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GHANACOLLEGEOFPHYSICIANSANDSURGEONS

Towardsthefellowshipprogrammeinorthodonticsinthe

FacultyofDentalSurgery

CURRICULUM

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OUTLINE

• Preamble

• Philosophy

• Aims/Objectives

• Admission requirements

• Course Duration

• Programme outline

• Training site(s)/ requirements

• Core competencies

• Fellow Activities

• Research

• Specialty Conferences (Local, Abroad)

• Recommended textbooks and Journals

• Assessment/ Evaluation Methods

• Final Assessment

• Time table

• Criteria for certification (General Fellowship criteria)

• Logbook/Portfolio

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1. Preamble Orthodontics and Dentofacial orthopaedics is the branch of Dentistry, which is concerned with the study of the growth of the craniofacial complex, the development of the occlusion and the diagnosis, prevention and treatment of dentofacial anomalies and malocclusions 2. Philosophy As with every other specialty in Dentistry, there is a lack of specialists and consultants in the field of orthodontics. The few orthodontists currently are concentrated in the largest cities of Ghana, that is in Accra and Kumasi. There are also very few orthodontists in the training institutions to mentor and train new specialists and consultants. Most orthodontic treatment in the Country is carried out by General Dentists with very little experience and knowledge in this specialty leading to compromised outcomes. It is thus imperative that more orthodontists are trained to fill this vacuum and provide quality care for patients needing treatment.

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3. Aims of the programme

1. To produce fellows who have completed their didactic and clinical education under the auspices and

direction of an advanced educational institution. 2. Offer comprehensive, contemporary and advanced knowledge in Orthodontics to consultant level;

instill the need for continuing professional development and lifelong learning;

3. Promote a critical approach to evaluating relevant literature so as to enable evidence-based practice in

Orthodontics to consultant level.

4. COURSE DURATION The course is expected to last for 2 years full time.

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4. Programme outline

The guidelines of the world federation of orthodontics (see appendix) for the training of orthodontic specialists

and consultants will be used throughout the programme

This programme is for those who have passed the three-year Membership examination in Orthodontics course

and would like to seek further consultant level training. These additional clinical years of education and training

would consolidate the candidate with valuable experience to the highest level endorsed by the world federation

of orthodontists In addition to academic inputs, the programme offers a major specialist led clinical component in

which the Residents will gain high level training on multi-disciplinary management for both children and adults

who require restorative and surgical treatments. Other components include clinical audit, governance and

research consolidation

The general requirements for the residency programme will be followed.(refer membership logbook) Apart from

that, the following requirements will have to be fulfilled.

1. Cleft rotation: the Senior Resident will have to spend a specified amount of time each year at the cleft lip

and palate clinic to acquaint themselves with the management of cleft lip and palate cases.

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2. The Senior Resident will spend a specific amount of time at the paediatric surgery department to acquaint

themselves with the management of patients with craniofacial anomalies and carry out research work

3. The last Friday afternoon of every month will be set aside for journal club, case discussions, research

work, special lectures and debates etc.

4. Every resident will have one session off (half day) during the week for independent work and research etc

and this time must be spent in the premises of the training institution

5. Tuesday afternoons are reserved for exposure clinics and all residents are required to be present.

Residents may also attend to a few cases if there is no exposure clinic.

6. Specified dates will be set aside for tutorials lectures, debates

7. Residents are required to do supervision work in the clinic and also deliver some lecture topics and mentor

junior residents

8. It is mandatory that Residents fabricate their own appliances and retainers

9. Each resident is encouraged to publish at least two peer reviewed articles during this period. You are also

required to participate in all the scientific conferences of the GCPS, COHS and the GDA and submit

posters, or abstracts for publication.

To this effect apart from the main research topic each resident is encouraged to have 3 smaller topics for

research.

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PATIENT LOAD

Each resident is required to start at least 15 new fixed appliance cases each year. Cases are expected to exhibit greater complexity with an IOTN of 3 and above.

