a clinical instructor in an ADA accredited orthodontic program. Active treatment ends when the same resident removes the appliances and places the patient in retention. In cases of multi-phased treatment, the final phase of full treatment (appliance placement to appliance removal) administered by a single resident is acceptable. A Confirmation of Residency Treated Cases (pdf) from the Program Director and/or Chairperson is required to assure that the cases presented meet these requirements. The balance of case requirements will be collected, either from residency within 24 months of graduation or from post-residency practice, within ten (10) and two (2) more attempts at completion of requirements. 2. Components of the Initial Certification Exam a. b. c. 3. Board Case Oral Examination (BCOE) Case Report Examination (CRE) Case Report Oral Examination (CROE)
Case Criteria for the Initial Certification Exam
The Case Report Examination component requires six (6) Case Reports consisting of a. three (3) cases with a DI of twenty (20) or greater, b. three (3) cases with a DI of ten (10) or greater. The six case presentation must contain: at least one (1) non-surgical case treated with four (4) quadrant extractions that demonstrates effective space closure (identified as Extraction Case). at least one (1) non-surgical case with bilateral end-to-end or greater Class II molar relationship present at the time of appliance placement. A unilateral full-step
Class II molar relationship is also acceptable. The final treatment result should exhibit a Class I molar and canine relationship (identified as Class II Case). no more than one (1) case treated with orthognathic surgery (identified as Surgical Case). Note that a surgical case is not required. Any surgical case needs interim (pre-surgical) records. Banking Process Of the six cases required, a minimum of three cases must be presented via personal appearance at the clinical examination. Of the cases that are presented from residency, cases which are Complete will be banked, or documented, at the ABO central office. The examinee must collect the balance of required cases, either from residency within 24 months of graduation or from post-residency practice, for grading within ten (10) years and two (2) more attempts. If at least three (3) cases are Complete and include at least one (1) case with a DI of 20 or above, and the BCOE is Complete, the examinee may mail the remaining cases to the ABO for grading at a future clinical examination. The examinee must return in person to a future clinical examination to complete the ICE requirements IF: o o o less than three (3) cases are Complete three (3) cases are Complete, but do not include one (1) case with a DI of 20 or above the BCOE is Incomplete
4.
If no cases from residency are Complete, the examinee, when ready, will submit a new registration and take the Beginning Certification Examination. If the examinee does not fulfill ICE requirements within ten (10) years and two (2) attempts, the examinee, when ready, will submit a new registration and will take the Beginning Certification Examination.
BEGINNING CERTIFICATION EXAMINATION

This clinical examination will be utilized by any orthodontist who meets all requirements for the clinical examination but did not take the Initial Certification Examination following graduation from an orthodontic graduate program. The time-limited certificate will expire ten (10) years from the completion of the Beginning Certification Examination. 1. Patient Source
Cases treated by the examinee from their clinical orthodontic practice are required. Exception Full-time orthodontic educators may present a maximum of three (3) cases that the educator directly supervised while teaching within an American Dental Association accredited orthodontic graduate program. The supervised cases may not include a case that will be presented to the ABO by a resident of the orthodontic program. 2. Components of the Beginning Certification Exam a. b. c. 3. Board Case Oral Examination (BCOE) Case Report Examination (CRE) Case Report Oral Examination (CROE)
Case Criteria for the Beginning Certification Exam
The Case Report Examination component requires six (6) Case Reports consisting of
a. b.
three (3) cases with a DI of twenty (20) or greater, three (3) cases with a DI of ten (10) or greater.
The six case presentation must contain: at least one (1) non-surgical case treated with four (4) quadrant extractions that demonstrates effective space closure (identified as Extraction Case). at least one (1) non-surgical case with a bilateral or unilateral full-step Class II molar relationship corrected to a Class I molar and canine relationship (identified as Class II Case). no more than one (1) case treated with orthognathic surgery (identified as Surgical Case). Note that a surgical case is not required. Any surgical case needs interim (pre-surgical) records.
GATEWAY CERTIFICATION EXAMINATION

This examination will be utilized by Diplomates who were certified via the Gateway Offer. The exam must be completed before the expiration date noted on the current ABO certificate. The new time-limited certificate will expire ten (10) years from the completion of the Gateway Certification Examination. 1. Patient Source
Cases treated by the examinee from their clinical orthodontic practice are required. Exception - Gateway Examinees, who are not full-time orthodontic educators, may bring one or two cases treated in their residency program. Exception Full-time orthodontic educators may present a maximum of three (3) cases that the educator directly supervised while teaching within an ADA accredited orthodontic graduate program. The supervised cases may not include a case that will be presented to the ABO by a resident of the orthodontic program. 2. Components of the Gateway Certification Exam a. b. c. 3. Board Case Oral Examination (BCOE) Case Report Examination (CRE) Case Report Oral Examination (CROE)
Case Criteria for the Gateway Certification Exam
The Case Report Examination component requires six (6) Case Reports consisting of a. three (3) cases with a DI of twenty (20) or greater, b. three (3) cases with a DI of ten (10) or greater. The six case presentation must contain: at least one (1) non-surgical case treated with four (4) quadrant extractions that demonstrates effective space closure (identified as Extraction Case). at least one (1) non-surgical case with a bilateral or unilateral full-step Class II molar relationship corrected to a Class I molar and canine relationship (identified as Class II Case). no more than one (1) case treated with orthognathic surgery (identified as Surgical Case). Note that a surgical case is not required. Any surgical case needs interim (pre-surgical) records.
FIRST RECERTIFICATION EXAMINATION

This clinical examination will follow successful completion of the Initial Certification Examination (ICE), the Beginning Certification Examination (BGCE), the Gateway Certification Examination, or any time-limited certification of earlier pathways. It can be taken no earlier than two (2) years prior to the expiration date of the current certificate and will include in-person oral examination. The time-limited certificate will expire ten (10) years from the completion of the First Recertification Examination. 1. Patient Source
Three cases treated by the examinee from their clinical orthodontic practice are required.* Cases must be initiated within ones current certification period or within the past ten years. * Exception Full-time orthodontic educators may present cases that the educator directly supervised while teaching within an ADA accredited orthodontic graduate program. The supervised cases may not include a case that will be presented to the ABO by a resident of the orthodontic program. 2. Components of the First Recertification Exam a. b. 3. Case Report Examination (CRE) Case Report Oral Examination (CROE)
Case Criteria for the First Recertification Exam
The Case Report Examination component requires three (3) Case Reports consisting of a. b. one (1) case with a DI of twenty (20) or greater two (2) cases with a DI of ten (10) or greater
The three case presentation must contain: at least one (1) non-surgical case with a bilateral or unilateral full-step Class II molar relationship corrected to a Class I molar and canine relationship (identified as Class II Case). no more than one (1) case treated with orthognathic surgery (identified as Surgical Case). Note that a surgical case is not required. Any surgical case needs interim (pre-surgical) records.
SECOND RECERTIFICATION EXAMINATION

This clinical examination will follow successful completion of the First Recertification Examination. It can be taken no earlier than two (2) years prior to the expiration date of the current certificate. The time-limited certificate will expire ten (10) years from the completion of the Second Recertification Examination. 1. Patient Source
Two cases treated by the examinee from their clinical orthodontic practice are required.* Cases must be initiated within ones current certification period or within the past ten years. *Exception Full-time orthodontic educators may present cases that the educator directly supervised while teaching within an ADA accredited orthodontic graduate program. The supervised cases may not include a case that will be presented to the ABO by a resident of the orthodontic program.
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2.
Components of the Second Recertification Exam a. Case Report Examination (CRE) - By Mail and/or Electronic Submission
3.
Case Criteria for the Second Recertification Exam
The Case Report Examination component requires two (2) Case Reports consisting of a. b. one (1) case with a DI of twenty (20) or greater one (1) case with a DI of ten (10) or greater
THIRD RECERTIFICATION EXAMINATION

This clinical examination will follow successful completion of the Second Recertification Examination. It can be taken no earlier than two (2) years prior to the expiration date of the current certificate. The time-limited certificate will expire ten (10) years from the completion of the Third Recertification Examination. 1. Patient Source
One case treated by the examinee from their clinical orthodontic practice is required.* The case must be initiated within ones current certification period or within the past ten years. *Exception Full-time orthodontic educators may present a case that the educator directly supervised while teaching within an ADA accredited orthodontic graduate program. The supervised case may not include a case that will be presented to the ABO by a resident of the orthodontic program. 2. Components of the Third Recertification Exam a. 3. Case Report Examination (CRE) By Mail and/or Electronic Submission
Case Criteria for the Third Recertification Exam
The Case Report Examination component requires one (1) Case Report consisting of a. one (1) case with a DI of ten (10) or greater
FOURTH RECERTIFICATION EXAMINATION

