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Administered by

2021 CANDIDATE MANUAL

PROSTHODONTIC/ENDODONTIC EXAMINATION

Please read all pertinent manuals in detail prior to attending the examination ONLY CITA PREPARED MANUALS AND FORMS MAY BE BROUGHT INTO THE EXAM

Copyright © 2021 Council of Interstate Testing Agencies, Inc. FINAL

CONTACT ADDRESS

1518 ELM STREET SUITE A SANFORD, NC 27330 PHONE & FAX

P: 919.460.7750 F: 919.460.7715 EMAIL

INFO@CITAEXAM.COM WEBSITE

WWW.CITAEXAM.COM

EXAM

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COUNCIL OF INTERSTATE TESTING AGENCIES

The Council of Interstate Testing Agencies, Inc. (CITA) is a not-for-profit corporation which serves the community as an independent regional testing agency. CITA administers the ADEX Dental and Dental Hygiene Examinations. CITA MISSION STATEMENT CITA’s mission is to provide psychometric, technical, and administrative services in the administration and delivery of clinical licensure examinations in dentistry and dental hygiene. CITA will demonstrate integrity and fairness as it assists with licensing boards of dentistry in their mission to protect the health, safety, and welfare of the public by assuring that only competent and qualified individuals are allowed to practice dentistry and dental hygiene. TESTING AGENCIES VS. LICENSING BOARDS Testing agencies contract with individual boards of dentistry to administer the clinical examination required for licensure in those states/jurisdictions. Testing agencies DO NOT have the authority to license individuals or implement policies that go beyond the laws of its member states/jurisdictions. The candidate must ascertain the qualifications and procedures necessary to obtain licensure in the intended jurisdiction of practice, prior to the candidate undertaking any activity or activities which may constitute the practice of dentistry. Candidates should contact the Licensing Board(s) in the jurisdiction(s) in which they intend to practice to find out what is required other than the ADEX exam to practice in their jurisdiction. DISCLAIMER CITA manuals have been developed to provide the candidate with the information required to be successful on the ADEX Dental Examination. Every effort has been made to ensure that this manual is accurate, comprehensive, clear, and up-to-date. In the rare instances when examination related instructions need to be updated or clarified during the examination year, changes will be posted on CITA’s website (www.citaexam.com). There may also be other test-related material sent to candidates directly by the CITA office should the need arise. All candidates who participate in the ADEX Dental Examination are responsible for reading and understanding all CITA manuals, any documented changes to the published CITA manual posted via the website, and for reviewing and understanding all other material provided by CITA. If in reviewing any CITA provided material, questions arise, it is the candidate’s responsibility to resolve those questions by directing them to the CITA office via email.

Before taking the CITA administered ADEX Dental Examination, each candidate will be required to sign forms certifying that he/she has read the 2021 CITA ADEX Dental Manuals and all other materials provided by CITA. Occasionally examinations are interrupted or postponed because of hurricanes, blizzards, other severe weather, power outages, or similar occurrences. CITA reserves the right in its sole discretion, to delay, halt, postpone, or cancel an examination because of unforeseen and serious events. In the event of predicted severe weather events, candidates should monitor the testing agency website and their email for site-specific candidate information.

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Table of Contents

See the Application Process Manual for:

• How to set up an online profile • Exam qualification information and form • How to apply for a Pros/Endo or Restorative/Perio only exam • How to request special accommodations

I. ADEX Exam 4 II. Admininistration Overview

Address Questions to Appropriate Agencies 5 Curriculum Integrated Format 5 18-Month Rule 5 Examination Cancellation Policy 6 Limited Liability Insurance 6 Three-Time Failure Rule 6 Releasing Results 7 Scoring to Jurisdiction Accepting the ADEX Exam Results for Licensures 7 Re-Examination and Remediation 7 Online Score Request 8 Appeal Process 8

III. OSCE (Diagnostic Skills Examination) Scheduling the OSCE 10 OCSE Content 11

IV. Standards of Conduct and Infection Control Standards of Conduct 13 Dismissal From Examination 14 Infection Control Requirements 14

V. Exam Overview Typodonts and Instruments 16 Practicing Prior to the Exam 16 Examination Schedules 16 Exam-Day Registration for Prosthodontics and Endodontics Exam Procedures 17 General Manikin-Based Exam Administration Flow 19 Prosthodontics Examination 19 Transition from Prosthodontic to Endodontic Procedures 22 Endodontics Examination 22 Exam Check-Out 25

VI. Scoring for Pros/Endo Exam Manikin-based Criteria 26 Scoring 26 Penalties 27

VII. Examination Forms 39 VIII. CITA Pre-Exam Checklist 40

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I. ADEX EXAM PART I: OSCE Examination The computer-based ADEX OSCE Examination (Previously known as the Diagnostic Skills Examination or DSE) is administered at a Prometric testing center of the candidate’s choice. PARTS II AND III: PROSTHODONTICS AND ENDODONTICS CLINICAL EXAMINATIONS The Prosthodontics and Endodontics Examinations are manikin-based exams administered at various testing sites. CITA strongly encourages candidates to thoroughly read the Prosthodontic/Endodontic Exam Manual prior to taking the exam. PARTS IV AND V: RESTORATIVE AND PERIODONTAL SCALING CLINICAL EXAMINATIONS

The Restorative and Periodontal Scaling Examinations can be patient-based or manikin-based exams administered at various testing sites. CITA strongly encourages candidates to thoroughly read the Restorative/Perio Exam Manual prior to taking the exam. Note: Candidates should check with their dental board to determine if they accept a manikin-based Restorative/Perio exam.

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II. ADMINISTRATIVE OVERVIEW This manual has been designed to assist candidates with the 2021 Pros/Endo examination and other pertinent administrative guidelines. The examination is based on specific performance criteria as developed by ADEX which will be used to measure the candidate’s clinical competency.

Please see the Application Process Manual for step-by-step instructions on how to set up an online profile and register for the ADEX exam through CITA.

ADDRESS QUESTIONS TO THE APPROPRIATE AGENCY

• CITA answers questions about the ADEX Examination Series. • Prometric answers scheduling questions about the OSCE (DSE). (See page 10) • Licensing boards of dentistry answer questions regarding licensure or licensing requirements.