6. FACULTY

All consultants at Department of orthodontics and Paedodontics and any other fellows of the Ghana College or other recognised institutions in the diaspora

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7. TRAINING SITE/REQUIREMENTS:

The site of training shall be at the University of Ghana School of Medicine and Dentistry(UGSMD) Dental clinic

and the Kwame Nkrumah University of Science and technology (KNUST) Dental School or any other institution

accredited by the college of Physicians and Surgeons. The Resident is required to have passed the

membership examination in orthodontics and per the requirements of the Ghana Health Service should have

served at least 1 year in the district

Residents must be enrolled full-time and are required to attend an adequate amount of faculty-supervised

clinical sessions to establish proficiency in clinical orthodontics. Twenty-four (24) hours per week of supervised

patient management is recommended. The trainee may spend more time in preparatory work in the form of

individual studies, research or other specific assignments. However, all clinical training and taught courses must

fit within an 8-hour daily work schedule. Ten to twelve hours per week, 25% to 30% of the programme should be

dedicated for research and administration (treatment planning, preparation of tutorials, assignments and case

presentations).

The number of new patients assigned to each resident should not be fewer than 30(15 per year) and equal or

more transferred patients will be assigned during the course of the study. Clinical responsibilities of the residents

should also include supervision of retention patients and recall for observation of former patients with special

clinical interest. A minimum of 2 hours per week should be devoted to case presentation and another 1 hour for

review of the current literature in the form of a journal club. Treatment modalities and appliances should include

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removable and fixed appliances, growth modification, orthognathic surgery, guided eruption of impacted teeth,

craniofacial anomalies, interdisciplinary management and preventive and interceptive case management.

EQUIPMENT

• Prior to the beginning of the Residency, each Resident must have a kit of wire bending pliers and wire cutters, soldering kit a digital SLR or compact digital camera (mobile phones are not accepted) and these must be available at all times

• Each Resident must possess a diary for the booking of appointments • Residents must obtain the separate illustrated manual to prepare for the fellowship examination in

orthodontics. This manual takes the resident through a step by step presentation of each case treated in a standardized form

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8. CORE COMPETENCIES

• Demonstrate the possession of in-depth and extensive current knowledge in Orthodontics to consultant

level • Undertake independent, proficient and advanced clinical practice in Orthodontics to the highest level in

either primary or secondary care settings.

• Relate Orthodontic care to other dental and medical specialties;

• Utilise problem-solving and decision-making skills to assess, diagnose and treatment plan advanced,

multi-disciplinary and complex cases;

• Accept secondary referrals for advice and treatment in Orthodontics;

• Understand and analyze the literature and research bases for evidence-based clinical care;

plan and perform research including clinical audits;

• Communicate effectively and interact with patients and colleagues in other dental and medical specialties;

• Be eligible for entry to sit the fellowship examination of the Ghana College of Physicians and Surgeons

• Evaluate psychological aspects of relevance to orthodontics

• Formulate a research hypothesis and design and conduct an experiment to test its validity

• Efficiently organize, present, and publish research findings, as well as present clinical cases in a

comprehensive manner.

• Coordinate an Orthodontic Specialty Practice.

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• Get acquainted with the different types of mechanics apart from the straight wire discipline in the

management of patients eg. Begg, Tip edge, Bioprogressive, Bi-dimensional, Alexander discipline,

MEAW, Damon System, lingual orthodontics and invisalign

Academic content:

• Advanced principles of Orthodontic diagnosis and treatment planning in children and adults

• Advanced clinical mechanics for treating a variety of malocclusions

• The current approaches to the scientific method of research

• The skill in multi-disciplinary management of children and adults requiring restorative and/or surgical

treatment

Disciplinary Skills - able to:

• Critically appraise scientific papers

• Reflect on case-studies, the integration of current clinical skills with new knowledge of the discipline

• Synthesize information in a manner that may be innovative, utilizing knowledge or processes from the

forefront Carry out orthodontic treatment in children and adults to a specialist standard of the

discipline/practice and from a wide range of sources

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• Discuss ethical and governance issues associated with research and patient treatment

• Apply principles of patient safety and a patient-centred approach to oral health care for children and adults

and recognise own limitations and when to seek advice

Attributes:

• Demonstrate high level competency in patient care, skill and knowledge

• Show professional judgement to implement clinical solutions in response to problems by developing

evidence based treatment plan and taking an holistic approach to solving problems and designing

treatment plans.