This clinical examination will follow successful completion of the Third Recertification Examination. It can be taken no earlier than two (2) years prior to the expiration date of the current certificate. The time-limited certificate will expire ten (10) years from the completion of the Fourth Recertification Examination. 1. Patient Source
One case treated by the examinee from their clinical orthodontic practice is required.* The case must be initiated within ones current certification period or within the past ten years. *Exception Full-time orthodontic educators may present a case that the educator directly supervised while teaching within an ADA accredited orthodontic graduate program. The supervised case may not include a case that will be presented to the ABO by a resident of the orthodontic program.
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2.
Components of the Fourth Recertification Exam a. Case Report Examination (CRE) By Mail and/or Electronic Submission
3.
Case Criteria for the Fourth Recertification Exam
The Case Report Examination component requires one (1) Case Report consisting of a. one (1) case with a DI of ten (10) or greater
VOLUNTARY RECERTIFICATION EXAMINATION

This clinical examination is voluntarily taken by Diplomates who have non-time-limited certificates. Case submission is by mail. 1. See Voluntary Recertification for more details or to take the online Board Case Test
TRADITIONAL OPTION I and II (limited)

These exam options are only available to candidates who sat for Oral Examination in 2004 and 2005 and received an extension date; and to candidates who are eligible to re-examine due to an Incomplete in a previous Option I or II examination. Click here for details.
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EXAMINATION PROCESS
Testing Protocol What to Expect
Protocol for Exam Completion of Exam Non-Completion of Exam or Recertification Information Request and Appeal Process
PROTOCOL FOR EXAM

A. Two Months Prior To Exam Following registration, and approximately two months prior to the exam date, the ABO will notify the examinee as to the date and time of their clinical exam, including case setup time and hotel information. B. Two Weeks Prior To First Day of Examinations Electronic case reports must be submitted to the ABO. You will be notified of the exact deadline for submission. C. Day Prior To Exam Setup of your cases will occur on the day prior to your exam. A bus will bring you and your cases from the hotel to the exam center at a pre-arranged time. You will leave the transport containers for your cases at the exam center. It is mandatory that you ride the bus from the assigned hotel to the exam center even if you are not staying at the hotel. D. Day Of Exam A bus will bring you from the hotel to the exam center at a pre-arranged time. You may not bring guests nor take anything into the exam center other than your identification documents. Prohibited items include cell phones, electronic devices, books or briefcases. Eating, drinking, and smoking are now allowed; water will be available. ORAL EXAM - Those examinees who must take the Board Case exam will be given time for review of the case. The examinee will then appear before two (2) Board Examiners who are unaware of the examinees identity prior to the interview. One or two portions of the Oral Exam will be administered: - Board Case Oral Examination on the Board Case that the examinee has reviewed for diagnosis and treatment planning. - Case Report Oral Examination on the examinees cases. NOTE: It is the policy of The American Board of Orthodontics to record, photograph, or otherwise document the clinical examination. The documentation will be used to monitor the reliability of the examinations, and for other internal Board purposes. The documentation is confidential and will be reviewed only by the directors, consultants and employees of the ABO. It is against Board policy to release records documenting the examinations to anyone, including the examinee. The examinee signs an agreement to the ABO policy on documentation in the Rules of Examination Affidavit. RETRIEVAL OF CASES You will collect your cases immediately following the exam using the transport containers left at the center. You will travel back to the hotel by bus. E. Notification Of Exam Results Correspondence will be sent by the ABO Executive Secretary within six (6) weeks of the Clinical Examination.
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EXAMINATION PROCESS
Testing Protocol (continued)
COMPLETION OF THE CLINICAL EXAMINATION
You will receive notification of successful completion of the Clinical Examination. You will also receive a Diplomate Certificate. For recertifying Diplomates, any remaining time on your current certificate will be added to the new certificate. A first-time Diplomate will receive the ABO lapel pin. The Diplomates name, public contact information and certificate expiration will appear on this websites directory of Diplomates.
NON-COMPLETION OF THE CLINICAL EXAMINATION

Initial Certification Examination Non-Completion Re-examination using the same criteria as applied to the case/s that were Incomplete. Source of the re-examination case/s o Case/s solely treated by the examinee either from their residency within 24 months of graduation or from their private practice.
Time limitation to return for completion of the Initial Certification Exam o The examinee has ten (10) years on two (2) separate occasions to present case/s to complete the Initial Certification Exam.
If the examinee does not fulfill ICE requirements, the examinee will submit a new application and will take the Beginning Certification Examination with six entirely new cases after satisfying current fees for the exam.
Beginning Certification Examination Non-Completion Re-examination using the same criteria as applied to the case/s that were incomplete. Source of the re-examination case/s o Case/s solely treated by the examinee in their private practice.
Time limitation to return for completion of the Beginning Certification Exam o The examinee has five (5) years on two (2) separate occasions to present case/s to complete the Beginning Certification Exam.
Option for Re-Examination of One Case by Mail If the examinee does not pass upon re-examination or elects not to return within the five (5) year time limitation for re-examination, the examinee will be required to submit a new registration and will take the Beginning Certification Examination with six entirely new cases after satisfying current fees for the exam.
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Gateway Certification Examination Non-Completion Exam taken prior to expiration of the time-limited Certificate: 1. One (1) to six (6) of the Diplomates cases is/are unacceptable. If this deficiency occurs prior to the expiration of the current time-limited certificate and there are future clinical exams scheduled before the expiration, the Diplomate may return to present new case/s to replace those deemed unacceptable. The new case/s must meet the criteria for the one/s that were deficient. The Diplomate maintains their time-limited certificate. 2. The Diplomate may retake the Gateway Certification Exam as often as needed as long as the current certificate is unexpired. A fee will be charged for each re-examination. 3. Whenever the Gateway Certification Exam is successfully passed, any remaining time on the current certificate will be added to the new certificate. Therefore, there is no penalty for taking the Gateway Certification Exam prior to expiration of the current certificate. Exam or Re-Exam taken in the year of expiration and no exams are scheduled prior to certificate expiration: 1. THREE (3) TO SIX (6) CASE ARE UNACCEPTABLE a. The Diplomate is no longer certified by The American Board of Orthodontics, and must immediately cease any and all recognition and acknowledgement of ABO certification. The Diplomates name is removed from any ABO listing of board certified orthodontists. b. The former Diplomate will submit a new registration and will take the Beginning Certification Examination with six entirely new cases. The current examination fee will be charged. 2. ONE (1) TO TWO (2) CASES ARE UNACCEPTABLE a. The Diplomate maintains Board certified status for one year (365 days) beyond certificate expiration and must return to a Clinical Examination during that year to present one or two entirely new cases using the same criteria as applied to the case/s that were Incomplete. A fee will be charged for the re-examination. b. Option for Re-Examination of One Case by Mail c. Following passage of the re-examination, the Diplomate will receive recertification for nine (9) years. d. If the Diplomate returns and does not successfully complete one or both re-examination cases, the Diplomate will no longer be board certified. The former Diplomate will submit a new registration and take the Beginning Certification Examination with six entirely new cases. The current examination fee will be charged. Voluntary Recertification Non-Completion A Diplomate may re-examine for the Voluntary Recertification as many times as desired by the Diplomate. There will be a nominal fee for each examination.
Recertification Examination/s Non-Completion Re-examination using the same criteria as applied to the case/s that were Incomplete. Source of the re-examination case/s o Case/s solely treated by the examinee in their private practice.
Time limitation to return for completion of the Recertification Exam
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The Recertification Exam may be retaken as often as needed as long as the current certificate is unexpired. A fee will be charged for each re-examination.
Option for Re-Examination of One Case by Mail If the examinee does not successfully complete re-examination or elects not to return, the examinee will be required to submit a new registration and will take the Recertification Exam that follows the last successful exam and bring entirely new case/s. The current examination fee will be charged.
NON-COMPLETION OF RECERTIFICATION
If a Diplomate is no longer certified by The American Board of Orthodontics, s/he must immediately cease any and all recognition and acknowledgement of ABO certification. The Diplomates name is removed from any ABO listing of board certified orthodontists. If a former Diplomate is under investigation for inappropriate use of the designation of Board Certification: a. b. The former Diplomate will be ineligible to participate in the clinical examination until a decision has been made by the Board regarding these allegations. If the allegations of inappropriate use of the designation of Board Certified are proven to be authentic, the orthodontist will be indefinitely prohibited from taking Clinical Examinations to obtain ABO certification.
REQUEST INFORMATION, RECONSIDERATION, OR APPEAL OF EXAMINATION RESULTS

Detailed policy and procedure can be found at Appeal Process for Adverse Certification Decisions.
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CLINICAL EXAM NEWS
Refer to this webpage for latest news on upcoming exams

http://www.americanboardortho.com/professionals/clinicalexam/exam_news.aspx
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PRESENTATION OF CASE REPORTS

