As you know, CDCA has changed the restorative and perio portion of the ADEX exam to be on manikins instead of live patients this year. I took these 2 sections of the exam on January 23, 2021. Overall, the day ran as expected and pretty similar to when I took the endo and prosth sections back in November. The only difference was that we had to have the CFE’s check our work more frequently instead of just turning in our completed procedures at the end. Here’s an overview and my recommendations for each section.
Restorative:
We were given our typodonts and the radiographs at around 7:30am and we were allowed to start setting up our instruments and supplies at 6am at the earliest. I got to school at 6:30am and ended up just sitting around for a while getting more nervous, so I would recommend going at 7:00/7:15am to have enough time to set up, get your typodonts and get ready to begin the exam at 8:30am. The radiographs they gave us were the exact same for all the students and were NOT representative of the lesions on the teeth we needed to restore. When you look at the teeth you can see a dark grayish tint in the enamel where the lesion is and that’s where you want to start your preps. The chief examiner told us that the teeth they had for us had caries on #8 mesial (he also said in the future that they will have teeth that will have caries on either the mesial or distal). For #30, you could see a dark tint on the mesial and the mesial half of the occlusal as well, so you’d do a conventional class II MO prep – not a slot prep on the mesial. The few classmates who sat around me had teeth/lesions that looked exactly like mine from the enamel surface, but the caries inside was a bit different for each of us. Also, once you break through the enamel layer the color of the caries turns clear so you need to use your explorer to detect if there is any caries left.
Some things that I would be careful with is that the teeth are pretty brittle, especially the enamel layer. Once you drill through with your high speed and use your explorer to see if there is any “stick” or caries left, push just hard enough to feel stick but don’t push too hard where you’d break the enamel off or fracture the tooth (yes, someone fractured their entire #30 within the first 10 minutes of starting the exam. But luckily the CFE had an extra typodont for the student to restart). If possible, I would avoid using your hatchet/chisel/any hand instrument to remove tooth structure if you can. I accidentally chipped too much tooth structure away on #8 because the enamel chips off so easily with minimal force. Luckily it didn’t make my prep too large and I was still in the “ACC” range. For #8 I did not have to request any modifications. For the prep on #30, I only needed to request one modification to reduce my axial wall more by 0.5mm due to caries. But, some of my classmates needed to request 4-5 modifications to be able to remove all their caries and some even had to do a pulp cap. So just be aware that that could be a possibility. The restoration for each tooth was pretty straight forward and just like we’d practiced since D1 year. I also noticed that the contacts between all the teeth were very tight compared to our operative typodonts we got first year.
Another note – when we send our typodonts to the graders to check our preps and restorations or to the “Express” lane for modification checks, it would take me about 35-45 minutes to get my typodont back. Some of my classmates were waiting for about an hour each time as well. So, make sure you consider how long that’ll take when planning out the 7 hours you have to do both restorative procedures. My recommendation is to start with #8 because the prep is smaller and it’ll be faster to complete. That way once that’s done you can use whatever time is left to work on #30 and the modifications you might need for it. If you need a CFE to come to you for help or to turn your typodont in, I would find a runner to get the CFE quickly so you don’t waste time. I would even raise my hand and get up to go to the main hall we have that runs down my school’s sim lab to see if I could catch a CFE’s attention quicker myself.
Furthermore, if you do not pass the prep check, you do not do the restoration. You simply move on to the next procedure.
Perio:
Once we’re ready to start the perio section, you go up to the front to collect your perio typodont and the sheet of the surfaces you need to scale. The sheet will state if you are assigned the lower left or the lower right quadrant and will list your required 12 surfaces. You are given 90 minutes to complete the procedure but you’ll most likely finish before that.
The gingiva of the typodonts are an opaque pink (not clear like the ones we got D2 year). The “calculus” is a thin gray film that’s restricted to 2-3mm right below the CEJ. The calculus is very easy to scale off and to be honest the tooth structure itself is very easy to scale off too, so just be careful not to overdo it and remove tooth structure/create any gouging. My classmates and I also ran into the issue of the teeth popping out of the socket while scaling because we were using too much force. The CFE’s just said to place the teeth back into the socket and to continue with the procedure. We did not have to make a note on our sheets saying that a tooth (or multiple) teeth popped out. Also, out of the 12 surfaces I was assigned 2 of them didn’t even have calculus on them to begin with! The chief examiner also told us that if there is calculus on a surface of a tooth, we did not have to scale it if it was not on our list of surfaces to scale.