(visit http://www.citaexam.com/states for licensing board contact information) CURRICULUM INTEGRATED FORMAT The Curriculum Integrated Format (CIF) is the pre-graduation format of the ADEX Dental Examination for D3 (junior) and D4 (final year) dental students of record. Both the Curriculum Integrated Format and the Traditional Format examinations are identical in content, criteria, and scoring. CITA allows D3 students to participate in the Pros/Endo parts of the ADEX Dental Exam. Most educators and students favor the administration of the Pros/Endo examination during the junior year of study as the Pros/Endo examination is closer to the students’ pre-clinical laboratory experience in working with typodont simulation. D3 students’ 18-month clock does not start until July 1st of the D4 (final) year. Failures received during a candidate’s D3 year do not count towards the three-time failure rule. 18-MONTH RULE *THIS RULE IS CURRENTLY WAIVED DUE TO COVID-19 PANDEMIC UNTIL ADEX BOD REINSTATES

If a Pros/Endo portion was taken as a D3, then as of July 1 of their D4 (final) year, a candidate has 18 months to complete all parts of the ADEX Dental Exam. It is in the candidate’s best interest to participate in the CIF format by taking the Pros/Endo sections of the exam and/or the OSCE (if authorized) before July 1 of their D4 (final) year if they are approved as competent to challenge the exam by the appropriate faculty of their dental school. A candidate who already has a dental degree or a D4 (final year) candidate who has NOT yet attempted any part of the exam has 18 months from his/her first attempt of any part of the ADEX Dental Exam to complete all necessary parts of the ADEX Dental Exam. If a candidate fails to complete all parts of the ADEX Dental Exam within his/her assigned 18-month time frame and in three (3) or fewer attempts, he/she must contact the licensing board in the jurisdiction of sought licensure for remediation requirements, and will be required to re-start the entire exam cycle once remediation requirements have been met. NOTE: To maintain the integrity of this rule, all unsuccessful candidate results will be shared among all testing agencies administering the ADEX Dental Exam.

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EXAMINATION CANCELLATION POLICY

CITA reserves the right to cancel or postpone any examination where: • The number of candidates registered to take the examination does not, in the sole discretion of

CITA, financially justify the administration of the ADEX Dental Examination • An emergency arises • Other unforeseen circumstances that are beyond CITA’s control.

Emergencies or unforeseen circumstances may include, but are not limited to: acts of nature, acts of terrorism, events resulting in the destruction of the CITA office or testing site facility, loss or delays in the delivery of necessary equipment and/or supplies by a shipping agent, failure of the testing site facility to provide expected and necessary services, equipment, supplies or personnel, or other similar events. Under no circumstance does CITA assume liability for costs incurred by candidates in preparing to take a CITA examination. This policy extends to situations where CITA may be forced to cancel an examination because of an emergency or unforeseen circumstance, such as those listed above, or for the lack of participants as explained above. However, if such an examination cancellation were to occur for those reasons stated or any reason in CITA’s sole discretion, CITA would refund candidates’ application fees, reassign candidates to the next available examination site, or reschedule the examination to the earliest possible date. LIMITED LIABILITY INSURANCE

CITA has a blanket professional liability insurance policy that covers all dental candidates and assistants for all ADEX Dental Examinations. The cost of that coverage is included in CITA’s examination fee. Therefore, candidates and/or assistants are not required to obtain additional limited liability insurance. THREE-TIME FAILURE RULE Candidates failing one part of the ADEX Dental Examination on three (3) attempts must begin the entire examination process again and retake all parts of the examination. Any parts in which the candidate may have been previously successful will not be recognized or counted toward successful completion of the retest of the entire clinical examination process. When this situation occurs, the candidate will be considered an initial applicant. The Three-Time Failure Rule starts on July 1 of a candidate’s D4 (final) year. Failures during a candidate’s D3 year do not count towards this rule. NOTE: To maintain the integrity of this rule, all unsuccessful candidate results will be shared among all agencies administering the ADEX Dental Exam. The three-time failure rule is in effect no matter which agency delivers the exam, or if a combination of agencies gives the parts of the exam. NOTE: Candidates should contact their licensing dental board for any required remediation prior to registering to restart their exam cycle.

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RELEASING RESULTS

Scores for all ADEX Dental Examinations are posted to candidate profiles within ten (10) business days of exam completion. An email will be sent to the candidate when the results have been released. The candidate will retrieve results from the Results tab of his/her BrightTrac profile. Students’ results are released to their dental schools who have entered into a confidentiality agreement with CITA. School coordinators at these schools will be given online access by CITA to view their students’ exam results. School coordinators can use the candidates’ results as opportunities for curriculum development and candidate remediation. Candidates who don’t check the “Release Results to School” box in their profile will not have results sent or have access to any failure photos. Upon completion of a scheduled exam, results are released to all jurisdictions via the DESP (online ADEX score portal) the week following the release of the exam results. This is true for international dentists and students who attend schools other than where they test.

CITA will inform licensing boards when a candidate’s conduct or performance raises issues of character and/or integrity that CITA feels should be made known to a licensure board. Results of unsuccessful candidates are also released to other agencies that administer the ADEX Dental Exam to maintain the integrity of the 18-Month Rule as well as the 3-Time Failure Rule.

SCORES TO JURISDICTIONS ACCEPTING THE ADEX EXAM RESULTS FOR LICENSURE

Results of ADEX Exams are uploaded weekly to the DESP (online ADEX score portal). All licensing dental boards have access to the DESP but not all licensing boards will retrieve results through this portal. These results typically are accepted by boards for five (5) years from the date of each candidate’s successful completion of all parts of the ADEX examination, or for a different time as determined by the individual licensing boards. Candidates should contact the individual licensing board of dentistry for an understanding of that board’s acceptance period for this examination and any other requirements that the candidate must fulfill to meet all standards and requirements for licensure. Completion of the ADEX Dental Examination alone MAY NOT qualify a candidate for licensure, as other requirements of each of the jurisdictions MUST be fulfilled before the candidate may engage in any activity or activities which may be construed as the practice of dentistry. It is the candidate’s sole responsibility to determine that all requirements have been met in the jurisdiction in which he/she wishes to practice before performing those acts which may constitute the practice of dentistry. Determinations as to who is qualified for licensure are controlled by individual jurisdiction law; consequently, the requirements may not be uniform from board to board. Each licensing jurisdiction may use the examination results to the extent authorized by its statutes.

RE-EXAMINATION AND REMEDIATION

Candidates failing any one part of the ADEX Examination on three (3) attempts should contact the licensing board of dentistry or jurisdiction in which they plan to apply for licensure to determine requirements for remediation. It is the candidate’s responsibility to obtain and complete all requirements

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for remedial education in accordance with the requirements of the licensing jurisdiction. Remediation may be provided at a candidate’s school as part of the Curriculum Integrated Format examination process. CITA does not require documentation of remedial education before re-examination for any part of the ADEX Dental Examination. CITA does not assume any responsibility for providing this information or for monitoring the completion of such requirements before re-examination. ONLINE SCORE REQUEST

Candidates should contact the licensing board where they are seeking licensure before submitting an online Score Request. Some dental boards will retrieve scores through the DESP (online ADEX score portal). If the dental board requires an official paper score report and/or copy of the manual, candidates must submit a Duplicate Score Request. Requests can be requested electronically via accessing the citaexam.com website, and then clicking Score Request at the top right of the home page. A fee of $35.00 will be charged per address to send paper score reports to the requested jurisdictions. FedEx services are available at an additional fee of $25, if requested. A physical address must be provided if requesting FedEx delivery as FedEx will not deliver to a P.O. Box. CITA will only send official scores directly to licensing dental boards for licensure purposes. We do not send official scores to individuals. All exam procedure attempts will be sent as part of a candidate’s official scores. Any other requests must be made in writing and approved by the CITA Board of Directors. Candidates can access an unofficial copy of their scores directly from the Results tab of their online profile for personal use.