• Demonstrate the ability to critically assess scientific papers and available evidence such as guidelines

using a variety of information sources.

• Evaluate critically the scope and limitations of the various techniques used in Orthodontics

• Develop an integrated insight into how the development and impact of their knowledge and skills is of

value and relevance to the workplace.

• Appraise systematically current evidence in Orthodontics and appreciate research inform practice

• Demonstrate the ability to sustain a critical argument in writing and through oral presentations

• Demonstrate ability to write a scientific paper

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9. FELLOW ACTIVITIES

PATIENT CARE • For every patient, Residents must have full documentation of records and this Includes a full detailed

history, study models trimmed to orthodontic specification, X-rays ( lateral cephs must be traced), pictures and these must be available at all times during patient treatment.

• During the period of residency training, every patient being treated will be strictly under the supervision of the consultant in charge.

CLINIC ETIQUETTE

• Residents must be at post at least 10mins before the start of clinic. Reprieve is given for the Resident attending lectures and seminars etc.

• At every quarter, each Resident will be required to submit an update and summary of cases done and of patients undergoing treatment

• The patients of the Consultant must be attended to before the patients of the Resident. In case you need to see your patient earlier, you must arrange to do so before the official start of the clinic

• The periods for your lab work and research work are not off days and thus you are to be present at all times. laboratory and research days for each Resident are mandatory and start at 8.30am and ends at 12 pm If for any reason you cannot make it, this has to be communicated to the HOD either verbally or in writing.

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• Absenteeism will not be condoned. Any missed day without any tangible reason will be deducted from your leave period

LEAVE PERIOD Your leave period should be planned at the beginning of the year and submitted to the HOD. This should be such that not more than two Residents are on leave at the same time since this could interrupt clinical work. Each Resident shall take full responsibility for his or her patient. Residents must plan their annual leave in advance so as not to coincide with the visits of their patients. Patients will only be attended to in your absence only in cases of emergency. 10. RESEARCH Six months into the residency programme each Resident is required to submit for Consideration, an outline of research topic to be undertaken for the fellowship programme. Each Resident is also required to identify three smaller topics to research on. Each Senior Resident should undertake a research project for which its methodology as well as the results

should be presented in the form of a dissertation. The Senior Resident should produce a bound dissertation of

research work before submission date and be able to discuss and defend the research in an oral examination.

Senior Residents are expected to publicize the findings of their research in a variety of ways, including (a)

Presentation at research seminars, (b) Presentation at national/international meetings and (c) Publication in a

refereed journal.

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11. SPECIALTY CONFERENCES Within 1-2 years of the fellowship programme, each Resident is encouraged to attend at least one International orthodontic/ paedodontic conference and submit at least one article and abstract for presentation or publication in any peer reviewed journal. The orthodontic courses attended will form part of the Resident’s final assessment before being required to take the examinations 12. COURSES The Senior Resident must make it an objective to attend at least one continuing education work shop to learn new techniques and methods in orthodontics 13. Specialty related journals The following journals are recommended for use by the fellowship resident.

• Journal of clinical orthodontics • Orthodontic update • Journal of orthodontics • American journal of orthodontics and dentofacial orthopaedics • Angle orthodontics • European journal of orthodontics • West African journal of orthodontics • Journal of the world federation of orthodontics

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14. Assessment There will be a system of ongoing evaluation and advancement. Written evaluations of the Residents, shall be

obtained from the training staff. The evaluation will include:

a. Cognitive skills;

b. Clinical skills;

c. Interpersonal skills;

d. Patient management skills; and

e. Ethical standards.

f. Research activity

Twice a year, the institution shall conduct constant evaluation of the performances of the Resident to assess the

progress forward (formative assessment). Procedures that are required are assessed and graded by trainers.