Selecting Cases for Presentation Proof of Treatment Case Report Preparation Download Case Report Forms and Instructions Suggestions for the Examinee
Selecting Cases for Presentation

The examinee will provide a case report for each case presented that contains certain expected patient records and reports that are required by the Board. The patient records should be of sufficient quality and accuracy that an appropriate diagnosis and observation of treatment results may be adequately viewed by the examiner. The case report will be evaluated for quality, accuracy and completeness of the patient records and reports in meeting ABO specifications. Currently published ABO clinical exam specifications apply to each years exam, no matter when the examinee began gathering records. A. Specific areas of criteria to be verified by the ABO Examiner: 1. Meets case submission criteria for the type of Clinical Examination a. b. c. 2. Cases must fulfill case requirements by exam type. Especially note the appropriate type of molar Class II relationship for the particular examination - Class II Molar Relationships Two Illustrations . Each case may satisfy only one case criteria. .
Meets case report requirements for patient records at each level of evaluation Especially note those conditions that will cause automatic rejection of a case: a. b. c. Case does not meet exam submission criteria.
Any posttreatment records are obtained beyond 12 months of appliance removal. Interim or Pre-Operative Records are not present for two-phased treatment or for surgical cases.
3.
Submission of measurement instruments to be used in the evaluation of cases. a. See overview of Discrepancy Index Scoring System (pdf) for example records and scoring discussion. b. See Grading System for Dental Casts and Panoramic Radiographs (pdf).
B. Specific areas of observation by the ABO Examiner: 1. 2. 3. 4. 5. 6. 7. 8. 9. Treatment complementing facial growth. Facial harmony -- balance and harmony of the soft tissue and proper proportion of facial structures. Maximum esthetics of the teeth and face. Dental health maximum health of the teeth, the supporting tissues and the adjacent structures. Optimal function, free of interferences and trauma. Excellent occlusion. Favorable intercuspation of the teeth. Alignment of permanent second molars. Favorable overjet and overbite relationship.
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10. 11. 12. 13. 14. 15.
Favorable correction of rotations of all teeth. Favorable axial inclination of all teeth. Complete space closure. Coordinated ideal archform with all the teeth aligned within the supporting structures. Good vertical control. Good stability.
Proof of Treatment
As part of exam registration, all examinees must sign a Rules of Examination Affidavit (pdf) for the ABO affirming that all the professional judgment and treatment was provided by the examinee for each of the patient case reports that are presented to the Board. In addition, the examinee must affirm that patient records have not been altered nor have they been presented to the Board in a previous examination. Finally, the examinee will also affirm that s/he has read the Appeal Process for Adverse Certification Decisions and agrees to the ABO policy on documentation of examination. Additional affidavit, submitted separately, is required under these circumstances: Initial Certification Examination - all recent graduates must have a signed Confirmation of Residency Treated Cases (pdf) by the Department Chairperson and/or Program Director to confirm that each case presented was treated by the examinee under the supervision of a clinical instructor in an ADA accredited orthodontic program. Gateway Offer orthodontists who are certified under the Gateway Offer may present one or two cases treated in their residency program for the First Recertification Examination; a signed Affidavit Two Residency Cases by the Department Chairperson and/or Program Director is needed for confirmation. Full-time Orthodontic Educators (1 FTE per week) - a signed Educator Supervision Affidavit (pdf) by the Department Chairperson and/or Program Director that up to three cases presented by the examinee were treated in the graduate orthodontic clinic entirely under the supervision of the examinee (as a full-time educator). The supervised cases may not include a case that will be presented to the ABO by a resident of the orthodontic program. NOTE: It is the examinees responsibility to obtain patient release for use of records and identification.
CASE REPORT PREPARATION

Patient Records Dental Casts Photographs Radiographs Tracings Record Requirements and Identification Case Report Forms Title Page Written Case Report Measurement Instruments (DI, C-R Eval, CMF) Assembly of Case Report Notebook Case Report Assembly Electronic Submission of Case Report Forms Electronic Submission Information Log into Clinical Exam Electronic Forms Submission Example Case Presentation (pdf, 4.0mb, 24pgs)
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Dental Casts
Each level of evaluation for a case (set of records) requires an accurate representation of the dentition, immediate supporting structures and occlusal relationships. Dental casts should be obtained from impressions that extend far enough into the sulcus to allow accurate reproduction of all soft tissue anatomy. Choice of Presentation a) ABO cast preparation should be trimmed in maximum intercuspation or in the intercuspal position. Documentation of a significant difference between the intercuspal and centric relation should be provided; a dimensionally stable bite registration is preferred. Second molars should be fully erupted and in their final position on the posttreatment casts. b) Casts on an adjustable articulator may be presented. Sufficient articulators must be provided to allow ease of examiner observation, with a minimum of one articulator per case report. c) The Board requires that final casts be a direct plaster/stone reproduction of the occlusal result, trimmed to ABO specifications, and/or mounted in centric relation, after intraoral impressions are produced. Stereolithic or other reconstructed casts created from computer generated images are unacceptable. d) Digital casts submitted in a computer format may be acceptable for pre-treatment casts only. See digital format eligibility and storage requirement at Digital Record Requirements. Cast Alterations Trimming or carving on the anatomical portion of the dental casts should be limited to the removal of bubbles and effects. Alteration of tooth anatomy is considered records falsification. A fixed retainer may be in place when posttreatment casts are made. After the casts are prepared, casts should be smoothed and polished in such a manner that tooth and soft tissue detail is not destroyed. Identification of Dental Casts Each dental cast (maxillary and mandibular) must be individually identified with the appropriate labeling. ABO trimmed casts are identified on the base as described in Record Requirements and Identification . Articulated casts are identified with labels placed either on an individual articulator for a set of casts or on the posterior surface of the mounting stone of each cast. Click on image to enlarge Dental Cast Guide
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Photographs
PHOTOGRAPHS - FACIAL
The facial photograph requirement for each case report is one (1) profile photograph, one (1) frontal photograph, and one (1) smiling photograph. The Board prefers that photographs be taken with relaxed lips; however, views with lips lightly touching are also acceptable. Supplemental photographs may be included and are encouraged. Glamour photos are not necessary. Facial photographs are required for the A, A1 and B levels of evaluation. They should be oriented to Frankfort horizontal. These photographs must fit in a collage photomount or, if computer generated, the photographs do not need to be placed in a photomount, but must be in the same arrangement. They should be as close to one-quarter life size as possible, from top of the head to the bottom of the chin. One can determine if the photographs are one-quarter life size by measuring on the patient the vertical distance from the hairline to the inferior border of the chin. If, for example, this is eight inches, the same dimension on the photograph should be two inches or one-fourth the actual measurement. Photographs may be printed in either black and white or color. The photographic method that is used on the A series of photographs should be repeated on the A1 and B photographs. The requirements for computer-generated images are found under the Digital Record Requirements. Digital photos must be printed on photo glossy paper. The examinee is reminded that all records are legal documents and must not be altered. Facial Photograph Requirements 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Quality standardized facial photographic prints either in black and white or color. Patients head oriented accurately in all three planes of space and on Frankfort horizontal. One (1) lateral view, facing to the right. Two (2) anterior views one with lips relaxed and one smiling. The photographic method used in A Records should be repeated in the A1 and B Records. Soft tissue areas of concern and of diagnostic value should be recorded in these photos. White, or light, background free of shadows and distractions. Quality lighting revealing facial contours. Ears exposed for purpose of orientation. Eyes open and looking straight ahead. Glasses removed. Photographs should be approximately one-quarter life size. If not computer-generated, photographs must fit in the collage photo mounts. Digital photos must be printed on photo glossy paper.
EXAMPLE PHOTO COLLAGE
EXAMPLE PHOTOS & RADIOGRAPHS (pdf)
PHOTOGRAPHS
- INTRAORAL
The minimum intraoral photographic requirement for each level of evaluation is one (1) frontal view, one (1) right lateral view and one (1) left lateral view with the teeth in maximum intercuspation and in color. Photographs of maxillary and mandibular occlusal views are recommended. Beginning with the Clinical Examinations of February 2010, maxillary and mandibular occlusal views are mandatory in each photographic series if treatment was initiated on or after May 1, 2009. The intraoral photographs are required for the A, A1 and B Records. They should be oriented to the occlusal plane. The color prints should be as close as possible to a 1:1 ratio with the patients own
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teeth. If mirror images are used, print them in reverse and mount them if you are looking at the patient. These photographs must fit in a collage photomount or, if computer generated, the photographs do not need to be placed in a photomount, but must be in the same arrangement. Slides are not permitted. The requirements for computer-generated images are found under Digital Record Requirements. Digital photos must be printed on photo glossy paper. The examinee is reminded that all records are legal documents and must not be altered. Intraoral Photograph Requirements 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Quality standardized intraoral prints in color. Patients occlusal plane parallel with the top and bottom of the mount. One (1) frontal view in maximum intercuspation. Two (2) lateral views (right and left). Maxillary and mandibular occlusal views are mandatory for 2010 and beyond if treatment was initiated on or after May 1, 2009. Free of distractions (i.e., cheek retractors, labels and fingers). Lighting should reveal anatomical contours with minimal shadows. Use two (2) cheek retractors. Free of saliva and/or bubbles. Clean dentition. Photographs should be as close to a 1:1 relationship as possible. If not computer-generated, photographs must fit in the collage photomounts. Digital photos must be printed on photo glossy paper.
EXAMPLE PHOTO COLLAGE
EXAMPLE PHOTOS & RADIOGRAPHS (pdf)