Overall, the perio procedure was very quick, easy and straightforward.
The environment for test day was very laid back and the CFE’s were all extremely nice, understanding and willing to help in any way they can. It wasn’t like the endo/prosth test day where we weren’t allowed to talk to one another, so that was really nice. Especially since we were all waiting for so long to get our typodonts back from the graders to continue working.
My school had exam dates on January 23rd and 24th, and we got our results in the afternoon on January 25th. Thankfully, I PASSED!!
Hope this information helps anyone who’s reading this on their exams in the future! If you have any questions feel free to reach out or comment below. Good luck!
Dentistry Master'd 
hello, thank you for your write up and congratulations on passing. i have recently failed the class 3 twice but passed everything else. i would take full responsibility if i felt like it was truly my skill of prepping, removing caries, etc. but that is not the case i believe it to be. the first time they said i didn’t remove all caries-i had no tug back with my explorer, no caries coming out with the spoon. and it sounded like sound dentin. fine bad luck, i was able to move onto the class 2 which i passed and the next day endo and prosth. just a couple of weeks ago, not even, i took the class 3 again but failed due to “inappropriate ask for an indirect pulp cap” and asking to remove caries without clinical justification. i saw blushing and since the chief said don’t ask for a liner for this exam, i wanted to let them know, i see the blushing of the pulp so i know in real life i wouldn’t just leave it! i let them know technically an indirect pulp cap is requested when you have a very small amount of caries left over the pulp but for the purposes of this exam since i was still within my modification, i removed caries. the denied it.
it comes back to me so at this point i was ready to turn it into the examiners for a prep check but i wasn’t sure if i needed to do anything before they, like forms, etc. so i called over the cfe and he took a look and said well ask for a .5mm modification to remove caries because if you have caries left, then you’re dead. so that got me nervous thinking is he trying to tell me something?! i didn’t even think i was allowed to do that because asking for an indirect or direct pulp cap should be your last modification request. but i figured he knew more than i did so i asked for the modification-i was incorrect, these cfes, the chief, even the doctor i spoke to in the appeals office are not on the same page. i asked for the second modification because i double checked with three explorers and got a significant stick with one of them! my heart sank, i was shocked but because of my first fail leaving caries behind, i asked for the modification thinking i may get some points taken off. well the two denied modifications cost me at least 30 points. i can’t imagine it was my prep which was ideal plus the little extra i took off for my granted modifications. they didn’t inform me i had already failed before the restoration but let me move onto the restoration. i finished, it was beautiful. i turned it in. didn’t feel like a got a perfect score but didn’t think i failed! i get my score a few days later. i ask about the appeals process, they tell me in reality these don’t get overturned and you have to prove what you think you’ve been faulted on. with the restoration in, there was no way i could do that. i have a time crunch and with the appeals process it can take a few months and while you’re waiting, you can’t sign up for the retake which even if they overturn their decision, you still have to take again regardless.
i took this exam back when it was still the NERB, passed the first time in all parts, my class 3 was way harder back then with having to build up the whole contact! i’ve been practicing for years. i truly don’t believe this is my skill but i need to learn to play the modification game and give the examiners what they want. that brings me to my questions to you giving you my background info on this exam! so it looks like you didn’t have modifications on your glass 3 but what about your classmates. how did they handle indirect pulp caps (i thought you fail if you leave caries behind so isn’t it better to keep requesting to remove caries and do a direct pulp cap if needed?!), direct pulp caps, how big were some of these modified preps? any pertinent information on the class 3 prep, modification requests, and restoration would be so appreciated. i have one more shot at this before i have to retake the whole exam again 😳. in a way this would be easier if i needed to improve my prep or restoration or make sure i don’t hit the adjacent tooth but it’s not any of that. i’m getting hung up on the details (like any good dentist 😉 and asking for modifications that they don’t deem necessary and so they think i don’t know when i’m doing. but in reality i’ve been working on real teeth for too long so when i see the pulp, i don’t ever think about just leaving it even if scratches hard! what i should have done if not listen to the cfe and just sent it in for grading after my denied pulp cap. or i should have just removed the slight stick i felt but i was afraid if i ended up getting into the pulp without a granted modification, then i fail too.
anyway, any help is appreciated! i never thought a fake tooth would give me so much trouble! ironically, i think the class 3 is the easiest of the whole exam!
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Hello. So sorry you have to go through that. If you don’t mind me asking, where did you purchase or rent your kits fo practising towards the exam? I took the exam and passed in 2016 on graduating from Dental school in Canada but apparently I need to write it again in order to be licensed in Florida. I am so lost and do not know where to start without having to empty my account to purchase all brand new instuments, typodonts and equipment!