Residents must have completed all the necessary procedures.

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15. Final assessment. Part II Fellowship Examinations Candidates must have received instruction in the application of the principle of ethical reasoning, ethical

decision-making and professional responsibility as they pertain to the academic environment, research, patient

care and practice management before the Final Fellowship Examinations.

There should be assessment of the achievement of the competencies for the specialty in all the three domains

(cognitive, psychomotor and affective) using formal evaluation methods;

a. Presentations

b. Assessment of log books

c. Assessment of interest in publication writing

d. Bi-annual reports of performance from their trainers

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The Format of the Examination

The Final Fellowship examination will consist of three parts:

a. Dissertation defense: 15 minutes of power point presentation followed by 45 minutes of questioning by

examiners.

b. Clinical case presentation: 15 minutes Power Point presentation by candidate and 45 minutes of

questioning by the Examiners. NB: five (5) Clinical Case Presentations covering different malocclusions of

the specialty including one interdisciplinary case should be submitted for the examination for assessment.

(for complexity of cases to be presented, check the illustrated manual) However, ONLY ONE will be

presented by the candidate, but all five (5) will be scored.

Full clinical records of the 5 cases must include:

i. Clinical photographs

(Extra-oral views) -frontal, lateral and three-quarters views

(Intra-oral views) - lower arch, upper arch, right and left lateral and frontal views in occlusion.

ii. Orthodontic casts

iii. Well-trimmed Orthodontic casts before and after active treatment. In- between treatment casts may be

included.

iv. Radiographs

v. Pre- and post treatment Lateral cephalograms including tracings and superimpositions should be

provided and in-between treatment Lateral cephalograms may be included.

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vi. Pre- and post treatment panoramic radiographs must be provided. In- between treatment panoramic

radiographs may be included.

vii. Pre- and post treatment upper anterior occlusal radiographs should be provided (where indicated). In-

between treatment of upper anterior occlusal views may be included.

Log book should be accepted at the time of application for the Final Fellowship Examination. The logbook

and Dissertation should be submitted and sent to the examiners 2-3 months prior to the examination. An

Internal Assessor shall be present at the examination.

NOTE: Candidates must pass ALL SECTIONS of the Final Fellowship Examinations to merit a PASS in the

examination

c. Specialty vivo voce and Log book assessment

Log-Book which must show clear evidence of treatment of different malocclusions from the beginning to the end

using various orthodontic techniques. Evidence of all the clinical records must be shown in form of case book.

One hour of questioning will be conducted covering a wide range of topics in orthodontics. There will be at least

two internal examiners and one external examiner present at the final exam

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16. Time Table At the beginning of each academic year (January) a time table will be drawn up. This will include laboratory-training schedules with the junior residents, weekly seminars and case presentations, lectures debates, assessments and research work. This will generally follow the guidelines set out by the world federation of orthodontists for the training of orthodontic specialists

17. Recommended textbooks

• Contemporary orthodontics by William R. Proffitt and Henry W. Fields • Diagnosis of the orthodontic patient by Mc Donald and Ireland • Removable orthodontic appliances by Isaacson et al., • Systemized treatment mechanics II by Mclaughlin, Bennet and Trevisi • Postgraduate notes in orthodontics by Atack et al.,

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18. Criteria for certification The minimum of two years senior residency training programme encompasses the full scope of Orthodontic

fellowship training leading to:

Fellowship of Ghana College of Surgeons in Orthodontics

The certification gives recognition to the effect that the holder has acquired the competences expected.

NOTE: Candidates must pass ALL SECTIONS of the Final Fellowship Examinations to merit a PASS in the

examination.