Radiographs
Periapical or Panoramic
Periapical and panoramic radiographs must be of diagnostic quality for each level of evaluation. If a panoramic radiograph is submitted, periapical radiographs of the maxillary and mandibular incisors are highly recommended. All films must be oriented correctly with right and left sides clearly marked. The name of the doctor should not be visible. Supplemental radiographs, such as occlusal, additional periapicals or tangential radiographs may be included as needed in the case report. Digital requirements are discussed under Digital Record Requirements. Digital radiographs must be printed on photo glossy paper. For patients 18 years of age and over, as well as for younger patients with signs/symptoms of periodontal involvement, and where pretreatment records were produced on or after March 1, 2007, the examinee must document that the patients periodontal status was amenable to orthodontic treatment prior to initiating care. Under these conditions, the examinee will utilize one or more of the following methodologies: 1. 2. 3. 4. 5. Full mouth periodontal probing recorded by the examinee prior to initiating orthodontic therapy Written documentation of pretreatment periodontal status, including a full periodontal charting, received from a periodontist, general or pediatric dentist Pretreatment panoramic radiograph, in conjunction with vertical or conventional bitewings, and maxillary and mandibular anterior periapical radiographs Full mouth series of periapical and bitewing radiographs CBCT (Cone Beam Computed Tomography) images that represent requirement #3 above
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Post-treatment documentation of similar format must be submitted for comparison of the patients initial and final periodontal status.
PHOTOS & RADIOGRAPHS (pdf) Cephalograms

Cephalograms must show as much anatomy as possible, especially in vital landmark areas, for each level of evaluation. They should be properly standardized, oriented and processed. The name of the doctor should not be visible. The soft tissue profile should be visible on lateral cephalograms. Posterior-Anterior (PA) or sub-mental vertex cephalograms may be included if pertinent to the case. Digital requirements are discussed under Digital Record Requirements. Digital radiographs must be printed on photo glossy paper.
EXAMPLE
ABO Policy Statement Regarding Lateral Head Film Radiographs

With the advent of three dimensional technologies, the inherent inaccuracies of traditional radiographs have come into question. While no person has ever believed that cephalometric data collection was an exact science, orthodontics has continuously placed a high degree of importance on superimpositions as an accurate way of: 1. 2. Determining changes in growth and development and treatment. Ascertaining the amount and direction of tooth movement.
Three dimensional volumetric assessments produce exact measurements.1. 2. When this type of data is compared to traditional cephalometric information (analogue and digital technology), indiscriminant errors in the actual location of vital landmarks necessary to establish superimpositions are found. In spite of this problem, the Board encourages the continued use of like cephalograms (i.e. cephalograms produced on the same machine), and expects examinees to produce high quality cephalometric radiographs using the ABO measurements to determine diagnostic approaches for patient care and to reveal the final treatment results. Use of these accurately traced cephalograms will give the examinee very valuable information about tooth movement, amount and direction of growth, or lack thereof. While the Board recognizes that magnification errors will always be present unless three dimensional volumetric radiographs are utilized, it does not dismiss the examinees responsibility: A. B. to inform the Board the conditions under which the initial, progress, and final cephalometric radiographs were obtained. to create radiographic superimpositions demonstrating the highest degree of accuracy possible
Where initial and final cephalograms are not performed on the same unit, cephalometric tracings are still required, but superimposition(s) are not required. It is the responsibility of the examinee to explain the reason for the absence of superimposition(s). Also, the examinee must be prepared to explain the changes that occurred during treatment.
1.
Adams G.L. GSA, Miller A.J.,Harrell Jr. W.E., and Hatcher D.C. Comparison between traditional 2dimensional cephalometry and a 3-dimensional approach on human dry skulls. Am J Orthod Dentofacial Orthop 2004; 126:397-409. Harrell WE, Jr., Hatcher DC, Bolt RL. In search of anatomic truth: 3-dimensional digital modeling and the future of orthodontics. Am J Orthod Dentofacial Orthop 2002;122:325-330.
2.
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Tracings CEPHALOMETRIC TRACINGS
Pretreatment tracings must be in BLACK. Interim tracings must be in BLUE. Posttreatment tracings must be in RED. Cephalograms must be accurately traced by the examinee using a small diameter (0.5 mm) pencil or pen for manual tracing, or using the computers drawing tool to trace the anatomical outline of a digital radiograph. Computer generated tracings are acceptable if prepared as instructed in the Digital Record Requirements. All tracings must be submitted on transparent media. Templates may be used to trace the tooth outlines. Anatomical structures should be identified accurately in preparation for the marking of landmarks and the drawing of reference lines. All measurements must be recorded on the Case Management Form and on the tracing (see examples). The soft tissue outline of the facial profile is required for each tracing. Note: The Frankfort horizontal (FH) line that is drawn on the original (A) tracing should be transferred to the A1 and B tracings by superimposing on the cranial base and transferring the original Frankfort horizontal. EXAMPLE 1 CEPHALOMETRIC TRACING REFERENCE EXAMPLE 2 CEPHALOMETRIC TRACING
COMPOSITE TRACINGS
A minimum of three (3) composite tracings are required comparing cephalometric tracings: 1. 2. 3. Craniofacial Maxillary Mandibular
The three composites are manually traced by the examinee from the individual tracings of the cephalograms. A small diameter (0.5 mm) pencil or pen should be used. The three composites may be on three separate sheets of tracing acetate or they may all be arranged on one sheet. When there is an Interim set of records, separate composites of A and B tracings, A and A1 tracings and A1 and B tracings are required. Digital superimpositions are acceptable if prepared as instructed in the Digital Record Requirements. All tracings must be submitted on transparent media. EXAMPLE OF COMPOSITE TRACINGS The following procedure for composite tracings is required: 1. 2. 3. 1. Craniofacial Composite register on Sella with the best fit on the anterior cranial base bony structures (Planum Sphenoidum, Cribiform Plate, Greater Wings of the Sphenoid) to assess overall growth and treatment changes. 2. Maxillary Composite register on the lingual curvature of the palate and the best fit on the maxillary bony structures to assess maxillary tooth movement. 3. Mandibular Composite register on the internal cortical outline of the symphsis with the best fit on the mandibular canal to assess mandibular tooth movement and incremental growth of the mandible.
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Examinees must use the same colors for the composite tracings that are used for the cephalometric tracings. Pretreatment tracings must be in BLACK. Interim tracings must be in BLUE. Posttreatment tracings must be in RED. All tracings must be submitted on transparent media. See ABO Policy Statement Regarding Lateral Cephalometric Radiographs and Superimposition of Tracings.
1.
Baumrind S, Miller D, Malthen R. The reliability of head film measurements 3. Tracing superimposition. AM J Orthod 1976; 70:617-644. Doppel D, Damon W, Joondeph D, Little R. An investigation of maxillary superimposition techniques using metallic implants. Am J Orthod Dentofac Orthop 1994; 105:161-168. Bjork A. Variations in the growth of the human mandible: longitudinal radiographic study by the implant method. J Dent Res 1963: 42:400-411.
2.
3.
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Digital Record Requirements GENERAL STATEMENT OF POLICY
The ABO's position on digital records, including but not limited to photographs, radiographic images and study casts is that it is the examinee's responsibility to substantiate the integrity of the records. The overall goal of records is to accurately represent the patient's clinical presentation at the beginning and end of treatment. It is therefore the examinee's responsibility to ensure that records production practices, techniques and technologies are accurate, unaltered, and satisfy ABO standards. Any steps in processing the data for purposes of clarification, presentation, analysis or otherwise should not bias, interfere with, and/or misrepresent the authentic anatomy of the patient. Examinees are reminded that all records are legal documents and must be unaltered in anatomical/diagnostic content. Examinees will prepare digital patient records using the same case report preparation for hard copy records published on this website.
VENDOR SOLUTIONS
Any commercial enterprise offering a product or service intended to aid the examinee in completing the Clinical Examination must accompany the offering with the following statements: This product is compatible with current standards for submission of case reports to The American Board of Orthodontics as published at www.americanboardortho.com. ** **The American Board of Orthodontics has not reviewed or tested this product and does not endorse, guarantee, or warrant its performance or compatibility with ABO standards. Examinees using software to produce digital images for case submission are expected to have thorough knowledge of such programs and should not contact the ABO to address questions regarding the use of the software.
PRESENTATION OF DIGITAL RECORDS IN PRINTED FORM