APPEALS PROCESS

If a candidate believes that his/her results were adversely affected by extraordinary conditions during the examination, the candidate may submit an appeal. Appeals are reviewed by a special committee whose charge is to review the facts, paperwork, and score tabulations to determine if the examiners’ findings substantiate the results. Appeals based on patient behavior, tardiness, or failure to appear will not be considered. The appeal process is the final review authority, and if the appeal is denied, there is no further review process authorized by or conducted by CITA or ADEX. Candidates who contact CITA’s administrative office regarding their examination results must indicate in written form VIA EMAIL whether expressing a concern related to the examination or initiating a formal appeal. A non-refundable $250.00 filing fee will be charged by CITA to file and process a formal appeal. Any request for an appeal must be received at CITA’s central office no later than fourteen (14) days following the official date on which the scores were released.

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CITA’s special committee is required to complete its review within sixty (60) days from the time of receiv-ing the formal request. During that time, the candidate may apply for re-examination. If the candidate files a formal request, retests and passes the examination before the request has been fully processed, the review will be terminated and the $250.00 filing fee will be forfeited by the candidate. In determining whether or not to file a petition for review, the candidate should be advised that all reviews are based on a re-assessment of documentation of the candidate’s paperwork for the examination. Candidates should understand that the review does not include re-grading of any exam performance. The review WILL NOT take into consideration other documentation that is not part of the examination process such as character references or testimonials, dental school grades, class ranking, faculty recommendations, or opinions of other "experts" solicited by the candidate. Also, the review will be limited to a consideration of the results of only one (1) examination at a specific test site. Candidates will not participate in the review process and will be notified in writing within sixty (60) days of receiving the review request as to the results of the review. Again, the review will not take into consideration other documentation that is not part of the examination process. Opinions of the candidate, auxiliaries, faculty members, patients, colleagues, examiners acting outside of their assignment area, or records of academic achievement are not considered in determining the results of the examination and do not constitute a factual basis for an appeal. Consideration can only be given to documents, radiographs, post-exam photographs, or other materials that were submitted during the examination and remain in the possession of the testing agency. Any candidate who receives a failing score on an ADEX examination may, on his/her behalf, submit a candidate appeal of that failing score. The examination series content is developed and revised by the ADEX Dental Examination Committee. This committee is comprised of representatives from every ADEX member jurisdiction, as well as the participating regional test administration agencies. The committee has considerable content expertise and also relies on practice surveys, current curricula, standards of competency and the American Association of Dental Boards (AADB)’s Guidance for Clinical Licensure Examinations in Dentistry publication to ensure that the content and protocol of the examination are current and relevant to practice. Examination content is also determined by such considerations as patient availability, logistical restraints, and the potential to ensure that a skill can be evaluated reliably. The examination content and evaluation methodologies are reviewed annually and periodically changed to reflect current best practices.

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III. OSCE (DIAGNOSTIC SKILLS EXAMINATION)

The computer-based ADEX OSCE is administered at a Prometric testing center of the candidate’s choice. The OSCE may be taken either before or after the Restorative/Perio and Pros/Endo examinations. It is given in one day and is approximately 4 hours long. The initial OSCE fee is included at no charge when a candidate has registered for both exams through CITA. As with all sections of the ADEX exam series, the 18-month and 3-time failure rules apply to the OSCE. (Candidates should consult the three-time failure and 18-Month Rules on page 5-6 for details)

A current listing of the locations of Prometric Testing Centers at which the computerized OSCE is offered throughout the year can be accessed by going to CITA’s website www.citaexam.com and clicking on the Prometric button on the home page. (Bottom right)

The candidate should check the candidate profile Apply tab for his/her eligibility number and OSCE scheduling instructions. Appointments must be scheduled with a minimum 24-hour notice. Appointments are made based on availability.

NOTE: Once the OSCE exam had been paid with CITA, the Eligibility Number can take up to 3-4 hours to transfer to Prometric for scheduling.

SCHEDULING THE OSCE (DSE) Candidates register for the OSCE via the Prometric website. Candidates will receive a confirmation email with scheduling directions. Candidates may schedule their testing appointment for Prometric online. Scheduling is available 24 hours a day. To schedule your exam by the Internet, the following steps must be completed for the DSE/OSCE exam:

1. Go to www.citaexam.com and click on the

Prometric button from dropdown. 2. Once you are taken to the CITA landing page,

click on Schedule. 3. This will take you to the Prometric Scheduling

page. Follow the instructions to register. 4. Make sure you have your Eligibility ID ready

to enter into the Eligibility Information Section of the form. This number is found in your BrightTrac Candidate Profile/Apply.

5. Continue to follow the steps until your appointment is complete.

6. To reschedule, click on re-schedule button. You will need your confirmation number. A candidate will receive an email confirmation of his/her Prometric test appointment. This confirmation will provide the candidate with the Prometric exam title, date, time, and location of his/her Prometric test appointment. MAKE SURE THE DATE, TIME AND LOCATION ARE CORRECT.

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Lack of receipt of an email confirmation does not invalidate the candidate’s testing appointment when scheduling. Candidates are responsible for noting the date, time, and location of their Prometric testing appointment when scheduling. Prometric Testing Centers are open for testing Monday through Saturday. The hours of each testing facility vary. CITA strongly encourages candidates to contact Prometric as far in advance of their wanted test date as possible. NOTE: If you want to request special accommodations, you must contact the CITA office at least 45 days prior to your desired OSCE exam date. A candidate must provide no less than 48-hours’ notice (Monday-Friday) to reschedule/cancel his/her testing appointment. Rescheduling/cancellation is done through Prometric’s Central Registration Office, NOT the local testing center. Their number is 1-800-797-1813 and are available 24 hours a day, 7 days a week. Failure to provide 48-hours’ notice will result in forfeiting the initial OSCE test fee. Candidates who fail to appear for their scheduled test appointment will be reported as a no-show and will need to reschedule as a retest candidate through CITA after paying the appropriate OSCE retest fee of $500. Requests for waivers must be submitted to CITA in writing within 72 hours of the missed testing appointment and must include a doctor’s note verifying a medical emergency. Take two forms of personal identification to the Prometric Testing Center: one with a recent photo, and both with a signature. Acceptable forms of ID include a valid current driver’s license, passport, and military ID. A credit card is acceptable as a secondary form of ID. An expired driver’s license is not a valid form of ID. If your name has changed due to marriage, divorce, or other legal reasons, bring a copy of the marriage certificate or court document to the Prometric Testing Center. OSCE (DSE) SCORING There are 165 scored points on the DSE OSCE. There are 15 of the 165 scored points that come from pilot questions. The final score of the DSE OSCE is based on the percentage of items answered correctly and scaled to equate scores from year to year. Out of 100 possible points, a scaled score of 75 or higher is required to pass. Results are released in accordance with CITA administrative procedures. OSCE (DSE) CONTENT Simulations of actual patients are utilized through computer-enhanced photographs, radiographs, optical images of study, working models, laboratory data, and other clinical digitized reproductions. Three subsections of the OSCE are designed to assess more complex levels of diagnosis and treatment planning knowledge, skills, and abilities. The table below summarizes the information covered on the OSCE as of January 1, 2021: In each subsection, candidates may skip or mark items to be considered later. Once a subsection is complete, the candidate must lock out of the subsection and will not be able to return to that subsection again. The time indicated on the computer screen is the amount of time for that subsection. There is no specific time limit for each question.

