The paper overviews recent and past studies of preconditioning, generation and spreading of North Adriatic Dense Water (NAdDW), by analysing both transient episodes and climatological data. The importance of wind stress, heat and water fluxes, and particularly river discharges during the preconditioning and generative period is emphasized, as well as the advection of saline levantine intermediate water from the southeast. After the generation, NAdDW affects deep and bottom layers of the middle and south Adriatic Sea, flowing as a dense current and mixing with the adjacent waters; it can be traced even in the Otranto Strait, contributing to the formation of deep water in the Eastern Mediterranean. Objective shortcomings and the projections in NAdDW investigations are also discussed, due to their high importance in the circulation of the Adriatic Sea, which may relate other similar basins around the world.