Appendix B

Blueprint

Background
 This Blueprint of the examination for the Membership in Orthodontics of the Royal College of Surgeons of
Edinburgh is based on the outcome competencies in Appendix A. These have also been described by the
JCSTD SAC in Orthodontics in the “GUIDELINES FOR THE UK THREE-YEAR TRAINING PROGRAMMES
IN ORTHODONTICS FOR SPECIALIST REGISTRARS AND OTHER POSTGRADUATE TRAINEES-
December 2003” (Page 11).

 Competencies have been identified as Essential(E) Desirable(D) or Advantageous(A)

 The Five components of the examination are:

1. Written Paper (180 SBA questions)

2. Diagnostic Examination (on 4 Case records)
3. Communication Examination (1 Scenario - OSCE)
4. Case Histories (Portfolio of 4 abbreviated documented treated cases)
5. Oral examination

 Each competency has been attributed one or more parts of the examination.

What the Specialist is able Outcomes for gathering clinical E D A Written Diagnostic OSCE Portfolio Oral
to do information Paper tests
The Specialist should be able to:
Take a History from Take a relevant and complete (medical
patients, relatives, and and dental) patient history and a history of √ √ √ √ √
others the presenting complaint
Undertake an intra and
extra oral examination of Perform a thorough clinical examination of: √ √ √ √
the head and neck
 anterior posterior, vertical, and
transverse facial proportions.
√ √ √ √
 soft tissues, dentition, and supporting
structures
√ √ √
Perform intra and extra oral examinations
comprising:
 TMJ and muscles of mastication √ √ √ √
 Periodontium √ √ √ √
 Teeth √ √ √ √
 Soft tissues and lymph nodes √ √ √ √
 Oral cancer screening √ √
 Skeletal pattern and occlusal
relationships √ √ √ √

Determine habitual occlusion, evaluate
Examine the occlusion
articulation, and jaw relationships √ √ √ √
Evaluate functional components of soft
tissue structures on morphology and √ √ √ √
understand their influence.
Take impressions of dental arches for
different orthodontic purposes. √ √
Be familiar with jaw registration using face
bow recordings and mount casts on an √ √ √ √ √
articulator.

1
What the Specialist is able Outcomes for gathering clinical E D A Written Diagnostic OSCE Portfolio Oral
to do information Paper tests
Obtain and interpret
relevant clinical, Take high quality extra-oral and intra-oral
radiological and laboratory photographs. √ √ √ √
investigations
Understand the use of radiographic
investigation and the appropriateness of √ √ √ √ √ √
each investigation to particular problems.
Understand the importance and limitations
of cephalometric analyses based on both √ √ √ √
manual and computer tracings.
Describe various forms of specialised
imaging techniques. Use of specialised
radiographic investigations: isotope scans, √ √ √ √ √
and computerised tomography, MRI, video
imaging, and 3D imaging.

What the Specialist is able Outcomes for treatment planning E D A Written Diagnostic OSCE Portfolio Oral
to do Paper tests
Plan appropriate management of acute
General
dental conditions. √ √ √ √ √
Develop a prioritised problem list, identify
possible solutions and alternative √ √ √ √
treatment plans.
Explain the treatment options, the risks
and benefits, and obtain informed consent √ √ √ √ √ √
for the agreed option.
Develop an appropriate sequence of
treatment. √ √ √ √
Refer patients when appropriate. √ √ √ √ √ √
Diagnose and classify common
craniofacial disorders, and know where to
Craniofacial Anomalies
find information about the more unusual √ √ √ √
syndromes.
Have an understanding of the role of the
Cleft Lip and Palate orthodontist in the multi-disciplinary care of √ √ √ √
patients with cleft lip and palate.
Understand the involvement of the
Integrating Restorative
Care
orthodontist in restorative treatment √ √ √ √ √
planning.
Understand specific indications for
orthodontic treatment for restorative √ √ √ √ √ √
problems.
Understand the limitations and contra-
indications of orthodontics in cases √ √ √ √ √ √
requiring multi-disciplinary restorative care.
Understand the materials and techniques
currently used in specific restorative √ √ √ √ √
situations.
Provide appropriate orthodontic treatment
for a range of routine restorative problems. √ √ √ √
Provide risk/benefit advice on long term
orthodontic - restorative treatment. √ √ √ √
Diagnose skeletal disproportion of such
Integrating Oral and severity that routine orthodontic
Maxillofacial Surgery procedures cannot achieve a result without √ √ √ √ √
a combination of surgery and orthodontics.
Knowledge of orthognathic surgical
techniques and be able to explain, in √ √ √ √ √ √
general terms, the risks and benefits.
Diagnose dento-alveolar problems
requiring surgery. Understand dento-
alveolar surgical procedures and carry out
associated orthodontic treatment. √ √ √ √ √ √
Malocclusion and medical Treat appropriately in the knowledge of
problems underlying medical conditions. √ √ √ √ √
Manage, advise and treat patients who are
physically or mentally challenged. √ √ √ √ √
Understand possible effects of medical
conditions which may affect general dental
or orthodontic patients. √ √ √ √ √

