ADEX Clinical Exam Preparation: 12 Tips and Tricks for the Hands-On Manikin Exams

ADEX hands-on exams · Updated September 2026

ADEX Clinical Exam Preparation: 12 Tips and Tricks for the Hands-On Manikin Exams

Five procedures, one manikin, three independent examiners and a strict clock. The clinical half of the ADEX Dental Examination rewards candidates who know the grading rules as well as they know the dentistry. Every tip below comes from the official 2026 ADEX Candidate Manual and Candidate Guide.

5hands-on exams
75to pass each part
3independent examiners grade you
0live patients: manikin and typodont
Know the shape of the day

The two clinical days, drawn to scale

Hover or tap a block. Widths are proportional to the time allowed. Your individual schedule is emailed about 2 to 3 weeks before your exam and can differ from the preliminary one.

Day with Periodontal, Endodontic and Prosthodontic

PerioEndoProsthodontic

Day with Anterior and Posterior Restorative

AnteriorPosterior
Timed procedureTimed procedureData entry or grading wait

Clinic doors open at 6:30 am for check-in and workstation setup. You may start an Endodontic or Prosthodontic procedure early with examiner authorization, but your finish time then moves with your start time. Breaks are your choice, and no time is added back for them.

Tip 1 starts here

How you are graded: the three ratings

Every procedure is judged by three calibrated examiners, working independently, against published criteria sheets. They see your candidate ID number, not your name.

ACC

Clinically AcceptableCompetent clinical judgment, knowledge and skill.

SUB

Marginally SubstandardLess than the expected judgment or skill.

DEF

Critically DeficientCritical areas of incompetence. Two or more examiners rating one criterion DEF means no points for that procedure and a fail.

The 3-SUB ruleIf examiners independently confirm three marginally substandard over-preparation criteria on the same procedure, it is treated as critically deficient and you fail that procedure. The applicable criteria are highlighted in yellow on the criteria sheets. A pass on each part needs a score of 75 or more.
You will not know how it wentCandidates are not told the outcome of any procedure during the exam. In the Restorative exam you still restore the tooth even if your preparation would fail. Results go out as pass or fail per part. If you fail, you receive the applicable criteria but not post-exam images or extra explanation.
Interactive

What if something goes wrong? Pick a situation

These are the rules the manual gives for the moments candidates fear most.

Choose a situation to see the rule.
Stop at once

Stop working immediately and notify the Clinic Floor Examiner

That is the manual’s instruction. Treating teeth or surfaces other than the ones approved or assigned is one of the 100-point penalty items, so every extra minute on the wrong tooth costs you.

Tell the examiner

Report it, explain your protocol, then disinfect

Once treatment has begun, tell the examiner if an instrument becomes contaminated, for example if it is dropped. Instead of replacing it, you explain the protocol you would follow with a patient and wipe down and disinfect the instrument before use. In the Periodontal exam, continuing to use it without that discussion carries a 100-point penalty.

Second chance, at a cost

-15 points, then one more try

You diagnose the lesion from a radiograph and enter a treatment plan on the tablet. A first misdiagnosis costs 15 points and you may try again. A second misdiagnosis on the same procedure costs all points (-100) and fails that procedure. A correct diagnosis is required to continue.

Ask first, and only if eligible

Submit a Modification Request before extending

The request must be approved before you extend any wall. Your whole preparation must already be within the acceptable range, and the wall you want to modify must already be at its maximum acceptable limit. State what you will change, where, why (for example, caries) and how much (for example, 1.0 mm). A denied request costs points, and a request showing a critical lack of judgment costs -100.

Declare it properly

Request “Identify/Diagnose Pulp Exposure”

Use the worksheet, call an examiner, and enter the location and approximate size on the tablet. If examiners find no exposure where you declared one, or find an exposure you did not declare, the penalty is -100 and you fail the procedure. A pulp cap is not required in this exam.

No one will stop you

Missing your finish time fails the exam

You are responsible for watching your own clock. Examiners are not responsible for stopping you at your assigned finish time, and failing to meet the timeline is a violation of exam standards with a penalty and failure.

The full list

12 tips, in three groups

Tap a group. Read the criteria sheet for each exam alongside these tips, because they hold the exact measurements.

1
Treat the criteria sheets as your syllabus

ADEX publishes a criteria sheet for every procedure, plus candidate worksheets and scoring rubrics. They are the exact basis of the grading. Only official ADEX publications are allowed in the clinic, along with your own handwritten notes inside the manual pages, so learn them before you arrive.

2
Practise on the same kind of typodont

You work on magnetically retained typodonts and proprietary teeth that ADEX gives you at check-in, mounted in a manikin with a facial shroud. ADEX points candidates to similar products for practice at Acadental.com. Practising on a different system means learning the feel of the teeth under the clock.

3
Rehearse with the real time limits

Periodontal 90 minutes, Endodontic 3 hours, Prosthodontic 4 hours, Anterior Restorative 3 hours, Posterior Restorative 3.5 hours. Include the waits: when you send a restorative preparation for grading it can be away for up to 30 minutes or more per visit, and your finish time does not pause. Fewer separate modification submissions also saves time.

4
Build your own instrument setup early

You bring your own instruments and materials, and no instrument list is provided, so use your own judgment about what each procedure needs. They must be clean and disinfected, though sterilization is not required on a manikin. Read the host site’s Site Info Sheet for supplies, PPE, equipment and rental, and join the Q&A Session ADEX offers before the exam.

