General tips:
- Read the criteria thoroughly. In fact, read the entire WREB candidate guide thoroughly, esp. right before the test. Know that passing depending on an overall weighted score; you can do poorly on certain things and still pass. For example, my rubber dam on my 2nd restorative patient was terribly placed and had blood/saliva on it because I was submitting to make the 4:30pm deadline. I am sure I did not pass the operative environment section for that case but still did OK overall. I actually didn't read the guide thoroughly and was unnecessarily stressed because of this.
- Case selection is 50% of succeeding on this test. It's tempting to get complacent, but making the effort to screen and screen thoroughly will make a difference. Put a good effort into the provisional acceptance if your school does that, it will save time during the test and make your day more efficient.
- I would pay patients in order to give yourself that extra security that they will show up. I did, and my patients were here 30 minutes before they said they would be and were very accommodating overall.
- Meticulously prepare. Compartmentalize all your instruments for your different procedures, and get rid of all the things you don't need. I borrowed backup instruments, handpieces, and burs from people so I could jump directly from one operative procedure into the other. Sharpen your instruments, get your hands on a cavitron for perio. Reload your burs.
Endo:
- Recommended teeth: maxillary central & maxillary 1st premolar with 2 roots. I actually used a maxillary molar due to my faculty's recommendation; you will have more leeway when it comes to access and accidental perforations. When I look back on it, I think a maxillary first premolar would have been more ideal due to not having to hunt around for the other canals (spent more time than I would have liked doing this during the WREB) - just be sure to practice a few accesses on max premolars and you should be fine. If you have been doing endo in clinic, I think reviewing endo techniques and procedures in your mind is sufficient for the instrumentation and obturation, but I would practice accessing a couple of teeth before the exam in order to make sure you don't perf.
- The best teeth will be teeth that have very tight apical constrictions to provide strong apical stops and canals thin enough to use rotary instrumentation + the single-cone technique, which will make your instrumentation quick and canal taper beautiful.
- Pre-measure your canals to estimate your working lengths and be sure to take IAF film. Make sure you take Master Cone Film as well and have that strong tugback before you obturate. They are really generous with the criteria. You can pass with GP 2mm short or 2mm long.
- Clean up your fills. Your posterior tooth should have GP just over the orifice of the canal and your anterior tooth should have GP to the level of the CEJ. Apparently, this counts for quite a bit in points.
- Mount correctly (read the manual carefully for instructions - level to the occlusal plane, following arch form as best as you can) and identify the correct tooth when you're writing it down on the worksheet. Double and triple-check your worksheet and your sextants to make sure all of the information is there. Someone I know got his tooth rejected because he wrote down the wrong tooth number (contralateral side). If your tooth is rejected, you don't get it back for remounts so have backup teeth as well.
Perio:
- Case selection! Avoid 3rd molars that are difficult to scale, make sure you have 2 unequivocal 5's on 2 different teeth. On the day of, you will have to anesthetize, probe, and record sites of calculus. You can do this when you're screening to save you time and stress and simply write down those values on the grading worksheet they give you the day of.
- Cavitron first to debride the big pieces of calculus.
- FULCRUM and scale carefully yet assuredly! Don't create flaps, which may result in automatic failure.
- I debrided 3 times and then instrumented 3 times until it was spotless. Then I took the Cavitron in again to clean up excess tissue tags.
- H2O2 rinse afterward will make the presentation of the patient's quad look very nice.
Operative:
- Know the definitions, criteria, submission procedure, and modification request procedures like the back of your hand. For example, WREB is a 3-day exam (excluding orientation). Know that if things go wrong (patient is late; you take a very long time prepping), you can always bring back a patient on the morning of the 3rd day to finish your restoration. You do not get points off for this. One of my classmates did not realize this and rushed his filling to make the 4:30pm deadline. I was in the same boat because I took a long time to prep and just brought my patient back Monday morning.
- Know how much each section is weighted. For example, a nice looking outline form will give you a lot of points.
- Tag your candidate guide so you can quickly reference pages you need during the test. For example, I tagged my definitions page and referred to it often when making modification requests.
- You CAN leave affected dentin behind and still pass (you would just get a 2 in internal form section I think), but I believe leaving caries behind is an automatic fail. If you are unsure, I would be strategic about it and put it down as a modification request, knowing that every rejected request is -0.5 from internal form. I had 2 of these requests rejected - I was fairly sure that it wasn't affected but decided not to take that chance and just took a chance on a modification request.
- CHECK FOR OCCLUSAL STAINING in the GROOVES CLINICALLY. If you are unsure of whether or not it may be carious, I would just do a conventional design and extend occlusally. Yes, doing slot preps will save you a lot of time, but only do so if you're 100% confident that you won't be leaving anything behind occlusally. If there is staining that you are 100% confident is hard, I would write a note saying you will apply a sealant.
- You can pulp expose and still pass; don't leave caries behind.
- Backup patients! Organize a pool of backups with your friends if necessary.
- Hatchets and gingival margin trimmers came in very handy for me in removing unsupported enamel, and smoothing out the margins of my box.
Overall, I think it was a fairly generous test. I was pretty cool and collected for the perio and endo sections, but for Operative I was very nervous. It took me much, much longer to drill preps than I normally do and was very stressful throughout. Again, I think reading the candidate guide more thoroughly could have made a big difference. I wanted my prep to be perfect when I didn't really realize and understand fully that you can get 5's even if proximal and gingival contacts were up to 1.0mm. I spent so much time trying to just have visually open contacts and very conservative preps. Looking back, I think I should have just went for it and had faith that even if I became too aggressive in one area, it wouldn't be a failing error.
If you guys have any additional q's, I would be happy to answer them.