The examinee will provide digital patient records in printed form. Insert printed pages into the case report notebook according to assembly instructions. Photographs and radiographs will be printed on photo glossy paper, with an ABO record identification label affixed to each page. Tracings and composite tracings, in 1:1 ratio to the cephalometric radiograph, will be printed on transparent media with an ABO record identification label affixed to each page. o Note: Computer technology may be used to produce ceph tracings and superimpositions but the examinee will be responsible for the accuracy of software renderings. The ABO welcomes and encourages hand-traced cephalograms and manual superimpositions so both the examinee and the board can access such accuracy. The examinee may be asked to produce hand-traced superimpositions to verify accuracy.
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DIGITAL CASTS
Digital pre-treatment casts are acceptable provided that the digital format is supported by software to view and measure the digital casts for Discrepancy Index (DI) in compliance with ABO case submission criteria. Digital interim casts are acceptable only between Phase 1 and Phase 2 treatment provided all active appliances are removed prior to taking the impression. For the upcoming clinical exam, the ABO is prepared to accept pretreatment and allowable interim digital casts in the following formats: OrthoCAD Vers 3.25 or later, GeoDigm eModel and Orametrix SureSmile. o Use OrthoCADs built-in DI scoring tool; save your scoring with the digital model. o The examinee using eModel may request DI-scored digital models by contacting GeoDigm directly. o Method for transferring digital SureSmile models to the ABO will be announced at a later date. o The examinee is responsible for all electronic scoring, whether self-scored or company-scored. Submit allowable pretreatment and interim digital via upload at Online Services Clinical Exam Electronic Submission. Digital models will not be accepted on portable media. Note: An accurate and stable occlusal registration (maximum intercuspation) for all digital casts is best achieved by using polyvinylsiloxane (PVS) bite registration material. Digital interim casts are not acceptable for pre-surgical study casts. Post-treatment digital casts are not acceptable at the current time. o Note: The Board requires that final casts be a direct plaster/stone reproduction of the occlusal result, trimmed to ABO specifications, and/or mounted in centric relation, after intraoral impressions are produced. Stereolithic or other reconstructed casts created from computer generated images are unacceptable.
ABO Directors are actively pursuing the implementation of an automatic scoring system for all digital casts.
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Title Page
Insert Title Page into clear overlay on front cover of notebook. All Case Report Forms, including the Title Page, can be downloaded at Case Report Forms and Instructions
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CASE REPORT PREPARATION Written Case Report

The ABO Written Case Report requires a specific format and sequence for the examinees discussion of the presented case. The amount of discussion for any particular section (e.g. DIAGNOSIS Skeletal, DIAGNOSIS Dental) will vary depending on the needs of the specific case, but you will be limited to the character constraints built into the electronic format of each section. Space left in each section is designed to accommodate variable font widths and will not allow characters over the maximum. You are encouraged to reduce your written description to be succinct, yet thorough. You need not use all available space. Please limit abbreviations to standard orthodontic abbreviations. To conserve space, do not use bulleting. Use standard keyboard characters. Do not paste in special characters. For , spell out degree or deg. Summary of Records and Treatment Dates a. b. c. d. The date which the last component of a RECORDS SET is taken should be used as the RECORDS DATE for that particular RECORDS SET (A, A1, and B). Note that all final (B) records must be obtained within 12 months of appliance removal for the Boards acceptance of the case. CASE CRITERIA IDENTIFIER Select an Identifier for each case that meets ABO-defined criteria; otherwise select Not Applicable. If more than one case meets the same criteria, select the same Identifier. In addition, note that one case may not satisfy two criteria. DI VALUE or CATEGORY NUMBER Enter DI Value (total DI); exception, if you are taking/retaking the Option I or II exam, enter Category Number for the case.
History and Etiology Diagnosis Include a brief description of the nature and extent of the anomalies for skeletal and dental and/or facial problems. Examinee may comment on the points used to record the arch widths on the Case Management Form. Specific Objectives of Treatment: a. Maxilla b. Mandible c. Maxillary dentition d. Mandibular dentition e. Facial Esthetics
Treatment Plan Include your diagnostic analysis and reason for choosing a particular treatment plan, extraction or non-extraction, appliances used, anchorage considerations, type of retention, supplemental therapy and prognosis. Appliances and Treatment Progress Include a description of appliances used and of the actual treatment, response to treatment and any complications. Do not record what was done at each visit. Results Achieved a. If differing radiographic units is noted with a checkmark, the examinee may need to elaborate to the examiner the reasons for the lack of superimposition(s) with an explanation of the cephalometric changes during treatment. b. Refer to the objectives stated for the maxilla, mandible, maxillary dentition, etc., and confirm that the objectives were reached or explain why an objective was not realized. Retention Describe appliances and supplementary procedures. Final Evaluation of Treatment Include all pertinent observations and prognosis for stability. Describe posttreatment changes. State what you learned about your specific diagnosis and treatment of the case.
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All Case Report forms and worksheets, can be downloaded at Case Report Forms and Instructions
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Measurement Instruments
The ABO has three (3) measurement instruments for the examinee to use in evaluation of the cases that are presented to the Board. The three measurement instruments are completed for each case report and are submitted electronically. 1. 2. The Discrepancy Index (DI) is a measure of the complexity of an orthodontic case on the pre-treatment dental casts. It is used by the Board in determining the criteria for case presentations. For an overview, see Discrepancy Index Scoring System (pdf). The Cast/Radiograph Evaluation (C-R Eval) is a measure of the results of treatment on the final dental casts and intraoral radiographs. For an instruction manual of the grading system for Cast Evaluation, see Grading System for Dental Casts and Panoramic Radiographs (pdf). The Case Management Form (CMF) is a measure of the changes in the skeletal, dental and facial aspects of the case.
3.
See Construction of the Mandibular Plane
for completing measurements in the DI and CMF.
For your convenience, the ABO has available for purchase a Calibration Kit. The ABO highly recommends the use of its Calibration Kit for cast and radiographic evaluation. It contains information that can assist you in making a quantitative assessment of the records that you plan to use for the clinical exam. The Directors will be using the same grading system contained in this kit to evaluate your treatment results. The Calibration Kit can be found at the eStore.
The following worksheets are for print use only. For electronic forms submission requirement, use ABO Case Report Work File (pdf) at Clinical Forms and Instructions
Discrepancy Index Worksheet for print (pdf) Discrepancy Index Instructions (pdf) For an overview, see Discrepancy Index Scoring System (pdf)
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Cast-Radiograph Worksheet for print (pdf) Cast-Radiograph Reference Sheet (pdf) For an overview, see Grading System for Dental Casts and Panoramic Radiographs (pdf)
Case Management Worksheet for print (pdf) Case Management Instructions (pdf)
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Case Report Assembly and Electronic Submission
For your convenience, here is a list of supplies you will need to assemble your case reports. Supplies Needed for ONE Case Report Notebook
Assembly and identification of records

See important details at Record Requirements and Identification All Posttreatment Records must be obtained within 12 months of appliance removal. Interim or Pre-Operative Records are mandatory for two-phased treatment and for surgical cases.
Presentation of case display

Dental Casts at each stage of treatment for each case; place in treatment order, then Case# order. Plaster models. If you have allowable digital pretreatment models, you will upload these at Online Services Clinical Exam Electronic Submission. Digital models will not be accepted on portable media. Case report notebooks, place in case number order; each will contain: Title page Patient records for each stage of treatment Copy of Case Report Forms (see details below)
Order of contents for each case report notebook

