AMERICAN DENTAL EXAMINERS (ADEX)
CSCE OSCE Exam
Proctored Examination
Official Practice Exam -- 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE RECERTIFICATION
100 120 75% Required
TABLE OF CONTENTS
Section 1: Endodontics ...................................... Questions 1-20
Section 2: Operative Dentistry ........................... Questions 21-42
Section 3: Oral Diagnosis and Treatment Planning ... Questions 43-64
Section 4: Periodontics and Oral Surgery .............. Questions 65-84
Section 5: Prosthodontics, Ortho, and Pediatric ..... Questions 85-100
Answer Key ............................................................. Last Page
EXAM INSTRUCTIONS
This practice exam contains 100 multiple-choice questions divided into 5 sections. You have 120 minutes to
complete the exam. Select the single best answer for each question. A passing score of 75% (75 correct
answers) is required. Each question presents a clinical scenario followed by four answer options. The correct
answer and a detailed rationale are provided immediately after each question for self-assessment. Review all
rationales carefully, as they explain why the correct answer is right and why the most tempting wrong answer is
incorrect.
ADEX CSCE OSCE -- 2026/2027 | Passing Score: 75% | Page 1 of 53
,SECTION 1: Endodontics -- 2026/2027 (Q1-Q20)
Q1 Question 1 of 100
A 42-year-old male presents with spontaneous, lingering throbbing pain in tooth #9 that
worsens with hot stimuli and is not relieved by cold. Percussion testing elicits tenderness, and
the tooth does not respond to electric pulp testing. The periapical radiograph shows a widened
periodontal ligament space. What is the most likely pulpal diagnosis?
A. Reversible pulpitis with symptomatic apical periodontitis
B. Irreversible pulpitis with symptomatic apical periodontitis
C. Necrotic pulp with symptomatic apical periodontitis
D. Pulpal hyperemia with normal apical tissues
Correct Answer: C
Rationale:
The lack of response to EPT and lingering hot pain with tenderness to percussion indicate pulp necrosis
with symptomatic apical periodontitis. Irreversible pulpitis would still show some vital response to pulp
testing. Reversible pulpitis would have brief pain response, and pulpal hyperemia would show heightened
but not absent vitality.
Q2 Question 2 of 100
A 35-year-old female presents for endodontic treatment of tooth #30. During access
preparation, the clinician encounters a calcified canal that cannot be located with a #6 K-file.
The working length radiograph shows the file is short of the radiographic apex by 4 mm. What
is the most appropriate next step?
A. Continue aggressive instrumentation with larger files to force through the calcification
B. Place calcium hydroxide as an intracanal medicament and schedule a follow-up appointment
C. Refer the patient to an endodontist for management of the calcified canal
D. Perform an apicoectomy to bypass the calcification surgically
Correct Answer: C
Rationale:
When a canal cannot be located or negotiated beyond a calcification, referral to an endodontist with
specialized equipment such as microscopes and ultrasonic instruments is the standard of care. Aggressive
instrumentation risks perforation. Calcium hydroxide alone cannot resolve an untreated canal.
Apicoectomy is premature without first attempting conventional treatment.
ADEX CSCE OSCE -- 2026/2027 | Passing Score: 75% | Page 2 of 53
,Q3 Question 3 of 100
A 28-year-old male presents with a sinus tract adjacent to tooth #7. The tooth was traumatized
5 years ago and currently shows no response to pulp vitality testing. A periapical radiograph
reveals a well-circumscribed radiolucency at the apex. What is the most accurate diagnosis?
A. Horizontal root fracture with inflammatory response
B. Acute apical abscess with parulis formation
C. Condensing osteitis associated with pulp necrosis
D. Chronic alveolar abscess with sinus tract
Correct Answer: D
Rationale:
A sinus tract associated with a necrotic tooth and periapical radiolucency is diagnostic of a chronic apical
abscess, also called chronic alveolar abscess with sinus tract. An acute abscess would present with
swelling, pain, and no sinus tract. Condensing osteitis shows increased radiopacity, not radiolucency. No
fracture is described in the clinical findings.
Q4 Question 4 of 100
During endodontic treatment of tooth #14, the clinician determines the working length using an
electronic apex locator that reads 0.5 mm short of the apex. The file is then positioned at this
length and a working length radiograph is taken. The radiograph shows the file tip extending 1
mm beyond the radiographic apex. What is the most likely explanation for this discrepancy?