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Thank you! and I’m so sorry to hear this! I’m hoping you pass the next time you take it!! For the class 3 no one I really talked to had to ask for mods in the prep. We were taught that if we do need a mod to only ask for it in increments of 0.5-1mm, so me and my friends would only ask in increments of 0.5mm unless there was a ton of stick. For the class 3, I also don’t think anyone asked for an indirect pulp cap. My instructors also told us it’s better to ask for a direct pulp cap than to ask for an indirect one and get it denied/they fail you for not having “good” clinical judgement. My best bet for you would be to make the “ideal” prep and check thoroughly with your explored for stick/caries. If you need mods, ask for it in increments of 0.5mm to remove all the caries and don’t ask for indirect pulp cap. Only ask for direct pulp cap if you pulp out due to removing caries. Obviously this isn’t what you do in real life but this is what we were told to help us pass this exam. As for the restoration, just make sure you have good contacts, remove all flash and extra composite anywhere and also be sure to polish it well so there’s no “ditching” at the margin when you run the explorer from composite to enamel, back and forth. I hope this helped and I answered your questions. If you have more questions, let me know!
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Thank you for writing this post. Did the examiners send you an ITC (Information to candidate) Form after you requested for IPC and Modifications? Did you have to review the form with the CFE?
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hello, thank you for your write up and congratulations on passing. i have recently failed the class 3 twice but passed everything else. i would take full responsibility if i felt like it was truly my skill of prepping, removing caries, etc. but that is not the case i believe it to be. the first time they said i didn’t remove all caries-i had no tug back with my explorer, no caries coming out with the spoon. and it sounded like sound dentin. fine bad luck, i was able to move onto the class 2 which i passed and the next day endo and prosth. just a couple of weeks ago, not even, i took the class 3 again but failed due to “inappropriate ask for an indirect pulp cap” and asking to remove caries without clinical justification. i saw blushing and since the chief said don’t ask for a liner for this exam, i wanted to let them know, i see the blushing of the pulp so i know in real life i wouldn’t just leave it! i let them know technically an indirect pulp cap is requested when you have a very small amount of caries left over the pulp but for the purposes of this exam since i was still within my modification, i removed caries. the denied it.
it comes back to me so at this point i was ready to turn it into the examiners for a prep check but i wasn’t sure if i needed to do anything before they, like forms, etc. so i called over the cfe and he took a look and said well ask for a .5mm modification to remove caries because if you have caries left, then you’re dead. so that got me nervous thinking is he trying to tell me something?! i didn’t even think i was allowed to do that because asking for an indirect or direct pulp cap should be your last modification request. but i figured he knew more than i did so i asked for the modification-i was incorrect, these cfes, the chief, even the doctor i spoke to in the appeals office are not on the same page. i asked for the second modification because i double checked with three explorers and got a significant stick with one of them! my heart sank, i was shocked but because of my first fail leaving caries behind, i asked for the modification thinking i may get some points taken off. well the two denied modifications cost me at least 30 points. i can’t imagine it was my prep which was ideal plus the little extra i took off for my granted modifications. they didn’t inform me i had already failed before the restoration but let me move onto the restoration. i finished, it was beautiful. i turned it in. didn’t feel like a got a perfect score but didn’t think i failed! i get my score a few days later. i ask about the appeals process, they tell me in reality these don’t get overturned and you have to prove what you think you’ve been faulted on. with the restoration in, there was no way i could do that. i have a time crunch and with the appeals process it can take a few months and while you’re waiting, you can’t sign up for the retake which even if they overturn their decision, you still have to take again regardless.
i took this exam back when it was still the NERB, passed the first time in all parts, my class 3 was way harder back then with having to build up the whole contact! i’ve been practicing for years. i truly don’t believe this is my skill but i need to learn to play the modification game and give the examiners what they want. that brings me to my questions to you giving you my background info on this exam! so it looks like you didn’t have modifications on your glass 3 but what about your classmates. how did they handle indirect pulp caps (i thought you fail if you leave caries behind so isn’t it better to keep requesting to remove caries and do a direct pulp cap if needed?!), direct pulp caps, how big were some of these modified preps? any pertinent information on the class 3 prep, modification requests, and restoration would be so appreciated. i have one more shot at this before i have to retake the whole exam again 😳. in a way this would be easier if i needed to improve my prep or restoration or make sure i don’t hit the adjacent tooth but it’s not any of that. i’m getting hung up on the details (like any good dentist 😉 and asking for modifications that they don’t deem necessary and so they think i don’t know when i’m doing. but in reality i’ve been working on real teeth for too long so when i see the pulp, i don’t ever think about just leaving it even if scratches hard!