2
What the Specialist is able Outcomes for treatment procedures E D A Written Diagnostic OSCE Portfolio Oral
to do Paper tests
The Specialist should be able to:
Understand and explain the theory,
Removable appliances indications, design and use of removable √ √ √ √ √
appliances.
Understand and explain the possibilities
and limitations of removable appliances. √ √ √ √ √
Appropriately evaluate the work sent to,
and received from, orthodontic √ √ √ √ √
laboratories.
Have sufficient understanding of the
process of fabrication so that they can
adjust and repair removable appliances in √ √ √ √ √ √
the laboratory and at the chairside.
Treat suitable patients with removable
appliances effectively. √ √ √ √
Explain to patients and parents the
benefits, process, likely outcome and
problems associated with removable √ √ √
appliance therapy.
Understand and explain the theory,
Functional appliances indications, design and use of functional √ √ √ √ √
appliances.
Understand and explain the possibilities
and limitations of functional appliances √ √ √ √ √ √
including timing of treatment.
Understand the fabrication of these
appliances and be able to adjust and
repair their chosen system in the √ √ √ √
laboratory and at the chairside.
Explain to patients and parents the
benefits, process, likely outcome and
problems associated with functional √ √
appliance therapy.
Understand and explain the theory,
Extra-oral appliances indications, design, use and safety of extra √ √ √ √
oral appliances including safety measures.
Understand and explain the possibilities
and limitations of extra oral appliances. √ √ √ √
Select, fabricate, adjust and repair extra
oral appliances in the laboratory and at the √ √ √
chairside.
Treat patients with extra oral appliances
Extra-oral appliances
and achieve a good standard of result. √ √ √
Explain to patients and parents the
benefits, process, likely outcome and
problems associated with extra oral √ √ √ √
appliance therapy.
Understand and explain the theory,
Fixed appliances indications, design and use of fixed √ √ √ √ √
orthodontic appliances.
Understand and explain the possibilities
and limitations of fixed orthodontic √ √ √ √
appliances.
Fabricate, adjust and repair fixed
orthodontic appliances at the chairside and √ √ √
in the laboratory.
Treat a wide range of suitable patients with
fixed orthodontic appliances and achieve a
good standard of result. The trainee
should have practical skills and clinical √ √ √
skills and a thorough knowledge of at least
one major type of fixed orthodontic
appliance system.
Explain to patients and parents the
benefits, process likely outcome and
problems associated with fixed orthodontic √ √ √ √
appliance therapy.
Understand and explain the theory,
Retention appliances indications, design and use of orthodontic √ √ √ √ √
retainers.