A. The apex locator is malfunctioning and should be recalibrated
B. There is a perforation on the distal aspect of the root
C. The radiograph is angled incorrectly causing parallax error
D. The canal has an apical constriction that is coronal to the radiographic apex
Correct Answer: D
Rationale:
The apical constriction, which is the narrowest portion of the canal, is typically located 0.5 to 1.0 mm
coronal to the radiographic apex. The apex locator reads to the constriction while the radiograph shows
the anatomical apex, explaining the discrepancy. This is a normal finding, not a malfunction. Perforation
would show a different pattern entirely.
ADEX CSCE OSCE -- 2026/2027 | Passing Score: 75% | Page 3 of 53
, Q5 Question 5 of 100
A 50-year-old female underwent root canal treatment on tooth #5 six months ago. She now
presents with persistent discomfort and a new periapical radiolucency that was not present on
the post-operative radiograph. The coronal restoration is intact. What is the most likely cause
of the failure?
A. Coronal leakage through the existing restoration
B. Foreign body reaction to the obturation material
C. Vertical root fracture of the mesial root
D. Missed canal with untreated bacterial contamination
Correct Answer: D
Rationale:
A new radiolucency developing after treatment with an intact coronal restoration most commonly indicates
a missed canal harboring bacteria, especially in maxillary premolars which frequently have a second
canal. Coronal leakage is less likely with an intact restoration. Vertical root fracture typically shows a
J-shaped radiolucency and more severe symptoms. Foreign body reactions to gutta-percha are extremely
rare.
Q6 Question 6 of 100
A 38-year-old male presents with a large periapical lesion measuring 12 mm in diameter
associated with tooth #8, which tested necrotic. After completing root canal treatment, what is
the most appropriate recall interval to assess healing before considering surgical intervention?
A. 3 months, as most periapical lesions show initial healing by this time
B. Immediately proceed to apical surgery to prevent further bone loss
C. 2 years, as complete healing of large lesions requires extended observation
D. 6 months to 1 year, as significant healing typically occurs within this timeframe
Correct Answer: D
Rationale:
The recommended recall period to assess periapical healing is 6 to 12 months, as most lesions will show
evidence of healing or reduction in size within this timeframe. Three months is too early to evaluate
meaningful healing of a large lesion. Two years is unnecessarily long before reassessment. Surgery
should only be considered after an adequate observation period demonstrates lack of healing.
ADEX CSCE OSCE -- 2026/2027 | Passing Score: 75% | Page 4 of 53
CSCE OSCE Exam
Proctored Examination
Official Practice Exam -- 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE RECERTIFICATION
100 120 75% Required
TABLE OF CONTENTS
Section 1: Endodontics ...................................... Questions 1-20
Section 2: Operative Dentistry ........................... Questions 21-42
Section 3: Oral Diagnosis and Treatment Planning ... Questions 43-64
Section 4: Periodontics and Oral Surgery .............. Questions 65-84
Section 5: Prosthodontics, Ortho, and Pediatric ..... Questions 85-100
Answer Key ............................................................. Last Page
EXAM INSTRUCTIONS
This practice exam contains 100 multiple-choice questions divided into 5 sections. You have 120 minutes to
complete the exam. Select the single best answer for each question. A passing score of 75% (75 correct
answers) is required. Each question presents a clinical scenario followed by four answer options. The correct
answer and a detailed rationale are provided immediately after each question for self-assessment. Review all
rationales carefully, as they explain why the correct answer is right and why the most tempting wrong answer is
incorrect.
ADEX CSCE OSCE -- 2026/2027 | Passing Score: 75% | Page 1 of 53
,SECTION 1: Endodontics -- 2026/2027 (Q1-Q20)
Q1 Question 1 of 100
A 42-year-old male presents with spontaneous, lingering throbbing pain in tooth #9 that
worsens with hot stimuli and is not relieved by cold. Percussion testing elicits tenderness, and
the tooth does not respond to electric pulp testing. The periapical radiograph shows a widened
periodontal ligament space. What is the most likely pulpal diagnosis?
A. Reversible pulpitis with symptomatic apical periodontitis
B. Irreversible pulpitis with symptomatic apical periodontitis
C. Necrotic pulp with symptomatic apical periodontitis
D. Pulpal hyperemia with normal apical tissues
Correct Answer: C
Rationale:
The lack of response to EPT and lingering hot pain with tenderness to percussion indicate pulp necrosis
with symptomatic apical periodontitis. Irreversible pulpitis would still show some vital response to pulp
testing. Reversible pulpitis would have brief pain response, and pulpal hyperemia would show heightened
but not absent vitality.
Q2 Question 2 of 100
A 35-year-old female presents for endodontic treatment of tooth #30. During access
preparation, the clinician encounters a calcified canal that cannot be located with a #6 K-file.