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Thank you! and I’m so sorry to hear this! I’m hoping you pass the next time you take it!! For the class 3 no one I really talked to had to ask for mods in the prep. We were taught that if we do need a mod to only ask for it in increments of 0.5-1mm, so me and my friends would only ask in increments of 0.5mm unless there was a ton of stick. For the class 3, I also don’t think anyone asked for an indirect pulp cap. My instructors also told us it’s better to ask for a direct pulp cap than to ask for an indirect one and get it denied/they fail you for not having “good” clinical judgement. My best bet for you would be to make the “ideal” prep and check thoroughly with your explored for stick/caries. If you need mods, ask for it in increments of 0.5mm to remove all the caries and don’t ask for indirect pulp cap. Only ask for direct pulp cap if you pulp out due to removing caries. Obviously this isn’t what you do in real life but this is what we were told to help us pass this exam. As for the restoration, just make sure you have good contacts, remove all flash and extra composite anywhere and also be sure to polish it well so there’s no “ditching” at the margin when you run the explorer from composite to enamel, back and forth. I hope this helped and I answered your questions. If you have more questions, let me know!
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hey, i was wondering do you have any resources on how you were instructed to place an indirect pulp cap and direct pulp cap. for example for the direct pulp cap, do they want you placing calcium hydroxide on just the exposure or the whole pink area exposed and almost exposed on the axial wall with the calcium hydroxide?
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We weren’t actually given clear instructions when I took it because my group was the first to take it at our school. But from other students who took it later after the school had more info on the test, they were told to just put it on the exposed spot. And to not request to ever to an indirect pulp cap. They said they’ve heard of people failing for poor judgment for asking for indirect pulp cap. So they said it’s better to pulp out and then as for a direct pulp cap.
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thank you so much. not being a student, i haven’t had any of this advice and unfortunately it cost me big. thanks for the info…from what i’ve gathered from other students like you who have taken the exam, they have said the same. they want you to treat it like a real tooth but not really 😏.
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You’re welcome, I’m happy to help! Haha that’s exactly it – treat it like a real tooth but not really.
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Appreciate the detailed descriptions and congrats. I m also without school coaching and try to best prepare for the exam. Q1) what is a good alternative to remove the cl 2 box “lip” if not using hatchet? 2) what s the dimensions m-d on your cl 3 axial and cavosurface? 3) Do you deepen (extend the entire facial aspect of the prep to make it level if you have to break facial contact? Thank you for a quick reply. So happy for you
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Hi! Thank you!
1) for the lip I just used my 330 bur real slowly to get rid of the lip and the 2 or 4 round bur. If you feel more comfortable using the hatchet definitely use that but make sure you’re very controlled while using it and aren’t using an excessive amount of force.
2) my dimensions were about 2mm mesial/distal, 3mm incisal/gingival and I ended up being about 1.5-2mm deep
3) no, I didn’t extend everywhere. If there’s caries in a specific location I just drilled there
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Thanks for the article! Do you have any tips on how to find the unstained decay on your class II specifically? When you did your final check before your prep check did you just use an explorer? Also, is there randomly placed decay that isn’t all grouped into one area around the staining on the class II?
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Thank you! No, there wasn’t any un-grouped decay in my teeth. It was all grouped together and I did my initial cut where I could see a slightly darker tint thru the enamel. And yes, I just used the explorer kind of trying to poke and scrape everywhere, every line angle, every point angle, everywhere on the surface to find any spot there could be that was slightly soft and not hard. As soon as I found a soft spot, I switched to my hand piece to remove it a little then checked again to make sure I got it all without removing too much tooth structure.
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Thanks so much for your tip!
I just tried practicing on the RDX teeth today, and I found it difficult to tell what’s caries and what’s not.
There were areas of dark yellow (as opposed to light yellow) but it was hard to explorer.
Are the carious spots definitely soft?
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No problem! And he’s the various spots are definitely soft. If there was a discolored hard spot (I didn’t have any but my friends did) they left it if it went beyond the ideal dimensions. If it was still in the dimensions they’d remove as much as they could.
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Hello. Thanks for your information.
My question is . If i have to ask for more than 1 mod. I have to ask for direct pulp cap all time.
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