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CITA does NOT offer any study material for the OSCE (DSE) Examination

OSCE (DSE) CONTENT FORMAT (as of Jan 1, 2021)

Patient Evaluation (PE)

Designed to assess the candidate’s ability to recognize critical clinical conditions or situations encountered regularly in the general practice of dentistry.

• Pathology • Physical Evaluation of

- Anatomy - Identification of Systemic Conditions - Radiology - Lab Diagnostics - Therapeutics

Simulated patients presented on a computer. 165 scored points:

• PE: 20% • CTP: 60% • PPMC: 20%

Time: 4 hours (max time allowed; time used may be less at the discretion of the candidate) A 15 minute break is given after each section. Results reported as either:

“PASS – 75 or greater” or

“Fail—less than 75”

Comprehensive Treatment Planning (CTP)

Designed to assess the candidate’s ability to recognize critical clinical conditions or situations encountered regularly in the general practice of dentistry, and also to identify the appropriate treatment options required for the clinical condition or situation depicted in simulations.

• Systemic Diseases/Medical Emergencies/Special Care and Oral Medicine

• Periodontal Diagnosis and Treatment Planning • Restorative Dentistry • Specialties

- Endodontics - Orthodontics - Oral Surgery - Pediatric Dentistry

Cross-Cutting Clinical Judgments Designed to assess the candidate’s abilities to recognize critical clinical conditions or situations encountered regularly in the general practice of dentistry and to formulate appropriate treatment options as well as evaluation of treatment outcomes. • Medical emergencies • Infection control • Prosthodontics

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IV. STANDARDS OF CONDUCT/INFECTION CONTROL STANDARDS OF CONDUCT The ADEX examination strives to evaluate the candidate’s clinical judgment and skills fairly. Also, conduct, decorum, and professional demeanor are evaluated. The candidate is required to adhere to the rules, regulations, and standards of conduct for the ADEX Dental Examinations. Throughout the examination, the candidate’s professional conduct and clinical performance will be evaluated. Several considerations will weigh in determining the candidate’s final score, and penalties may be assessed for violation of examination standards and/or certain procedural errors, as defined and further described within this manual.

1. Unethical personal/professional conduct: Any substantiated evidence of collusion, dishonesty, use of unauthorized assistance, intentional misrepresentation during registration or the course of the examinations or failure of the candidate to carry out a directive of the Chief examiner shall automatically result in failure of all five examination sections. The candidate and assisting auxiliary must behave ethically and properly. Patients shall be treated with proper concern for their safety and comfort. Improper behavior is cause for dismissal from the examination at the discretion of the Chief examiner and will result in failure of the examination. Additionally, the candidate shall be denied re-examination through any testing agency who administers the ADEX Dental Exam for one full year from the time of the infraction.

2. Termination of the examination(s): CITA reserves the right to terminate or delay the examination(s) at any time if, 1) that action becomes necessary to safeguard the health, safety, or comfort of the patient, 2) the candidate or examiners are threatened in any manner, or 3) other interfering events occur that are not under the control of CITA.

3. Completion of the examinations: Examination procedures performed outside the assigned time will be considered incomplete, and the candidate will fail the examination part. If all specified materials and required documentation are not turned in at the end of an examination, then that exam will be considered incomplete, and the candidate will fail all exams involved.

4. Misappropriation and/or damage of equipment: No equipment, instruments, or materials shall be removed from the examination site without written permission of the owner. Willful or careless damage of dental equipment, typodonts, manikins or shrouds may result in failure. All resulting repair or replacement costs will be charged to the candidate and must be paid to the host site before the candidate’s examination results will be released.

5. Submission of examination records: All required records and radiographs must be turned in before the examination is considered complete. If all required documentation is not turned in at the end of the examination, the examination will be considered incomplete, and the candidate will fail all exams involved.

6. Assigned procedures: Only the treatment and/or procedures assigned may be performed. Performing other treatment or procedures may result in failure of the examination.

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7. Electronic recording devices and cameras: The use of electronic recording devices or cameras by the candidate, an auxiliary, or a patient during any part of the examination is a violation of examination guidelines and may result in failure of the entire ADEX Dental Examination. However, intra-oral photographs may be taken by authorized examiners or school personnel during the examination for future examiner standardization and calibration.

8. Electronic equipment: The use of any electronic equipment for functions other than the time-clock function is not permitted on the clinic floor by candidates, auxiliaries, or patients during the examination. Any such use will be considered unprofessional conduct and may result in dismissal from the examination. If using a phone for timekeeping purposes, set it to airplane mode.

DISMISSAL FROM EXAMINATION In addition to the standards of conduct listed in the previous section, the following list is provided as a quick reference for candidates. While the following is not an all-inclusive listing, it does provide examples of behaviors that may result in dismissal/failure of the examination: • Using unauthorized equipment at any time during the examination

• Performing required examination procedures outside the allotted examination time

• Failure to follow the published time limits and/or complete the examination within the allotted time

• Receiving assistance from another practitioner, including another candidate, dentist, school representative(s), etc.

• Exhibiting dishonesty

• Failure to recognize or respond to systemic conditions that potentially jeopardize the health of the patient, and/or total disregard for patient welfare, comfort and safety

• Unprofessional, rude, abusive, uncooperative or disruptive behavior to other candidates and/or exam personnel

• Misappropriation or thievery during the examination

• Non-compliance with anonymity requirements

• Non-compliance with established guidelines for asepsis and/or infection control

• Use of any electronic equipment in the clinic/simlab for reasons other than using the clock function on the device (if using a phone for timekeeping purposes, set it to airplane mode)

• Use of electronic recording devices, cell phones (unless used for timekeeping purposes and in airplane mode), smart watches, headphones or cameras by the candidate during any part of the examination

INFECTION CONTROL REQUIREMENTS Although this is a manikin-based examination, all candidates must follow the current recommended infection control procedures as published by the Centers for Disease Control and Prevention for the Prosthodontic and Endodontic Examinations. These infection control procedures must begin with the initial set-up of the unit, continue throughout the Prosthodontic and Endodontic Examinations and conclude with the final clean-up of the operatory. Failure to comply will result in loss of points and any violation that could lead to direct patient harm will result in failure of the examination.

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The only exception to standard infection control precautions is that the candidate is not required to maintain protective eyewear on the manikin during manikin procedures. Infection control will be monitored by the CFEs. As both the endodontic and prosthodontic procedures are considered to be on the same patient, it is not necessary to sanitize the operatory or sterilize instruments between these procedures. As much as possible, dental professionals must help prevent the spread of infectious diseases. Because many infectious patients are asymptomatic, all patients must be treated as if they are, in fact, contagious. Use of barrier techniques, disposables whenever possible, and proper disinfection and sterilization are essential. Candidates must adhere to the following infection control procedures: 1. Barrier protection

• Gloves must be worn when setting up or performing any intra-oral procedures and when cleaning

up after any treatment. Do not wear hand jewelry that can tear or puncture gloves. If rips or tears occur, new gloves are needed. Do not wear gloves outside the operatory.