3
What the Specialist is able Outcomes for treatment procedures E D A Written Diagnostic OSCE Portfolio Oral
to do Paper tests
The Specialist should be able to:
Understand and explain the possibilities
Retention appliances
and limitations of orthodontic retainers. √ √ √ √
Understand the fabrication, adjustment
and repair orthodontic retainers in the √ √ √
laboratory and at the chairside.
Fit retainers and supervise retention in
suitable patients. √ √ √ √
Explain to patients and parents the
benefits, process, likely outcome and
problems associated with the use of √ √ √ √
orthodontic retainers.
Guiding the developing Demonstrate an understanding of the
occlusion development of malocclusion. √ √ √ √ √
Describe procedures to reduce the
severity of the malocclusion by interceptive √ √ √ √ √
measures.
Describe the indications and contra-
indications for such procedures. √ √ √ √ √
Understand the timing of the various
procedures and be able to use growth
charts and understand the limitations of √ √ √ √ √
facial growth prediction.
Describe the limitations of such
interceptive procedures. √ √
Discuss current knowledge on growth and
growth modification procedures. √ √ √ √ √ √
Demonstrate an understanding of the
Adult Orthodontics indications and limitations of adult √ √ √ √ √
orthodontic treatment.
Describe the principles of treatment in the
non-growing patient. √ √ √ √ √ √
Describe the modifications to the
Adult Orthodontics biomechanics and treatment techniques √ √ √ √ √
required for adult treatment.
Understand the role of adult orthodontic
treatment within the interdisciplinary team √ √ √ √ √
management of appropriate cases.
Carry out a full range of treatment in
conjunction with periodontal/restorative
advice from restorative specialists and √ √ √
consultants.
Provide risk/benefit advice for the adult
and demonstrate an understanding of √ √ √
stability and retention of such cases.
Demonstrate an understanding of relevant
Cranio-mandibular
dysfunction
literature and provide a critical appraisal of √ √ √
it.
Demonstrate an understanding of the
possible relationship between
craniomandibular dysfunction and √ √ √ √ √
malocclusion or orthodontic treatment.
Describe treatment modalities for
craniomandibular dysfunction. √ √ √ √ √
Cranio-mandibular Provide a rational basis for the aims and
dysfunction limitations of such treatment. √ √ √ √ √ √
Play a part in interdisciplinary teams as
General
appropriate.
Carry out planning and orthodontic
Interface with Oral and
Maxillofacial Surgery
treatment of joint dentoalveolar surgical / √ √ √ √ √
orthodontic cases at an advanced level.
Have an understanding of the interface of
orthodontics and oral and maxillofacial √ √ √ √
surgery.
Understand the oral surgeons viewpoint
and the surgical difficulties and √ √ √
complications.

4
What the Specialist is able Outcomes for treatment procedures E D A Written Diagnostic OSCE Portfolio Oral
to do Paper tests
The Specialist should be able to
Understand fully the implications of the
Interface with Oral and patients medical history in planning and
Maxillofacial Surgery executing oral surgical/orthodontic √ √ √
treatment.
Take into account the risk/benefits and
health gains of such treatment. √ √ √ √
Understand the treatment approaches to
Interface with Restorative periodontal disease and other restorative
Dentistry including problems and be able offer an informed √ √ √ √ √
Implantology perspective on those cases which have
occlusal problems.
Carry out orthodontic treatment in relation
to the prevention and treatment of
periodontal disease and be able to discuss √ √ √ √
the risk /benefit aspects of such treatment.
Identify those cases seen in childhood for
which orthodontic treatment is indicated on √ √
periodontal grounds.
Describe the involvement of the
orthodontist in treatment planning where √ √ √ √ √
osseointgrated implants are used.
Treat cases prior to and after the use of
osseointegrated implants. √ √ √ √ √
Carry out orthodontic treatment in co-
Interface with Paediatric
Dentistry
ordination with paediatric dental √ √ √
consultants and specialists.
Demonstrate an understanding of the
Interface with Paediatric treatment approaches to dental disease in
Dentistry children and be able offer an informed √ √ √ √ √
perspective on those cases.