19. logbook/portfolio E-logbooks will be provided by the College and procedures done by trainees approved by Trainers and

accepted at the time of application for the Final Fellowship Examination. The e-logbook and Dissertation would

be submitted to the College to be sent to the examiners 3 months before the proposed examination date for

assessment by internal and external Assessors. Senior Residents who commenced their training before the

introduction of the e-logbooks will record all procedures done in the hard copy log book. (an example is found

below) The logbook will be assessed before the candidate is allowed to take the final examination.

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20. Appendix (taken from the WFO guidelines for the training of orthodontists) Course work/topics to be covered A. Biomedical sciences with emphasis on biological and medical subjects • Growth and development

• Anatomy of the head and neck

• Genetics

• Embryology of the head

• Cell and molecular biology

• Oral immunology and microbiology

• Oral physiology

• Biostatistics

• Research methodology

B. Basic orthodontic subjects

• Development of the dentition

• Physiology of the stomatognathic system

• Orthodontics as it relates to growth

• Biomechanics

• Dental radiography

• Introductory orthodontic seminars/diagnosis and treatment planning

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• Cephalometric radiography

• Orthodontic materials

• Occlusion and TMJ

• Iatrogenic effects from orthodontics

C. Special orthodontic subjects

• Biomechanics and tooth movement

• Obstructive sleep apnea and orthodontics

• Interdisciplinary treatment (eg, prosthodontics-periodontics)

• TMD and orthodontics

• Orthognathic surgery joint clinics and seminars

• Face asymmetries

• Class I malocclusion

• Class II malocclusion

• Class III malocclusion

• Vertical problems

• Maxillary constriction

• Orthodontic diagnosis in 3 dimensions of space

• Orthodontic techniques

• Cleft lip and/or palate treatment

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• Adult orthodontics

• Noncompliance treatment

• Temporary anchorage device (TAD)

• Practice management

Appendix 2: Educational Topics

BASIC MEDICAL SUBJECTS

Growth and development Somatic growth and variations

Growth adolescent acceleration Development of the craniofacial complex Genetic/environmental factors and

growth Determination of skeletal and biological age Stages of sexual development

Anatomy of the head and neck

Craniofacial structures Skeletal deformities Craniofacial malformations

Genetics The genetic basis of diseases

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Genetic diseases - syndromes

Cancer genetics

Gene therapy and bioethics Development of malformations

Genetic and epigenetic control of growth

Embryology of the head

Development of jaws, teeth, and face Teratogenesis and syndromes Development of clefts

BASIC ORTHODONTIC SUBJECTS

Development of the dentition Development of normal occlusion Tooth eruption

Development of abnormal occlusion Local and genetic factors

Deviation from normality

Agenesis and supernumerary teeth

Physiology of the stomatognatic system Constituent muscles, bone, and cartilage Abnormal function

TMJ physiology and function in health and

disease

Diagnostic procedures Therapeutic protocols

Orthodontics as it relates to growth

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Types of growth in bone, condyle, and sutures Adaptation of tissues to stimuli

Mechanical stimulation

Dentofacial orthopedics

Biomechanics

Equilibrium of bodies Mechanics of solids Viscoelasticity

Oral and maxillofacial radiography

Periapical radiographs [intra- and extraoral technique]

Variables affecting the quality of radiographs

Cell and molecular biology Cell metabolism

Tooth movement and reaction to force Biochemical pathways of force transduction

to cell

Biological mechanisms of root resorption Biological events accompanying force

application to cartilage, bone and periodontal ligament

Oral immunology and microbiology Oral immunology

Saliva and the formation of acquired pellicle Oral microbiology

Biofilms

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Oral physiology Physiology of speech, swallowing and gestation Physiology of TMJ

Physiology of breathing and swallowing

Normal and abnormal breathing and

obstructive sleep apnea

General and oral pathology

Systemic diseases (growth and sex hormone imbalances, hepatitis, HIV, leukemia

osteoporosis, and endocarditis)

Oral manifestations of diseases (radiation,

cysts, herpes, and aphtha)