• Wash and dry hands between procedures and whenever gloves are changed. • Wear clean, long-sleeved uniforms, gowns or laboratory coats, and change them if they become

visibly soiled. Remove gowns or laboratory coats before leaving the clinic area. • Wear facemasks and protective eyewear with side shields during all procedures in which splashing

of any body fluids is likely to occur. Discard masks if the masks become damp or soiled. • Do not wear open-toed shoes. • Cover surfaces that may become contaminated with impervious-backed paper, aluminum foil or

plastic wrap. Remove these coverings (while gloved), discard them, and replace (after removing gloves).

2. Sterilization and Disinfection • If not barrier wrapped, surfaces and countertops must be pre-cleaned and disinfected with a site-

approved tuberculocidal hospital-level disinfectant. • Handpieces, prophy angles, and air/water syringes must be sterilized before and after use or

properly disposed of after use. • All waste and disposable items must be considered potentially infectious and shall be disposed of

in accordance with federal, state, and local regulations.

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V. EXAMINATION OVERVIEW TYPODONTS AND INSTRUMENTS The Pros/Endo examination consists of two parts: Endodontics (part II) and Prosthodontics (part III). CITA will provide all typodonts for the Pros/Endo exam. CITA uses two (2) different typodonts. The teeth numbers used for the exam are the same with both models. Check the Site Information Sheet for details on which typodont will be used at the selected exam site. Candidates should review the Site Information Sheet (located on the Document Tab of the candidate’s BrightTrac profile) for their exam site before taking the exam. Other than the instruments and materials provided by the testing site, candidates are responsible for providing the instruments, files, and materials of their choice. Rotary instruments are permissible during the Endodontic Examination. Refer to your Site Information Sheet for any COVID-19 related information. FOR PRACTICING PRIOR TO YOUR EXAM

CITA Typodont: This typodont is only used at ECU and UPR exams. CITA has developed a typodont manufactured especially for CITA (with biphasic teeth) by Nissin Dental Products Inc. They can be purchased from Kilgore International at www.kilgoreinternational.com by ordering the CITA-EP KIT - COMPLETE TESTING KIT. Acadental Typodont: All other CITA testing sites require candidates to use the Acadental typodont model. Please reference your Facility Information Sheet for details about required typodonts. Setup and mounting procedures of Acadental typodonts will be covered on-site during registration. To order Acadental typodonts, visit www.acadental.com. Select the ModuPRO Exam Practice Kit.

*Note: Endodontic teeth (#8 and #14) for both models are manufactured by Acadental. Candidates may order the endodontic teeth via Acadental’s website: www.acadental.com.

EXAMINATION SCHEDULES *NOTE: Auxiliary personnel and/or laboratory technicians are not permitted to assist a candidate during the Prosthodontics or Endodontics Examination. Violation may result in failure of the examination. Timely Arrival Candidates are responsible for determining travel and time schedules to ensure CITA’s time requirements are met. The candidate is expected to arrive at the examination site at the designated registration time stipulated in the published schedule for that particular examination. Failure to follow this guideline may result in failure of the examination.

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Candidates will be informed in the Apply section of their BT Profile and via email as to the date on which they are scheduled to take each part of the examination. Candidates should note that the Pros/Endo examination has specific time restraints. All procedures for each examination must be completed within the allotted time for that section. The following schedule is an example of the administration of these examinations; however, examination schedules are not finalized until after the 30-day application deadline. Candidates’ confirmed schedules will be emailed approximately 30 days before the exam.

** Candidates only taking the Endodontics Exam may be scheduled for the 6:30 am registration followed by an 8:00 am start time if seats are available. A notification will be listed in the Exam Acceptance email.

EXAM-DAY REGISTRATION FOR PROSTHODONTICS AND ENDODONTICS

Candidates will begin the day by attending the exam-day registration. An exam packet with assigned operatory/unit numbers will be given to each candidate who presents proper ID and required paperwork.

Candidates may not wear scrubs or lab coats that have ANY visible identifying names or practices on them during the exam.

To be completed and brought to the exam day registration: 1. Certificate of Examination (All candidates)

2. COVID-19 Liability Waiver & Release form if still applicable

3. TWO Forms of Identification: To receive all examination materials at

registration, candidates must provide their 3-digit sequential number available through their BrightTrac profile under the Apply Tab, along with two forms of personal identification. One ID must contain the candidate’s signature and one must have a photograph which is similar to the uploaded profile photo. Form can be found in the BrightTrac profile under the Documents tab.

Time Assignment

6:30am – 6:45am Candidate Registration (Prosthodontic Examination)

7:00am – 8:00am Prosthodontic Set-Up (Candidate allowed into simulation labs)

8:00am – 12:00pm Prosthodontic Examination (4 Hours)

Candidates may transition from Pros to Endo Section

12:00pm – 12:15pm Candidate Registration (Endodontic Examination** )

12:30pm – 1:00pm Endodontic Set-Up (Candidate allowed into simulation labs**)

1:00pm – 4:00pm Endodontic Examination**

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Acceptable forms of ID include:

• Current driver’s license • Current passport • Military ID • Employee ID • School ID • Voter registration card (signed) • A national credit or debit card is an acceptable secondary form of ID.

Not Acceptable forms of ID include:

• Expired Driver’s License • Expired Passport • Social Security Card

The candidate’s name on both forms of ID must match the name used for registration. If the name on the identification presented differs from the name (other than middle name or initial) used for registration, official documentation or authorization of a name change must be presented for admittance to the examination. If a candidate is not admitted because he/she fails to provide this documentation, his/her examination fee will be forfeited.

Once identification has been verified, each candidate will receive his/her packet. Each packet will include a minimum of the following items:

Candidate ID badge Candidate Identification Labels Survey

Candidate registration may be conducted in a room or area other than the simulation laboratory where the manikin-based clinical simulation examination will be conducted. Candidates should, therefore, consult the finalized examination schedule, which is emailed after the exam has closed (30-days before the exam). Candidates may work only in the clinic, operatory, or laboratory spaces as authorized. Violation of this standard will result in failure of the examination(s). Candidates MUST be registered during the specified time for the scheduled exam(s) according to the finalized examination schedule, or they will NOT be allowed to sit for the examination. There will be no exceptions! Candidates taking both the Prosthodontics and Endodontics Exams are required to attend the morning exam-day registration. They will be automatically confirmed for both the morning Prosthodontics and afternoon Endodontics Exams at that time. If the candidate is only taking the Endodontics Examination, the candidate is required to register for the Endodontics Examination at the scheduled Endodontics Examination registration time. If space allows, every effort will be made to start Endodontic only candidates in the morning session. Check the Exam Acceptance Email sent before the exam for confirmation of registration time. NOTE: Candidates who took the Patient Examination the previous day will not be provided with a new packet. The candidate must retain and bring his/her Candidate ID badge and labels. There will be no exceptions!