How the Specialist Outcomes for Application of basic E D A Written Diagnostic OSCE Portfolio Oral
approaches clinical clinical science Paper tests
practice
The Specialist should be able to
understand and apply basic clinical
sciences to their clinical practice. He/she
should be able to:
Recognise normal and abnormal structure,
function and behaviour appropriate to the
General
patient’s age, general health and √ √ √ √
circumstances.
Apply knowledge of the pathophysiology of
common dental/oral health problems. √ √ √
Recognise the potential impact of medical
history on dental treatment. √ √ √ √
Apply knowledge of pharmacology. √ √ √
Apply behavioural management
techniques, recognising the social, cultural √ √ √
and psychological aspects of patient care.
Apply the principles of infection control to
ensure safety of patients and dental staff. √ √ √ √ √ √
Explain the cellular and biological
mechanisms involved during orthodontic √ √ √
tooth movement and tooth eruption.
Explain the cellular and biological
mechanisms involved in mechanical
Cell and Molecular biology
loading of tissues during facial √ √ √
“orthopaedics”.
Explain the cellular and biological basis of
theories of root resorption. √ √ √
Use the knowledge gained in this section
in other biological areas of orthodontics. √ √

5
 Understand how DNA replicates, realise
that genes are sequences of nucleotides
as part of a DNA molecule and that genes
Genetics
code for polypeptides. Understand the √ √ √
role of messenger RNA, transfer RNA and
the ribosome.

How the Specialist Outcomes for Application of basic E D A Written Diagnostic OSCE Portfolio Oral
approaches clinical clinical science Paper tests
practice

The Specialist should be able to

understand and apply basic clinical
sciences to their clinical practice. He/she
should be able to:
Understand how DNA is transferred from
parent to offspring in sexual reproduction.
Genetics Understand the terms dominant and √ √ √
recessive and how sexual reproduction
produces variation in offspring.
Describe in simple terms, how the relative
positions of gene loci on chromosomes are
determined. Outline the use of restriction
enzymes in removing sections of the √ √ √
genome and describe the formation of
recombinant DNA.
Explain what is meant by a genetic
disorder and how genetic screening is
carried out. Explain the theoretical basis
of genetic fingerprinting and outline how
this is carried out. Understand how these √ √ √ √
techniques may be utilised in determining
a genetic basis for malocclusions and
craniofacial disorders.
Use this knowledge to understand the
genetic basics of craniofacial syndromes. √ √ √ √
Describe normal embryological
craniofacial development with a clear
Craniofacial embryology
understanding of cellular and molecular √ √ √
mechanisms involved.
Describe in anatomic terms the
development of the orofacial complex and
teeth. Understand the cellular and √ √ √ √
molecular mechanisms, which contribute
to formation of these structures.
Demonstrate how disruption of normal
development can contribute to the major √ √ √ √
craniofacial disorders.
Use the knowledge gained to have a
fundamental understanding of clinical √ √ √ √
problems in craniofacial disorders.
Describe normal body growth and
Somatic and craniofacial development from birth to adulthood.
growth Demonstrate a clear understanding of the √ √ √ √
relevance to clinical orthodontics.
Describe methods available and limitations
for studying physical growth of the body
and jaws. Discuss the relevance to √ √ √ √
orthodontic practice.
Provide a critical appraisal of the theories
of craniofacial growth. √ √ √ √
Demonstrate an understanding of the
clinical implications of jaw growth in the √ √ √ √ √
child, adolescent and adult.
Use the knowledge gained to provide a
rational basis for the limitations and timing √ √ √ √ √
of orthodontic treatment.
Diagnose and discuss the likely
Physiology of breathing,
involvement of respiration, deglutition and
swallowing, mastication
soft-tissue patterns in the aetiology and √ √ √ √
and speech
treatment of malocclusion.
Describe in detail the contribution of the
occlusion to temporomandibular joint √ √

6
 disorders, tooth wear and periodontal
breakdown.
Physiology of breathing, Use the knowledge gained to achieve
swallowing, mastication realistic aims and objectives in clinical √ √ √
and speech orthodontic treatment.