Anatomical landmarks in intra- and extraoral radiographs

Caries diagnosis through radiographs Periodontal diagnosis and radiographs Oral and maxillofacial applications

Orthodontic applications

Digital imaging

Cone beam computed tomography Radiation safety

Introductory orthodontic seminars/diagnosis and treatment-planning Medical/dental history

Records

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Extra- and intraoral examination

Diagnostic sequelae

Photographic assessment

Model analysis (crowding/space assessment, Bolton analysis, set-up)

Cephalometric radiography Lateral

Posterior - anterior

Landmark identification

Measurements

Noninvasive techniques

Analyses (Steiner, Wits, Downs, Hasund, Coben, Bjork, Sassouni, Tweed, Ricketts,

McNamara, and Pancherz) Superimpositions (overall, regional) 3D imaging

Biostatistics Regression and correlation

Parametric and nonparametric analyses Analysis of variance

Meta analysis

Applications in orthodontics Biostatistic-epidemiologic surveys Clinical research in orthodontics

Research methodology

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Ethics and integrity in research Design of a study

Submission of a protocol Statistical analysis of findings

Orthodontic materials Alloys

Polymers

Ceramics

Bonding to enamel

Bonding to restorative materials Enamel side effects

Occlusion and temporomandibular disorders (TMD) Anatomy and function

General TMJ concepts

Normal occlusion and function Differential diagnosis of TMD

TMD in children, adolescents and adults Management philosophies

Iatrogenic effects from orthodontics Classification of undesirable tissue, organ, and system effects

Enamel effects during bonding; debonding and treatment with fixed appliances

Root resorption

Damage to tooth-supporting tissues Risk-management principles

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Appendix 2: Educational Topics (continued)

SPECIAL ORTHODONTIC SUBJECTS

Biomechanics and tooth movement Methods of study

Applications to clinical practice

Obstructive sleep apnea and orthodontics

Interdisciplinary treatment (prosthodontics, periodontics, etc)

TMD and orthodontics

Orthognathic surgery joint clinics and seminars

Face asymmetries

Classification Etiology Diagnosis Treatment options

Class I malocclusion patient Diagnosis

Etiology

Treatment planning

Class II malocclusion patient Diagnosis

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Etiology

Treatment planning Headgear

Functional appliances

Class III malocclusion patient Diagnosis

Etiology

Treatment planning Face mask, chin cup

Vertical problems Open bite

Deep bite Diagnosis

Etiology Treatment-planning

Maxillary constriction Rapid maxillary expansion

Diagnosis

Appliances (Quad-helix, Haas and Hyrax expanders)

Effects on periodontium

Effects on airway

Orthodontic diagnosis in 3 dimensions of space

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Sagittal Transverse Vertical Appliances

Orthodontic techniques Straight-wire

Tweed

Ricketts

Standard edgewise Tip-edge

Self-ligating techniques Clear sequential appliances

Cleft lip and/or palate treatment

Indications, timing, protocols Interdisciplinary approach Speech therapy Psychological Involvement

Adult orthodontics Esthetics

Emergence profile

Periodontal considerations

Treatment planning complex cases Limitations of reconstructive techniques

Noncompliance treatment

TAD

Accelerated osteogenic orthodontics (eg, Wilckodontics)

Practice management

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Sterilization and disinfection protocols Orthodontic practice: setting up/the design process

Orthodontic practice: engaging with the team/the building process

Medical and legal aspects of orthodontic care Practice visits and discussion with private practitioners

Professional ethics

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Appendix iv Membership of society 12. Each member may join as a student member of the Ghana Society of orthodontists. Being a member of the Ghana Society of orthodontics grants you special priviledges to join affiliate societies like the world federation of orthodontics and the American association of orthodontics I hereby agree that I have read and understood the listed guidelines and code of conduct for my orthodontic residency and I promise to abide by them. I agree that failure to do so may result in punitive measures being taken against me. ................................................. ............................................. Resident. Head of Department