The working length radiograph shows the file is short of the radiographic apex by 4 mm. What
is the most appropriate next step?
A. Continue aggressive instrumentation with larger files to force through the calcification
B. Place calcium hydroxide as an intracanal medicament and schedule a follow-up appointment
C. Refer the patient to an endodontist for management of the calcified canal
D. Perform an apicoectomy to bypass the calcification surgically
Correct Answer: C
Rationale:
When a canal cannot be located or negotiated beyond a calcification, referral to an endodontist with
specialized equipment such as microscopes and ultrasonic instruments is the standard of care. Aggressive
instrumentation risks perforation. Calcium hydroxide alone cannot resolve an untreated canal.
Apicoectomy is premature without first attempting conventional treatment.
ADEX CSCE OSCE -- 2026/2027 | Passing Score: 75% | Page 2 of 53
,Q3 Question 3 of 100
A 28-year-old male presents with a sinus tract adjacent to tooth #7. The tooth was traumatized
5 years ago and currently shows no response to pulp vitality testing. A periapical radiograph
reveals a well-circumscribed radiolucency at the apex. What is the most accurate diagnosis?
A. Horizontal root fracture with inflammatory response
B. Acute apical abscess with parulis formation
C. Condensing osteitis associated with pulp necrosis
D. Chronic alveolar abscess with sinus tract
Correct Answer: D
Rationale:
A sinus tract associated with a necrotic tooth and periapical radiolucency is diagnostic of a chronic apical
abscess, also called chronic alveolar abscess with sinus tract. An acute abscess would present with
swelling, pain, and no sinus tract. Condensing osteitis shows increased radiopacity, not radiolucency. No
fracture is described in the clinical findings.
Q4 Question 4 of 100
During endodontic treatment of tooth #14, the clinician determines the working length using an
electronic apex locator that reads 0.5 mm short of the apex. The file is then positioned at this
length and a working length radiograph is taken. The radiograph shows the file tip extending 1
mm beyond the radiographic apex. What is the most likely explanation for this discrepancy?
A. The apex locator is malfunctioning and should be recalibrated
B. There is a perforation on the distal aspect of the root
C. The radiograph is angled incorrectly causing parallax error
D. The canal has an apical constriction that is coronal to the radiographic apex
Correct Answer: D
Rationale:
The apical constriction, which is the narrowest portion of the canal, is typically located 0.5 to 1.0 mm
coronal to the radiographic apex. The apex locator reads to the constriction while the radiograph shows
the anatomical apex, explaining the discrepancy. This is a normal finding, not a malfunction. Perforation
would show a different pattern entirely.
ADEX CSCE OSCE -- 2026/2027 | Passing Score: 75% | Page 3 of 53
, Q5 Question 5 of 100
A 50-year-old female underwent root canal treatment on tooth #5 six months ago. She now
presents with persistent discomfort and a new periapical radiolucency that was not present on
the post-operative radiograph. The coronal restoration is intact. What is the most likely cause
of the failure?
A. Coronal leakage through the existing restoration
B. Foreign body reaction to the obturation material
C. Vertical root fracture of the mesial root
D. Missed canal with untreated bacterial contamination
Correct Answer: D
Rationale:
A new radiolucency developing after treatment with an intact coronal restoration most commonly indicates
a missed canal harboring bacteria, especially in maxillary premolars which frequently have a second
canal. Coronal leakage is less likely with an intact restoration. Vertical root fracture typically shows a
J-shaped radiolucency and more severe symptoms. Foreign body reactions to gutta-percha are extremely
rare.
Q6 Question 6 of 100
A 38-year-old male presents with a large periapical lesion measuring 12 mm in diameter
associated with tooth #8, which tested necrotic. After completing root canal treatment, what is
the most appropriate recall interval to assess healing before considering surgical intervention?
A. 3 months, as most periapical lesions show initial healing by this time
B. Immediately proceed to apical surgery to prevent further bone loss
C. 2 years, as complete healing of large lesions requires extended observation
D. 6 months to 1 year, as significant healing typically occurs within this timeframe
Correct Answer: D
Rationale:
The recommended recall period to assess periapical healing is 6 to 12 months, as most lesions will show
evidence of healing or reduction in size within this timeframe. Three months is too early to evaluate
meaningful healing of a large lesion. Two years is unnecessarily long before reassessment. Surgery
should only be considered after an adequate observation period demonstrates lack of healing.
ADEX CSCE OSCE -- 2026/2027 | Passing Score: 75% | Page 4 of 53