How the Specialist Outcomes for Application of basic E D A Written Diagnostic OSCE Portfolio Oral
approaches clinical clinical science Paper tests
practice

The Specialist should be able to

understand and apply basic clinical
sciences to their clinical practice. He/she
should be able to:
Recognise patients who might benefit from
psychological support before, during and
Psychology
after orthodontic, orthognathic or √ √ √ √
craniofacial treatment.
Describe strategies utilised by
psychologists for coping and motivation.
Apply motivation strategies to orthodontic √ √ √
patients.
Apply this knowledge to providing realistic
patient expectations and satisfaction. √ √ √

How the Specialist Outcome for Clinical reasoning and E D A Written Diagnostic OSCE Portfolio Oral
approaches clinical judgement Paper tests
practice
The Specialist should be able to:
Assimilate and critically analyse history,
examination and investigation findings to
General
formalise a diagnosis and identify potential √ √ √ √
solutions.
Make decisions based on evidence based
practice. √ √ √ √ √
Formulate a plan of action appropriate to
the needs and wishes of the patient. √ √ √ √ √
Devise creative solutions to problems and
restrictions encountered. √ √
Perform various cephalometric
Growth and Treatment
Analysis
superimposition methods, and discuss √ √ √
their possibilities and limitations.
Understand the restrictions of analysis of
growth and treatment change. √ √ √ √
Understand the validity and limitations of
the various methods of growth prediction √ √ √ √ √
including computerised prediction.
Long Term Effects of Understand the long term effects of
Orthodontic Treatment orthodontic treatment in individual patients. √ √ √ √ √
Describe a variety of retention methods
and regimes based on current thinking. √ √ √ √ √ √
Understand specific occlusal traits that are
more susceptible to relapse and discuss √ √ √ √ √
measures taken to minimise relapse.
Discuss the factors involved in root
Iatrogenic Effects of
Orthodontic Treatment
resorption and understand orthodontic √ √ √ √ √
mechanics aimed at minimising resorption.
Describe the process of enamel
demineralisation and it’s contributing
factors including inadequate oral hygiene √ √ √ √ √
and inappropriate diet.
Describe the long term effects of
orthodontic treatment on periodontal
structures in both healthy patients and √ √ √ √ √
those with periodontal problems.
Explain the possible adverse effects on
Iatrogenic Effects of
Orthodontic Treatment
dento-facial appearance and aesthetics of √ √ √
alternative treatment plans.
Discuss the effects of contact of various
orthodontic materials on soft tissues. √ √ √ √

7
How the Specialist Outcomes for Communication E D A Written Diagnostic OSCE Portfolio Oral
approaches clinical Paper tests
practice
The Specialist should be able to:
General Demonstrate active listening skills. √ √ √
Demonstrate appropriate communication
skills with patients. √ √ √
Demonstrate appropriate communication
skills (verbal and written) with other √ √ √ √ √
professional colleagues.
Demonstrate appropriate communication
skills with others in the dental team in
order to ensure efficient and effective √ √ √ √ √
working.
Demonstrate appropriate case
presentation skills, give appropriate advice
and information to promote learning in √ √ √ √
others.

How the Specialist Outcomes for Health Promotion E D A Written Diagnostic OSCE Portfolio Oral
approaches clinical Paper tests
practice
The Specialist should underpin their
practice with an understanding of health
promotion. He/she should:
Take into consideration the impact of
General social, cultural and behavioural factors on √ √ √ √ √ √
dental health.
Keep up to date with strategies for
prevention of disease in different settings
e.g. primary prevention, screening, public √ √ √
awareness campaigns.
Collaborate with other professionals in
health promotion and disease prevention. √ √ √ √
Apply the knowledge principles and
methods of health promotion so as to
include an appropriate health promotion √ √ √ √ √
dimension to most clinical contacts.
Discuss the relationship between oral
Oral Health
health and malocclusion. √ √ √ √
Describe and diagnose the aetiological
features encountered in orthodontic
practice with regard to development of √ √ √ √ √
periodontal problems and soft tissue
lesions.
Carry out procedures to detect orthodontic
patients with a high risk of developing √ √ √ √ √
periodontal problems.
Prescribe methods of reducing the
potential for iatrogenic damage during √ √ √ √
orthodontic treatment.
Provide risk/benefit advice for the
improvement of overall oral health with √ √ √ √
orthodontic treatment.
Describe methods of enhancing patient
Health Education
understanding of orthodontic treatment. √ √ √
Describe oral health programmes and
patient motivation techniques for the √ √ √ √
individual patient.
Describe methods of ensuring patient
understanding of orthodontic treatment
and that proposed for the individual √ √ √ √
patient.