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GENERAL MANIKIN-BASED EXAM ADMINISTRATION FLOW

Treatment of Simulated Patient

The Prosthodontics Examination (limited to four hours) is immediately followed by the Endodontics Examination (limited to three hours). If a candidate finishes the prosthodontic procedures early, he/she may proceed to the endodontic procedures without waiting. However, the candidate will only be allowed the standard three hours for this section. In any case, before proceeding to the endodontic procedures, a CFE must be requested to check the completion of the three prosthodontic procedures, the measurement of the endodontic tooth, and assist in mounting the endodontic typodont in the typodont head. CFEs will monitor the progress of all candidates and should confirm that all candidates have their manikin heads mounted, properly articulated, and are ready to undergo treatment. The Chief or a CFE will announce the beginning of the examination at 8:00 am.

Once the examination has begun, the manikin will, from that point forward, be regarded as a “live” patient and all infection and barrier controls must be observed and maintained by the candidate. Failure to observe established protocols is a violation of examination protocol and will result in a penalty being assessed to the candidate. Repeated failure to observe appropriate infection control protocols will result in failure of the examination.

NOTE: A CFE must be notified immediately in case of equipment failure; he/she will contact school maintenance personnel. The malfunction will be corrected or the candidate relocated. If it is determined by the Chief that a candidate has lost significant time due to equipment malfunction, he/she may adjust the candidate’s exam finish time.

PROSTHODONTICS EXAMINATION Prosthodontics Exam Start Candidates enter the clinic/lab at 7:00 am and set up all necessary instruments and materials to begin the PROSTHODONTICs examination. Between 7:00 am and 8:00 am, CFEs will assist candidates with preparing for the Prosthodontics Examination. The Prosthodontics Examination will begin at 8:00 am. Candidates may NOT begin the Prosthodontics Examination until instructed by the CFEs. The candidate may perform the prosthodontic procedures in any order. Candidates will add a Candidate ID label to each of the Progress Forms, the plastic bag in the typodont box and the small brown envelope. CANDIDATES SHOULD NOT PLACE A LABEL ON THE TYPODONT. A CFE will share any announcements and provide instructions to the candidates regarding any necessary adjustments and/or mechanisms that may affect creating a best fit occlusion.

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A CFE will check each mounting to verify that occlusal inter-digitation has been maximized for the candidate. Should an issue occur with affecting a proper occlusal scheme, the candidate should contact the CFE immediately. If necessary, the carrier tray can be replaced and another carrier tray prepared for that candidate. **Setup of Acadental typodonts will vary from site to site.

The candidate should inspect the carrier tray, teeth, and tissue for damage. All damage should be noted on the Progress Form. The CFE will approve the mounting of the typodont by entering his/her

examiner number in the appropriate place on the candidate’s Progress Form. Marking Teeth Teeth may be marked on the typodonts before treatment as a precaution against preparing the wrong tooth. However, they may only be marked after the typodont has been mounted, approved by a CFE, and the treatment-time portion of the examination has begun. The marking must be done intra-orally, and must follow CDC guidelines (barrier-wrapped writing instrument). No part of the typodont can be marked except for teeth #3, #5, and #9. Fabricating Putty Matrix Fabricating an occlusal putty matrix or an occlusal index is required and is encouraged to be done during the set-up period. The manikin will not be considered a “live” patient until the beginning of the clinic period is announced, so the matrix may be made on the benchtop without using gloves. The putty matrix may be made during the exam period but will be made with the consideration that this is a live patient (using gloves and other infection control procedures). After the exam, the CFE will collect all putty matrices, impressions, and models fabricated during the prosthodontic exam. NOTE: All grading is based on putty matrix “Reduction Guide” to confirm a DEF. Graders will use the candidate’s putty matrix unless they are not of usable quality in which case the examiners will grade using the manufacturer putty matrix. Examiners will utilize putty matrices as well as adjunctive instrumentation to ensure that a proper and accurate assessment has been made of the candidate’s performance. Completion of the Prosthodontic Exam When the candidate has finished the prosthodontics portion of the examination, the candidate must first obtain permission from the CFE to dismantle the typodont. A CFE will come to the candidate’s unit, oversee the dismantling of the typodont, and assist the candidate in turning in the carrier tray and typodont. All candidates will discontinue treatment by 12:00 pm. Failure to discontinue treatment of the Prosthodontics Exam by 12:00 pm is a breach of examination protocol and will result in dismissal from the examination.

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Prosthodontics Content

Section III: Prosthodontic Examination – 100 points

The Prosthodontics Examination is a manikin-based examination consisting of three procedures completed on artificial teeth:

Important Notes about the Prosthodontics Examination Preparation

Air/Water spray: Although candidates may use both air and water spray, candidates are encouraged to use only air when preparing the teeth. If water spray is utilized, a mechanism to collect and remove the water must be in place during the use of the water spray. Patient simulation: The correct patient/operator position must be maintained while operating. Throughout the manikin procedures, the treatment process will be observed by CFEs and evaluated as if the manikin were a live patient. Manikins are not required to wear protective eyewear but are subject to the same treatment standards as a live patient. The facial shroud may not be displaced other than with those retracting methods that would be reasonable for a patient’s facial tissue. Assigned teeth: Only the assigned teeth may be treated. If the candidate begins a procedure on the wrong tooth, he/she must notify the CFE immediately. Security requirements: No written materials may be in the operating area other than a copy of the candidate manual or parts thereof, notes written on these copies, and pertinent CITA examination forms. Additional pages of instruction or written notes cannot be pasted or attached in the manual. Written notes on the pages or cover of the manual are allowed. Assistants: Auxiliary personnel are not permitted to assist during the manikin-based examinations. Candidates may not assist each other or critique or discuss one another’s work. Prohibited materials: Impressions, registration, overlays, pre-made putty matrix, clear plastic shells, models, extra teeth, or pre-preparations are not permitted to be brought to the examination site. However candidates are allowed to take impressions and pour up models during the exam, but all impressions and models must be turned in at the end of the exam. Failure to follow these requirements will result in confiscation of the materials as well as dismissal from and failure of the examination. Isolation dam: No isolation dam is required for the crown preparations. Equilibration prohibited: No equilibration will be permitted on the typodont before or after any crown preparation.

CONTENT FORMAT

1. Tooth #3: Cast metal crown preparation as a posterior abutment for a 3-unit bridge

2. Tooth #5: Porcelain-fused-to-metal (PFM) crown preparation as an anterior abutment for the same 3-unit bridge, plus an evaluation of the line of draw for the bridge abutment preparations

3. Tooth #9: Ceramic crown preparation

Performed on a manikin Time Allowed: 4 hours

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TRANSITION FROM PROSTHODONTIC TO ENDODONTIC PROCEDURES Candidates may transition to the endodontic procedure once completing the prosthodontic procedures. Candidates who finish the prosthodontic procedures early and have completed the check-out from that part may proceed to the endodontic procedures without waiting; however, the three-hour time limit for the endodontic procedures will still apply. Candidates must notify the CFE if after finishing the prosthodontic procedures, they wish to begin the Endodontics Exam. The CFE will guide the candidate through changing the module and typodont mounting. The CFE will then note the start and finish time on the candidate’s Progress Form. Candidates should expect the following when transitioning from the prosthodontic to endodontic procedures: 1. The CFE will confirm with the candidate that he/she has finished the prosthodontic procedure.