Title Page Pretreatment Records (A) Photographs Insert page into clear overlay on front cover of notebook. Required, BLACK dots Place photographs into photo mount sheet; if digital photos, follow same arrangement on an 8.5 x 11 digital print; place photo collage, photo mount or digital printout, into a sheet protector. Insert all radiographs or digital printouts in one pocket of pocket divider. Insert ceph tracings or digital printouts in the same pocket as the radiographs. Insert periodontal record/s in the same pocket as the radiographs. If needed, BLUE dots; use separate sheet protector and pocket divider; follow same order as (A) records. Required, RED dots; use separate sheet protector and pocket divider; follow same order as (A) records. Insert composite tracings or digital printouts into a sheet protector. Insert printed copy of case reports (Pgs. 2-8 of Case Report Work File), stapled, into the back pocket of notebook.
Radiographs Ceph Tracings Periodontal Record/s Interim Records (A1) Posttreatment Records (B) Composite Tracings Copy of Case Report Forms
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Electronic Submission
Case reports and allowable pretreatment digital models must be submitted to the ABO electronically prior to your exam date. Case report data consists of four reports: Written Case Report (WCR), Discrepancy Index (DI), Cast-Radiograph Evaluation (C-R Eval), and Case Management forms (CMF). All reports and instructions required for one case have been combined into a downloadable PDF Case Report Work File. You have the option of uploading reports from one or more Case Report Work Files. Alternately, you may enter your reports directly to the ABO electronic submission site. Or, you may use a combination of both methods. Choose how you will begin your case reports: OR 1. 2. 3. 4. 5. 6. 7. 8. 9. Start at Step 1 - Enter case report data to a work file on your local hard drive. Start at Step 4 - Enter case report data directly to the ABO electronic submission site. Download CaseReportWorkFile.pdf from the ABO Download Webpage. Adobe Reader, Version 9 or later, is required. * We recommend you use Save-As with a descriptive filename for each case. Enter case report data to each work file at your convenience. In the year prior to your intended clinical exam, register for the exam and you will be informed by email when the ABO electronic submission site is available to you. Login at Online Services Clinical Exam Electronic Submission. Follow prompts to upload each Case Report Work File from Step 3 or to enter case reports directly. ABO case numbers will be assigned automatically according to ascending sequence of DI value (or Category number). Your data will be verified against the current years exam specifications. ** You may return to update your data as many times as needed before the submission deadline.
10. If you have allowable pretreatment digital models to submit, you will upload by selecting Submit Model in the Action column. 11. When finished, mark the reports for each case as Complete and select SUBMIT TO ABO. 12. After submission, use the Print PDF feature to save a read-only copy of your case reports. Print pgs 2-8 and insert in the back pocket of your case report notebook.
* Other PDF viewers are not fully functional and should not be used. Work at the same local hard drive to insure you are always using the same version of Adobe Reader. ** Currently published ABO exam specifications apply to each year's exam, no matter when the examinee began gathering records. If you upload a former years Case Report Work File, you will be alerted if any data has not transferred. You are encouraged to login early and verify your case reports against current year specifications.
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Download Case Report Files, Instructions and Exam Affidavits
The CaseReportWorkFile contains all required case forms and instructions for one case: Written Case Report, Discrepancy Index, Cast-Radiograph Evaluation and Case Management Forms. You may choose to upload data from the CaseReportWorkFile and/or you may enter data directly into the ABO electronic submission webpages. See Electronic Submission. We recommend you use Save-As and a descriptive filename for each case report work file. Adobe Reader, Version 9 or later, is required.
Case Report Work File including Instructions Print only version DI, C-R Eval, and CMF Title Page for Case Report Notebook Affidavit - Initial Certification Affidavit Two Residency Cases Affidavit - Educator Supervision Cases
CaseReportWorkFile (pdf) Measurement Instruments Template (doc) Form (pdf) Form (pdf) Form (pdf) Instructions (pdf) Additional, as required Additional, as required Additional, as required
References for View and Print

Clinical Examination Guide Grading System for Casts and Radiographs Discrepancy Index Scoring System DI and C-R Eval Measurement Demonstration Example Photos & Radiographs Example Case Presentation Record Requirements and Identification Booklet (pdf, 1.5mb, 56 pgs) Booklet (pdf, 0.5mb, 22 pgs) Booklet (pdf, 3.0mb, 24 pgs) Video Demonstration Slides (pdf, 1.5mb. 23 pgs) Booklet (pdf, 4.0mb, 24 pgs)
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Suggestions for Examinees
View Example Case Presentation (pdf, 4.0mb, 24pgs) The following suggestions are intended to help examinees who are preparing for the Clinical Examination: 1. The best suggestion is to READ, STUDY AND COMPLY with the instructions on the ABO website and be attentive to all details. Currently published ABO clinical exam specifications apply to each years exam, no matter when the examinee began gathering records. While it is understandable that compromise treatment is a reasonable alternative for patients who refuse ideal treatment, these patients records usually do not demonstrate the examinees ability to diagnose and treat reasonably difficult malocclusions. Therefore, they are usually not good or acceptable Board cases. As stated, you are expected to bring case reports that are challenging and represent your best work. The Board expects all case exhibits to be well treated. Simply put, poorly finished exhibits, even though they may be difficult and interesting, are not acceptable. Because the Board examiners can only evaluate the records as presented, all treatment, especially occlusal interdigitation should be completely finished. Examiners will not presume that favorable changes will occur with growth or time for patients that are not completely finished. Second molars should be fully seated and in occlusion. The examinee is expected to understand exactly what happened during the treatment of each patient, including work done by other specialists. It should be clear that a surgical orthodontic case had a presurgical treatment plan. You must know what surgical procedures were performed and the extent to which your presurgical treatment goals were achieved. Simple alignment of the teeth and referral of the patient to an oral and maxillofacial surgeon to decide what to do is unacceptable. Interim records are required for patients who had two-stage treatment. Preoperative records are required for patients whose treatment included orthognathic surgery. Interim or preoperative (A1) records to be complete are the same as pretreatment and posttreatment records. In describing your treatment, the Written Case Report should be detailed enough so that the examiners can understand the appliance and principles that you have used in treatment. For instance, the statement placement of a maxillary headgear is not as precise as the statement placement of a high-pull facebow headgear. Clearly identify your treatment objectives, evaluate whether or not you have met them, and comment appropriately in the Written Case Report. Do not confuse treatment objectives with appliances; i.e., placing a straight wire appliance, a TPA or a segmental arch is not a treatment objective. Treatment objectives relate to changes in dental, skeletal and soft tissue structures. The Case Management Form Examinee Treatment Objectives should be a summary of the objectives stated in the Written Case Report. Cephalometric tracings and superimpositions, analog or digital, must be detailed and accurate. They must be submitted on transparent media in 1:1 ratio to the cephalometric radiograph so that reference points can be verified. The ABO welcomes and encourages hand-traced cephalograms and manual superimpositions so both the examinee and the board can access such accuracy. The examinee may be asked to produce hand-traced superimpositions to verify accuracy. Common errors made by examinees: Transparent media is not used for tracings; therefore, reference points cannot be verified. Cephalogram and tracing or superimposition are not in 1:1 ratio. Superimpositions are not registered according to specifications at Composite Tracings. Treatment plan/objectives are not realistic and do not explain how the result was achieved (e.g. mechanics used, anchorage, etc.) Case Management Form Examinee Treatment Objectives do not summarize the objectives stated in the Written Case Report.
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VOLUNTARY RECERTIFICATION
Voluntary Recertification Board Case Exam - enter here
The Process of Voluntary Recertification

Voluntary recertification does not require a trip to St. Louis. Lifetime Diplomates who volunteer for recertification must complete the following steps: 1) Submit one case treated to board standards from the personal practice of the Diplomate. Any case that meets the criteria of the First Recertification Exam is acceptable. 2) Submit your case reports for this one case to the ABOs electronic submission website. 3) Either, prepare treatment plans for two cases provided by the Board on a secured area of the ABO website; Or, score ten of your own consecutively finished cases using the Grading System for Dental Casts and Panoramic Radiographs (pdf); Or, submit three (3) cases that were a part of your original clinical exam case display. The cases need to be analyzed using the current measurement instruments for Discrepancy Index, CastRadiograph Evaluation, and Case Management.
Upon registration, you will receive a case report notebook and a measuring gauge with instructions for submitting your case records by mail. You will also receive a login and instructions to submit your case reports online and to take the Board Case Test online. As a not-for-profit organization, it is necessary to charge a nominal fee for this process. Once you are recertified, you will receive a certificate indicating your accomplishment. To register for voluntary recertification, go to Register for Clinical Examination.
Background
In February 1999, in order to establish guidelines and procedures relative to the recertifying process, all current ABO directors were required to complete a recertification examination. This examination, while voluntary, required that each director present one case report of a patient who had been treated recently and to treatment plan a case they had not seen previously. The current directors were examined by former ABO directors. In February 2000, all former directors who continued as examiners and each newly appointed director were required to recertify in the same manner. At present, the ABO is encouraging all Diplomates who are not required to recertify to do so voluntarily. While the ABO feels that a recertification examination should not be as extensive as the initial Clinical Examination, the Board does believe that such examination must involve diagnosis and treatment planning of clinical records, and have structured the Voluntary Recertification Exam accordingly.
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TRADITIONAL EXAM OPTION I AND II