8
How the Specialist Outcomes for Attitude, Ethics and E D A Written Diagnostic OSCE Portfolio Oral
approaches clinical Legal responsibilities Paper tests
practice

The Specialist should be able to:

Demonstrate an understanding of patient
General
psychology in relation to health education. √ √ √ √
Demonstrate an ethical and moral
approach (to patients, their relatives,
colleagues and staff, and research √ √ √
undertaken).
Demonstrate confidentiality, integrity,
truthfulness and respect, without
discrimination, towards patients and √ √ √
colleagues.
Demonstrate an appropriate approach and
response to complaints about √ √ √ √
performance.
Recognise and respond to legal
responsibilities. √ √ √
Recognise and respond appropriately to
colleagues whose professional conduct √ √ √
gives cause for concern.

How the Specialist Information handling E D A Written Diagnostic OSCE Portfolio Oral
approaches clinical Paper tests
practice
The Specialist should:
Keep accurate and contemporaneous
General patient records in relation to clinical and √ √ √ √
laboratory work.
Conform to ethical and legal imperatives in
respect to data. √ √ √
Use computers to access information from
appropriate sources and use the √ √ √
information for effective practice.
Demonstrate understanding and
application of appropriate methodology √ √ √
when participating in audit activities.
Demonstrate understanding of research
methods and statistical evaluation and be √ √ √
able to critically assess published work.
Evaluate the scientific basis of existing and
new clinical practices. √ √ √
Computer Based
Technology
Have practical experience of computer √ √ √
technology relevant to orthodontics.

The Specialist as a Role of the Orthodontist within the E D A Written Diagnostic OSCE Portfolio Oral
professional Health Service Paper tests
The Specialist should:
Have an acceptance of code of conduct
General
and required personal attributes. √ √
Understand the role of the orthodontist in
primary and secondary health care. √ √
Appreciate the role of the orthodontist as a
manager.
Work co-operatively in a team. √ √
Accept responsibility for teaching others. √ √
Recognise merits in colleagues in other
disciplines, so that multi-professional
opportunities for patient care are √ √ √ √
enhanced.
Appreciate the role of, and undertake the
process of clinical governance, in order to
maintain the highest standards of patient
care.

9
 The Specialist as a Role of the Orthodontist within the E D A Written Diagnostic OSCE Portfolio Oral
professional Health Service Paper tests
The Specialist should be able to:
Understand their responsibilities in relation
Health and Safety to Health & Safety, COSHH, and Radiation √ √ √
Safety.
Understand their legal and ethical
responsibilities. √ √ √
Understand the concepts of good surgery
design and stock control. √ √ √
Ensure appropriate protocols are
established for referral of patients. √ √ √
Legislation and Ethics Prioritise patients fairly √ √ √ √
Understand the medico legal obligations
as they relate to the practice of √ √ √
orthodontics.
Counsel and reconcile on matters of
Surgery Management
clinical dispute. √ √ √
Control standards of care. √ √ √
Understand the problems and implications
of staff management and the principles of
Personnel Management
equal opportunities and sex discrimination √ √ √
in the workplace.
Understand the concepts relating to sound
Finance
financial management. √ √ √
Audit Run an audit cycle with set standards. √ √ √
Understand the organisation of Health
Health Service Structures
Service structures nationally. √ √ √

The Specialist as a Personal Development E D A Written Diagnostic OSCE Portfolio Oral

professional Paper tests
Self awareness – reflects on own personal
General
strengths and limitations. √ √ √
Continuing professional development –
sets clear learning goals, pursues them
and applies the learning to the practice of
dentistry. √ √ √
Personal growth – accepts and responds
appropriately to constructive criticism from
patients, peers and supervisors. √ √ √
Self-care – identifies problems and issues
in relation to own wellbeing and their
potential impact on practice. √ √ √
Career Development – recognises career
alternatives in dentistry. √ √ √
To be given the opportunity to develop
additional experience in areas of practice
in which the individual feels to be deficient
or in which he or she wishes to develop a
special interest. √ √ √

10