2. The CFE will then instruct the candidate to remove the typodont from the simulation head and place it on the benchtop.

3. The CFE will unscrew the top carrier tray security screw and remove the prosthodontic carrier tray from the head.

4. The candidate will clean the typodont with cotton gauze and water, at chair-side. The typodont is not to be removed from the candidate’s station, nor should it leave the visual sight of the CFE.

5. The CFE will place the carrier tray in the candidate’s bag (with a Candidate ID label) which was included in the candidate’s typodont box.

6. The CFE will then fold the candidate’s Progress Form and place it into the plastic bag along with the candidate’s putty matrix, impressions, and models.

7. If the candidate is taking the endodontic exam, the CFE will then assist the candidate in measuring the length of the tooth and securing it in the typodont. Candidates will need to have a measuring device (ruler, boley gauge, etc) to measure the Endo tooth #8. After measurement, the Endodontic carrier tray will be mounted in the Manikin head and any occlusal adjustments will be made.

8. If time allows, the candidate may elect to take a break. After returning from the break, a finish time for the endodontic exam will then be assigned. Please note, regardless of when the candidate starts the exam, the end time will be no later than 4 pm.

ENDODONTICS EXAMINATION PROCEDURES

Endodontics Exam Flow

Candidates enter the clinic/lab at 12:15 pm and set up all necessary instruments and materials to begin the Endodontics Examination if not given an earlier time by CITA personnel. Between 12:15 pm and 1:00 pm the CFE will verify the following:

1. The tooth for the endodontic fill has been measured and secured in the typodont. 2. The manikin head is properly assembled. 3. Any defective equipment or materials have been identified and corrected or replaced. The

Endodontic Examination will begin when the CFE gives the candidate a start time. Candidates may NOT begin the Endodontics Examination until instructed by the CFEs.

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When the candidate has finished the endodontic procedures, the candidate should request a CFE to oversee the dismantling of the typodont and assist the candidate in submitting the carrier tray and typodont. Candidates only taking the Endodontic Exam may be scheduled for the 6:30 am registration followed by an 8:00 am start time if seats are available. A notification will be listed in the Exam Acceptance Email. Endodontic Content Section II: Endodontics Examination – 100 points The Endodontics Examination is a manikin-based examination consisting of two procedures:

Important Notes about the Endodontics Examination Radiographs: Since the tooth length is directly measured before the procedure, no radiographs are utilized before or after treatment. Isolation dam: The use of an isolation dam is required for each endodontic procedure (two isolation dams, one for each tooth treated). An isolation dam clamp should not be placed on the teeth on which the endodontic procedure is performed, as doing so may cause the crown to separate from the root of the manikin tooth. Clamping of adjacent teeth or ligation is the acceptable methodology to be employed. ALL treatment must be done with the isolation dam in place. Instruments: Other than the instruments and materials provided by the testing site, the candidate is responsible for providing the instruments, files, and materials of his/her choice. Rotary instruments are permissible during the Endodontics Exam. All instrumentation should be done with proper lubrication to avoid file separation.

CONTENT FORMAT

1. Tooth #14: An access opening on a posterior tooth #14.

Candidates must achieve direct access to all three canals. 2. Tooth #8: An access opening, canal instrumentation and

obturation on an anterior tooth. Tooth #8 is considered to have a normal size pulp chamber for a 21 year old. The size, shape, and extent of the prepared access opening should reflect such anatomy and will be graded accordingly. Canal instrumentation to a minimum size equivalent with a 35-40 file on the #8 endodontic tooth will be required prior to obturation.

Performed on a manikin

Time Allowed: 3 hours

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Prohibited treatments: On the anterior tooth, the use of warm gutta-percha or carrier-based, thermo-plasticized gutta-percha techniques shall not be used, as they may cause damage to the plastic endodontic tooth. Tooth Fractures: If the tooth fractures during treatment, contact a CFE immediately. Reference point: The cementoenamel junction (CEJ) on the facial surface should be used as the reference point to determine the fill depth in the pulp chamber. Filling material: No temporary filling material, cotton pellet or restorative material should be placed in the pulp chamber. Marking Teeth: Teeth may be marked on the typodonts before treatment as a precaution against preparing the wrong tooth. However, they may only be marked after the typodont has been mounted, approved by a CFE, and the treatment-time portion of the examination has begun. The marking must be done intra-orally, and must follow CDC guidelines (barrier-wrapped writing instrument). Teeth may be marked before placing the isolation dam. No part of the typodont can be marked except for teeth #8 and #14. Gutta-Percha: Only pink gutta-percha may be used for the examination. The use of white gutta-percha is prohibited. Treatment Transitions: Candidates do not need to notify a CFE when they transition from the anterior to posterior treatment or vice versa. Endodontics Examination Procedures Candidates may also request assistance from a CFE at the beginning of the endodontic procedure as follows: (Steps 1-4 would only be done if Endo is done as a stand-alone section)

1. The CFE will remove the endodontic carrier tray from the candidate’s typodont box and confirm with the candidate that the number on the carrier tray is that of the candidate.

2. The CFE will remove the anterior endodontic tooth and place it on the benchtop for the candidate to measure and record the length. The candidate should inspect the carrier tray, teeth, and tissue for damage. All damage must be noted on the Progress Form.

3. The candidate will place the measurement in the appropriate box on the Progress Form and then place the tooth on the benchtop.

4. The CFE will secure the individual tooth into the carrier tray and then place the endodontic carrier tray into the manikin head and make any occlusal adjustments.

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5. The CFE will place his/her examiner number on the Progress Form indicating the mounting has been completed and checked.

6. The CFE will assign a finish time. The CFE will record the finish time on the Progress Form.

7. The candidate will be instructed to begin treatment and request a CFE when he/she is finished with the endodontic procedure.

8. At the end of the endodontic procedure, the CFE will, when requested by the candidate, instruct the candidate to dismount the typodont.

9. The CFE will collect the endodontic carrier tray and typodont, the opposing arch and the Endodontic Progress Form, all of which will be placed in the candidate’s typodont box and turned into a CFE.

Candidate endodontic end times will be generated as each candidate transitions from the prosthodontic procedures to the endodontic procedures. The CFE will maintain a list of the candidates and their assigned end times. CFEs will monitor that list and note if candidates work beyond their assigned finish times. Candidates must complete all treatment by the assigned finish time. Continuing to work on the simulated patient beyond the assigned finish time is a breach of examination protocol and cause for failure of the examination. EXAMINATION CHECK-OUT Once all attempted procedures have been completed, follow the steps below:

1. Request a CFE to confirm all procedures have been completed 2. Turn your Photo ID badge into the CFE (unless taking Restorative/Perio Exam the next day) 3. Place your Survey in the designated envelope

Candidates will NOT be dismissed from the examination site until they have completely checked out. Candidates should request the help of a CFE if they need assistance with the check-out process.