NOTICE: These exam options are only available to candidates who sat for Oral Examination in 2004 and 2005 and received an extension date; and to candidates who are eligible to re-examine due to an Incomplete in a previous Option I or II examination.
1.
Components of the Option I and II Exams a. Board Case Oral Examination (BCOE) b. Case Report Examination (CRE) c. Case Report Oral Examination (CROE)
2.
Case Criteria for the Option I and II Exams The Option I presentation must include ten case reports according to Category or ten case reports according to DI. Case Category Specifications for Option I Case Selection by DI for Option I. Two (2) cases may be used from orthodontic training program with affidavit from Program Director confirming individual care by examinee. Full-time orthodontic faculty may use three (3) clinically supervised cases. Additionally, the remainder of cases from private practice may contain two category substitutions (from categories 1-8) with no more than two cases in any one category.
The Option II examinee may present any six (6) completed case reports, including post-treatment records, of the initial twelve (12) approved sets of records previously presented to a Director of the Board. These six (6) case reports will be examined in the same way as the ten category cases are examined under the Option I. The examinee may withdraw from the Option II at any time and take the Option I. 3. Incomplete examinees who did not pass one or more cases at the Clinical examination Continue your original path with two more attempts to return with the incomplete case(s) within 5 years from your original Clinical Examination. 4. Certificate time-limits If you applied prior to January 1, 1998, successful passage of the Clinical Exam will earn a NON TIME-LIMITED certificate. Therefore, no recertification will be required, but voluntary recertification is encouraged. If you applied after January 1, 1998, successful passage of the Clinical Exam will earn a 15 YEAR TIME-LIMITED certificate.
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Appendix of Exhibits
Referenced as in the clinical narrative
A-2
The American Board of Orthodontics Case Category Specifications

Revised 4-2-2008 Eligibility for Option I or II examination by Case Category is as follows: Candidates who sat for Oral Examination in 2004 and 2005 and received an extension date. Candidates who are eligible to re-examine due to an Incomplete in a previous Option I or II examination. If presenting cases by Category, the entire case display must be based on Category. Adherence to the category specifications, with exceptions as noted, is mandatory. All surgery cases need pre-surgical records.
1. Early Treatment Malocclusion

Either a one- or a two-stage treatment started in the primary or mixed dentition and completed in the permanent dentition. Stage one treatment must display observable improvement. Initial records (A-1) taken prior to the start of phase one are required. If treatment is in two stages, interim records (A-2) must be shown following the completion of stage one or prior to the start of stage two. The final records (B) must be taken within one (1) year of appliance removal.
Substitution: If a candidate is in a restricted practice or unable to fulfill the case requirements for the early treatment malocclusion, an alternate assignment may be made at the discretion of the Board. Generally, the Board will assign the candidate an adult malocclusion. DI substitution is permissible provided the request is for a substitution of early treatment with a DI of 20 or greater. A request for substitution must be submitted in writing to the ABO office at least three (3) months before the examination.
2. Adult Malocclusion
A surgically or non-surgically treated adult over the age of 21 at the beginning of treatment that fulfills all of the category requirements from one of the case categories #3 through #8. Pre- and post-treatment periodontal charting, and pre- and post-treatment periapical and bitewing radiographs are also recommended.
Substitution: If a candidate is in a restricted practice and is unable to fulfill the requirements for adult malocclusion, an alternate assignment may be made at the discretion of the Board. Generally, the alternate assignment will be a growing patient whose malocclusion fulfills all of the category requirements from one of the case categories #4 through #8. A request for substitution must be submitted in writing to the ABO office at least three (3) months before the examination.
3. Class I Malocclusion treated with bilateral extraction of permanent teeth in the maxillary and mandibular arch 4. Deep Overbite Malocclusion
A malocclusion with retroclined maxillary central incisors, anterior teeth in 100 percent overbite or greater, and an FMA not greater than 22 degrees and/or an SNa Go-Gn angle not greater than 29 degrees.
5. Class II* Division 1 Malocclusion

A malocclusion with an FMA not less than 30 degrees and/or an SNa to Go-Gn angle not less than 37 degrees.
6. Class II* Division 1 Malocclusion treated with extraction of permanent teeth

A malocclusion with a mandibular arch length discrepancy which requires bilateral extraction of permanent teeth in the mandibular arch. The case report should demonstrate the candidate's ability to manage extraction spaces as well as control anchorage and the vertical dimension. A-3
7. Anteroposterior Skeletal Discrepancy

A Class II* malocclusion with an ANB angle not less than 6 degrees or a Class III** malocclusion with an ANB angle not less than -2 degrees.
8. Transverse Discrepancy
A posterior crossbite malocclusion that requires complete appliance treatment. Prior to treatment, at least one (1) posterior quadrant must be in complete lingual or buccal crossbite.
9. Optional
The case selected for this category must have a Discrepancy Index score of 7 or greater. This category does not apply to Voluntary Recertification.
10. Optional
The case selected for this category must have a Discrepancy Index score of 7 or greater. This category does not apply to Voluntary Recertification.
*For the malocclusion to satisfy the Class II category requirement, the mesiobuccal cusp of the maxillary permanent first molar must occlude, at least on one side, in the embrasure between the mandibular second premolar and the mandibular permanent molar, or farther to the mesial. If the maxillary or mandibular permanent first molar is missing, the buccal cusp of the maxillary second premolar must occlude in the embrasure between the mandibular first and second premolars, or farther to the mesial. ** For the malocclusion to satisfy the Class III category requirement, the mesiobuccal cusp of the maxillary permanent first molar must occlude, at least on one side, in the distobuccal groove of the mandibular permanent first molar, or farther to the distal. If the maxillary permanent first molar is missing, the buccal cusp of the maxillary second premolar must occlude in the mesiobuccal groove of the mandibular permanent first molar, or farther to the distal.
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American Board of Orthodontics Case Selection by Discrepancy Index for Option I

Revised 4-2-08 and 10-17-08 Eligibility for Option I examination by Discrepancy Index is as follows: Candidates who sat for Oral Examination in 2004 and 2005 and received an extension date. Candidates who are eligible to re-examine due to an Incomplete in a previous Option I by DI examination. If presenting cases by Discrepancy Index, the entire case display must be based on DI. Adherence to the specifications for Discrepancy Index is mandatory.
Select cases according to the following scoring system: two (2) cases must have a DI of twenty-five (25) or greater six (6) cases must have a DI of sixteen (16) or greater two (2) cases must have a DI of seven (7) or greater.
The ten case presentation must contain: at least one (1) case started in the mixed dentition and identified as mixed dentition. at least one (1) full-step Class II molar relationship* and identified as Class II Case. at least one (1) full-step Class II molar relationship* which requires four (4) quadrant extractions and identified as Class II/Extraction Case. at least one (1) adult case (21 years or older), which may be surgical or other and identified as Adult Case. no more than two (2) combined surgical-orthodontic cases and identified as Surgical Case. All surgery cases need interim (pre-surgical) records.
* See illustration and definition of Full-Step Class II molar relationship under the Clinical
Examination, Selecting Cases for Presentation section of the ABO website.
A-5
The American Board of Orthodontics Option for Re-Examination of One Case by Mail
Applicable only if the examinee has passed the Board Case Oral Examination. If eligible for re-examination, the examinee may elect to submit a new case by mail that meets the criteria for the previously Incomplete case. The examinee must complete the online registration for Re-Examination of One Case by Mail. Refer to the ABO website to view Exam Dates and Fees for registration deadline and the reexamination fee. Collect affidavit(s) if required for the type of clinical exam. See Proof of Treatment on the ABO website for relevant affidavits. Ship the hard copy Case Report and casts, along with affidavit(s) if required, to the ABO central office no later than two weeks prior to your clinical exam. There will be no face to face oral exam for the One Incomplete Case Option. However, the ABO examiners may contact the examinee for any needed elaboration concerning the presented case.
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CLASS II MOLAR RELATIONSHIPS TWO ILLUSTRATIONS
ILLUSTRATION 1 of 2: FULL-STEP CLASS II MOLAR RELATIONSHIP For the malocclusion to satisfy the ABO definition of a full-step Class II molar relationship, the mesiobuccal cusp of the maxillary permanent first molar must occlude, at least on one side, in the embrasure between the mandibular second premolar and the mandibular permanent first molar, or farther to the mesial. If the maxillary or mandibular permanent first molar is missing, the buccal cusp of the maxillary second premolar must occlude in the embrasure between the mandibular first and second premolars, or farther to the mesial. If the maxillary permanent first molar has drifted mesially due to premature loss of the deciduous second molar, that is not considered a Full-Step Class II molar relationship.
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ILLUSTRATION 2 of 2: END-TO-END CLASS II MOLAR RELATIONSHIP This example demonstrates an end-to-end molar relationship which satisfies ABO criteria for Initial Certification only. It is to be distinguished from the full-step Class II of the preceding illustration.
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Construction of Mandibular Plane