5
Periodontal: work the score, not just the scaling

The 100 points split into calculus detection (16, on 4 surfaces of 4 assigned maxillary teeth), calculus removal (66 for 12 key surfaces, plus 6 for complete removal in the assigned mandibular quadrant) and probing depths (12, on two teeth, with 1 mm leeway). Tissue damage is penalised: four or more minor sites, or one major site, is an automatic fail. An unreported broken instrument tip counts as major damage.

6
Endodontic: use the correct isolation, fill and irrigant

You treat tooth #8 (access, canal preparation and obturation) and tooth #14 (access and canal identification), in any order, with a separate dam for each. Holes may be punched in advance, but the dam goes on only after the exam starts. On #8 use pink or colored gutta-percha, irrigate with water only (other irrigants may make the result ungradable and require a retake), and clamp only adjacent teeth, not treated ones.

7
Prosthodontic: plan the three preparations together

You prepare a ceramic crown on #9 and zirconia crowns on #5 and #3, which are the two abutments of a 3-unit bridge, so they must share a common line of draw. Taper greater than 16 degrees is critically deficient. Make your putty matrices during setup with the matrix former ADEX provides. Occlusal equilibration is prohibited, and digital scanning is not allowed.

8
Restorative: diagnose first, isolate always

You get one radiograph per procedure and must diagnose and record a treatment plan before you may start. A rubber dam is required for every procedure, with at least one tooth either side under it and an unobstructed view of the whole preparation. The preparation must be graded before you begin the restoration, and the composite is presented without surface glaze or sealer. Amalgam is not an option.

9
Learn what counts as caries, and when to ask

ADEX defines simulated caries as material a sharp explorer can penetrate with light pressure, showing “tug-back”. Your job is to remove it completely within the acceptable dimensions. If you truly need to go beyond them, that is a Modification Request, which you should only submit when the conditions in the scenario above are met.

10
Communicate the way a clinician would

Stop and report a wrong tooth, report a contaminated instrument, and use the digital worksheet and tablet properly: the worksheet is only your draft, and you are responsible for checking every entry before you submit it. Unprofessional attitude towards examiners or staff, and poor simulated-patient management, are penalised too.

11
Know the check-in and conduct rules cold

Bring a physical photo ID (digital IDs are not valid). Keep your photo badge label on your outermost garment and label your forms and arches with your candidate ID. Wear a mask, gloves, scrubs, closed-toe shoes and protective eyewear or loupes with side shields. Phones, smartwatches and cameras are prohibited and photography means immediate dismissal. Dental assistants are not allowed. Never remove typodont arches until an examiner tells you to.

12
Plan for retakes before you need them

There is a 10-day wait after a failure before you can re-attempt that part. Fail one procedure in Endodontic or Prosthodontic and you retake all procedures in that part, while the two Restorative exams are retaken separately. Three failures of the same part restarts the whole series, and everything must be passed within 18 months of your first attempt.

Interactive

Pick your timeline for a suggested practice plan

These plans are our suggestions, not ADEX requirements. Adjust them to your weakest exam.

Choose how long you have.

8 weeks

Weeks 1 to 2Read the manual and all criteria sheets. Set up a practice station and your instrument set.
Weeks 3 to 5One exam a week, timed, then self-grade against the criteria sheet.
Weeks 6 to 7Full-day simulations for both exam days, including tablet-style write-ups.
Week 8Fix your weakest exam, then rest before the exam.

4 weeks

Week 1Criteria sheets, setup and a first timed run of every exam.
Week 2Timed repeats of your two weakest exams.
Week 3One full simulation of each exam day.
Week 4Review your losses against the criteria, then rest.

2 weeks

Days 1 to 3Criteria sheets and your checklist.
Days 4 to 10Timed reps aimed at where you lose points: over-preparation, taper, isolation.
Days 11 to 13One full simulation of the exam day you fear most.
Day 14Rest and prepare your kit.
Interactive

Exam-day kit checklist

Tap each item as you pack it. All rules are from the ADEX manual.

Quick answers

Frequently asked questions

Do I work on real patients?
No. Every clinical procedure is performed on a simulated patient manikin with typodont models, in a clinic or simulation lab, within a set time.
Can I bring notes into the clinic?
Only official ADEX publications (the Candidate Manual, Candidate Guide and criteria sheets) are permitted, along with your own handwritten notes or drawings inside the manual pages.
What does a retake cost?
According to ADEX, a second attempt at a clinical exam has no exam fee, but you pay the typodont fee ($150 per procedure) and the facility fee. A third attempt is $1,495 per clinical exam plus the facility fee. Confirm current fees with ADEX before you register.
Is the DLOSCE part of this?
The DLOSCE is the computer-based half of the same ADEX Dental Examination. It is scheduled and studied for separately. Read our DLOSCE preparation tips, and the overview of the whole exam, linked below.

Planning your route to a US licence?

The order of your exams, your US program and your state all shape when you sit this exam. Message our Admin Team with Dr. T and Dr. Kaur on WhatsApp and we will help you plan it.

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Current as of 28 September 2026. Sources: ADEX 2026 Dental Candidate Manual (Clinical), ADEX 2026 Candidate Guide and the ADEX Dental Examination page. Practice plans and the “What if?” summaries are TSB’s own condensations of the manual’s rules, not exam content. Rules, fees and schedules can change; confirm with ADEX and your state board before you register. Educational content, not licensing advice.

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