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VI. SCORING AND PROS/ENDO EXAM CRITERIA Pros/Endo CRITERIA Testing agencies throughout the U.S. have worked together with ADEX to draft and refine the performance criteria for each procedure in this examination. For the majority of those criteria, gradations of competence are described across a 3-level rating scale. Those criteria appear in the manual and are the basis for the evaluation system. Some criteria only have defined criteria to meet two of the ratings: “Wrong tooth/Surface treated” is scored as either Acceptable or as Critical Deficiency. The “Treatment Management” criteria, while scored across the three rating levels of Acceptable, Marginally Substandard, and Critical Deficiency. SCORING Subject Matter Experts (SMEs) have determined that there are specific performance criteria for each procedure that determine whether the performance demonstrates a pre-determined level of acceptable clinical competency. The specific line item criteria or criterion which are used by the examiners in the rating of the candidate’s performance in each of those scored points/criteria are typically separated into three categories: Acceptable (ACC), Marginally Substandard (SUB), and Critical Deficiency (DEF). The rating levels are as follows: Acceptable: The treatment is of acceptable quality, demonstrating competence in clinical judgment, knowledge, and skill.

Marginally Substandard: The treatment is of poor quality, demonstrating less than desirable clinical judgment, knowledge of, or skill in the mechanical and physiological principles of restorative dentistry, which if left unmodified, will substantially shorten the life of the restoration.

Critical Deficiency: The treatment is of unacceptable quality, demonstrating critical areas of incompetence in clinical judgment, knowledge, or skill of the mechanical and physiological principles of restorative dentistry. The tooth may or may not be temporized, or the treatment plan must be altered and additional care provided to sustain the function of the tooth and the patient’s oral health and well-being.

A candidate’s score for each line item criteria is determined by confirmation of one of those scoring criteria by at least two of the three graders for any given line item criteria. If a criterion is assigned a rating of critical deficiency by two or more examiners, no points are awarded for that procedure or for the examination section. All grading is based on putty matrix “Reduction Guide” to confirm a DEF. Examiners will use the candidate’s putty matrix unless they are not of usable quality in which case the examiners will grade using the manufacturer putty matrix. Examiners will utilize putty matrices as well as adjunctive instrumentation to ensure that a proper and accurate assessment has been made of the candidate’s performance.

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Scores will be posted on the website and disseminated to licensing boards as either:

Ø “Pass – 75 or greater” for a passing score or Ø “Fail – less than 75” for a failing score.

The CITA office WILL NOT provide tabulated scores to candidates, dental boards, or other agencies. PENALTIES Throughout the examination, the conduct and clinical performance of the candidate will be observed and evaluated. Many considerations are weighed in determining the final scores. Penalties are assessed for violation of the examination standards for the following procedural errors: This list is not exhaustive, and penalties may be applied for errors not specifically listed since some procedures will be classified as unsatisfactory for other reasons or a combination of several deficiencies.

PATIENT MANAGEMENT DEDUCTION

Failure to complete an examination procedure 100 Points

Violation of examination standards, rules or guidelines, or time schedule 100 points

Treatment of teeth other than those approved or assigned by examiners 100 Points

Gross damage to adjacent tooth structure – teeth or tissue 100 Points

Failure to complete treatment within the stated guidelines of the examination 100 Points

Rude attitude, and/or inconsiderate/uncooperative with examiners/other personnel 100 Point

Gross infection control violation: Items by report 1- 10 Points Poor simulated patient management and/or disregard for the simulated patient’s welfare or comfort 10 Points

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Prosthodontic Three-SUB Rule: If examiners confirm 3 marginally substandard over-preparation criteria on the same procedure, then the procedure will be determined to be critically deficient and the candidate will fail that procedure.

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PROSTHODONTICS PROCEDURES CRITERIA

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ENDODONTICS PROCEDURES CRITERIA

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VII. EXAMINATION FORMS The following forms apply specifically to the Prosthodontic and Endodontic procedures of the ADEX Dental Exam. Forms required for registration can be found in a candidate’s profile under the Documents tab. Progress Forms (Provided By CITA) Color-coded Progress Forms are utilized to track the candidate’s progress through each procedure, collect examiner signatures for all completed portions of the examination, and provide appropriate progress notes from the candidate to examiners during treatment. Candidates will be provided with identification labels to place on each procedure’s progress form, as indicated on the form. The Prosthodontics and Endodontics Examination Progress Forms will be collected by the CFE as each of the manikin-based procedures are completed. Penalty Deduction Form Should a candidate fail to comply with the standards and guidelines outlined in this manual, the CFE and/or Chief Examiner will complete a Penalty Deduction Form detailing the candidate’s error.

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COVID-19 Liability Waiver and Release If COVID-19 is still a factor in the 2021 season, a COVID-19 Liability Waiver and Release form is required at the exam site. This form is found on your CITA BrightTrac Profile on the Dashboard in the Document section.

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VIII. CITA PRE-EXAM CHECKLIST BEFORE EXAM � If attempting the Patient-based exam, read the entire Patient-based exam manual. � If attempting the Manikin-based exam, read the entire Manikin-based exam manual. � Complete the online registration by following the instructions in the Application Process

Manual located on the www.citaexam.com website. � Check your online profile to verify that all exam parts have been selected (Apply tab) and that

all fees have been paid (Dashboard tab) before the 30-day deadline. PROMETRIC TESTING CENTERS � Select the Prometric Testing Center where you will take the OSCE. After registration has been

processed and CITA has sent an authorization letter, schedule appointment with Prometric by clicking the Prometric link on www.citaexam.com

� Take two forms of personal identification to the Prometric Testing Center: one with a recent photo, and both with a signature. Acceptable forms of ID include a valid current driver’s license, passport, and military ID. A credit card is acceptable as a secondary form of ID. An expired driver’s license is not a valid ID. If your name has recently changed due to marriage, divorce, or other legal reasons, bring a copy of the marriage certificate or court document to the Prometric Center.

TAKE TO THE CLINICAL EXAMINATION SITE AND THE EXAM REGISTRATION � Two forms of identification, one with a signature and one with a recent photograph.

Acceptable forms of ID include a valid current driver’s license, passport, military ID, and employee ID. A credit card is acceptable as a secondary form of ID. An expired driver’s license is not a valid ID.

� Passport-size photo of your dental assistant and/or interpreter and completed Dental Assisting Form/Interpreter Form (if applicable).

� The assigned testing site, time, and 3-digit sequential number (available for printing from CITA online profile under the Apply tab).

� A ballpoint pen to be used on the Progress Forms only. � Two #2 lead pencils, small pair of scissors, and tape (to adhere assistant’s photo to the ID

badge). � All necessary materials, forms, and instruments. � Patient-based exam manual and/or Manikin-based manual. � Required documents. PATIENTS (Patient-based sections only) � Complete appropriate CITA forms for each patient before the exam. � Ensure that the patient meets the ADEX requirements as published in the Patient-Based Exam

Manual. � Bring all necessary radiographs to the testing site. � Review all the evaluation criteria that are in the clinical sections of the examination series. � Inform the patient that this exam is not a complete oral care treatment. � Ensure that a back-up patient(s) is/are available if needed