Scroll to see two Illustrations
A-9
Supplies Needed For ONE Case Report Notebook

Item 3-ring binder 1 Photo Mount sheets Quantity Description , vinyl on hardboard, clear overlay on cover, two interior pockets Black, custom-made; can be ordered from P&G Products, 800-367-8847 #ABO-12 with occlusal views, #ABO-13 without occlusal views Top-loading, non-glare, 3-hole punch 3-hole punch Purpose Case report notebook
Only for non-digital photo display
2 (3 if Interim Recs)
Sheet protectors Pocket dividers
3 (4 if Interim Recs) 2 (3 if Interim Recs)
For digital or non-digital photo collage, and composite tracings. For all radiographs and cephalometric tracings
Additional Supplies as needed:

ABO measuring gauge 1 Included in Calibration Kit; can be ordered separately from the eStore For measurement of casts and panoramic radiographs
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The American Board of Orthodontics RECORD REQUIREMENTS AND IDENTIFICATION

Case report records must be presented for each level of evaluation: Pretreatment, Interim (or PreOperative) if indicated, and Posttreatment. All Posttreatment Records must be obtained within 12 months of appliance removal. Interim or Pre-Operative Records are mandatory for two-phased treatment and for surgical cases. All records in the case report must be clearly marked as shown with the following information: 1. 2. 3. 4. 5. A Examinee ID number Case number (assigned electronically, according To DI value or Category number, from low to high) Date of record Patient age to the nearest month (example: 14-7) Stage of treatment identified by colored dot: -- BLACK dot Pretreatment records Interim records if indicated or Pre-Operative records Posttreatment records
Label for Composite Tracing of Pre and Post TX
ID# 99999 2-14-02
#1 14-7
ID# 99999 12-3 14-7
#1
A1 -- BLUE dot B -- RED dot
Records to be marked for each level of evaluation include dental casts, photographic collage, all radiographs, all cephalometric tracings and composite tracings. Doctors name, if present, should not be visible. Adhesive labels, not embossed tape, must be used to identify hard copy records. Color marker or color printer may be used for DOT on label.
LABELING DENTAL CASTS
Place the identification label on the base of each dental cast.
ID#69088
#6
When casts are placed on their backs the label is visible.
2-14-02
12-3
ID#69088
#6
2-14-02
12-3
P
A - 11
DENTAL CAST GUIDE These diagrams serve as a guide to cast preparation.
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EXAMPLE FACIAL & INTRAORAL COLLAGE
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PHOTO MOUNTS WITH AND WITHOUT OCCLUSAL VIEWS

Photographs must fit in the photomount. If photographs are digital, they do not need to be placed in a photomount, but must be printed in the same arrangement. Black, custom-made; order from P&G Products, 800-367-8847, #ABO-12 with occlusal views, #ABO13 without occlusal views.
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EXAMPLE 1 CEPHALOMETRIC TRACING REFERENCE
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EXAMPLE 2 CEPHALOMETRIC TRACING
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EXAMPLE OF COMPOSITE TRACINGS
(use the composite tracing of Case #3 of the example cases on the website)
A - 17
MAJOR REVISIONS HISTORY

06/23/06 New Publication
12/20/06 Radiographs policy. Beginning 2009, bitewings and periapicals mandatory for adults 21 and over. 3/8/07 Exam protocol. BCOE review time changed from one hour to one-half hour. 6/22/07 Clinical Exam option. Option for Re-examination of One Case by Mail added. 7/9/07 Discrepancy Index Form. More treatment complexities specified under OTHER; Cephalometrics scoring guide is revised for clarity, BUT CALCULATED POINTS REMAIN THE SAME. 12/17/07 Electronic Guidelines. In-person exam digital records clarification; future electronic submission format policies published. 4/3/08 Traditional Option I and II. Eligibility is limited to those who received valid extentions. 6/1/08 DI and CMF Ceph Measures. Go-Gn measure changed to MP measure in DI and CMF. Electronic submission of Synopsis, DI, CE, CMF. These forms will not be included in case report notebook. Case report notebook. Notebook assembly revised. Examinee Kit is no longer offered.
6/1/08 (continued) Radiographic policy. Documentation required for adults 18 years of age and older and for periodontically-involved adolescents if treatment was initiated on or after March 2007. Cast-Radiograph Evaluation. Root angulation scoring will omit maxillary and mandibular canines. Digital Cast guidelines. One digital format acceptable in 2009 for pretreatment and certain interim casts; occlusal registration for digital casts is best achieved with PVS material. Discrepancy Index. DI scoring system with examples are provided for download; clarification on scoring for crowding, anomalous morphology, and missing teeth. Selecting Cases for Presentation. More detail provided on board expectations and required completeness of records and reports. 9/22/08 Discrepancy Index. Revision to scoring for Anterior Open Bite. 11/21/08 Mandibular Plane. New exhibit to demonstrate construction of MP for completing measurements in DI and CMF. 4/1/09 Photographic occlusal views date change. Beginning 2010, maxillary and mandibular occlusal views are mandatory if treatment was initiated on or after May 1, 2009. 4/1/09 Superimpositions. If differing radiographic units, ceph tracings are required but superimposition(s) are not required.
4/1/09 Final Casts clarification. Stereolithic or other reconstructed casts created from computer generated images are unacceptable as final casts. 6/1/09 Case Report Work File. All case report forms and instructions are combined into one downloadable file. Option to upload as an electronic forms submission. Option to print submitted forms. Initial implementation 2009-2010. 10/1/09 Emodel pretreatment digital models are acceptable. 4/1/10 ICE Banking Process published. 4/12/10 C-R Eval Buccolingual Inclination Exception: Do not score the mandibular 1st premolars nor the distal cusps of the second molars. 7/19/10 Enhanced Case Report Work File released. Allowable pretreatment models will be submitted via upload to ABO electronic submission site. 12/8/10 DI clarification on scoring for Overjet and for Anterior and Lateral Open Bite. 3/15/11 Recertification Exam requirements announced for 1st, 2nd, 3rd, and 4th Recertifications. Exam renamed to Gateway Certification Examination.
A - 18

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The American Board of Orthodontics

Clinical Examination Guide

Pg-37 Pg-38 Pg-13

Presentation of Case Reports

Exam Components Board Case Oral Exam Worksheet

Exam Components Overview

Components of the Clinical Examination A. CASE REPORTS PRESENTED BY THE EXAMINEE

BOARD CASES PRESENTED TO THE EXAMINEE

Explanation of the Board Case Oral Exam

Sample Board Case Oral Exam - enter here

INITIAL CERTIFICATION EXAMINATION

Case Criteria for the Initial Certification Exam

BEGINNING CERTIFICATION EXAMINATION

Case Criteria for the Beginning Certification Exam

GATEWAY CERTIFICATION EXAMINATION

Case Criteria for the Gateway Certification Exam

FIRST RECERTIFICATION EXAMINATION

Case Criteria for the First Recertification Exam

SECOND RECERTIFICATION EXAMINATION

Case Criteria for the Second Recertification Exam

THIRD RECERTIFICATION EXAMINATION

Case Criteria for the Third Recertification Exam

FOURTH RECERTIFICATION EXAMINATION

Case Criteria for the Fourth Recertification Exam

VOLUNTARY RECERTIFICATION EXAMINATION

TRADITIONAL OPTION I and II (limited)

PROTOCOL FOR EXAM

NON-COMPLETION OF THE CLINICAL EXAMINATION

Time limitation to return for completion of the Recertification Exam

REQUEST INFORMATION, RECONSIDERATION, OR APPEAL OF EXAMINATION RESULTS

CLINICAL EXAM NEWS

Refer to this webpage for latest news on upcoming exams

PRESENTATION OF CASE REPORTS

Selecting Cases for Presentation

10. 11. 12. 13. 14. 15.

CASE REPORT PREPARATION

CASE REPORT PREPARATION

CASE REPORT PREPARATION

EXAMPLE PHOTO COLLAGE

EXAMPLE PHOTOS & RADIOGRAPHS (pdf)

EXAMPLE PHOTO COLLAGE

EXAMPLE PHOTOS & RADIOGRAPHS (pdf)

CASE REPORT PREPARATION

PHOTOS & RADIOGRAPHS (pdf) Cephalograms

ABO Policy Statement Regarding Lateral Head Film Radiographs

CASE REPORT PREPARATION

PRESENTATION OF CASE REPORTS

PRESENTATION OF DIGITAL RECORDS IN PRINTED FORM

CASE REPORT PREPARATION

CASE REPORT PREPARATION Written Case Report

CASE REPORT PREPARATION

See Construction of the Mandibular Plane

for completing measurements in the DI and CMF.

CASE REPORT PREPARATION

Assembly and identification of records

Presentation of case display

Order of contents for each case report notebook

PRESENTATION OF CASE REPORTS

References for View and Print

PRESENTATION OF CASE REPORTS

The Process of Voluntary Recertification

TRADITIONAL EXAM OPTION I AND II

The American Board of Orthodontics Case Category Specifications