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Vital pulp therapies (VPTs) aim to preserve the vitality of the pulp. The European Society of Endodontology have begun a campaign to raise awareness on the efficacy of VPTs following on from the publication of their 2019 position statement, aimed at both specialists and general dental practitioners. This review examines the current evidence surrounding VPTs and provides a rational approach to the management of the exposed pulp with the aid of case studies. Success lies in accurate diagnosis and case selection, along with well-executed treatment and appropriate follow-up protocols. The introduction of calcium silicate cements has made these treatments more predictable.

This is the first article in a series reviewing the current literature surrounding the management of deep caries in permanent teeth. Approaches to caries management are continuing to evolve, with more conservative management increasingly favoured. This philosophy has never been more important than in managing the deep carious lesion. Evidence is emerging that the use of selective caries removal to reduce the risk of pulp exposure, in conjunction with calcium silicate cements, can be successful in maintaining pulp vitality, delaying the restorative cycle and prolonging the lifespan of the tooth.

Aim To investigate the consistency of commissioning and provision of enhanced NHS endodontic services across England. Methods The level of provision for enhanced endodontic services was sought using two methods. An electronic questionnaire was distributed to each of the thirteen director of commissioning operations (DCO) teams in NHS England to determine the perception from commissioners of what endodontic services are currently provided and commissioned. A systematic search to assess what is advertised by enhanced endodontic providers was also carried out to cross-reference with the information gained from electronic questionnaires. Results A 77% response rate to the questionnaire was achieved. Eight out of the ten DCO teams that replied provided enhanced NHS endodontics to a greater or lesser extent, one did not and one was unsure. Three teams did not respond. Providers of services included dentists with enhanced skills, endodontic specialists, and dentists working within district or dental hospitals. Five out of ten DCO teams commissioned level two services and six commissioned level three services. Dental hospital acceptance criteria for enhanced endodontics differ regionally, but most accept level three and some level two complexity treatments, depending upon capacity at the time. Conclusions This investigation demonstrates that although the majority of NHS commissioning areas within England provide enhanced endodontic services, these are not the same across the country. Therefore, patients are not getting equal access to services and it may vary depending upon location.

Surgical extrusion is a recognised treatment option for teeth that have insufficient coronal tooth structure remaining due to deep caries, resorption or traumatic injury. However, the technique has not been widely adopted, arguably because extraction of a severely compromised tooth may be difficult to achieve in a gentle and predictable way. In this paper, we present our novel approach to surgical extrusion and subsequent management of teeth using a vertical extraction system (Benex), which has become the method of choice in the authors' practice for many teeth that would otherwise be deemed unrestorable. We describe the clinical procedure in detail and discuss the advantages and disadvantages compared to alternative approaches, including surgical crown lengthening and orthodontic extrusion.

Aims To investigate current trends in endodontic irrigation amongst general dental practitioners (GDPs) and dental schools within UK and Ireland. Secondly, to evaluate if significant differences exist between the irrigant practices of National Health Service (NHS) and private GDPs.Methodology In 2019, an online questionnaire was distributed to the 18 dental schools within the UK and Ireland and 8,568 GDPs. These surveys explored current trends in teaching and usage of endodontic irrigants. Chi-squared tests were performed to make comparisons between NHS and private GDPs (α0.01).Results All 18 dental schools (100%) and 495 GDPs (6%) returned valid questionnaires. Three hundred and thirty (66.7%) practitioners were NHS and 165 (33.3%) were private. There was strong consensus on irrigation teaching amongst dental schools. These results aligned with GDP responses in terms of irrigant selection (sodium hypochlorite [NaOCl]); NaOCl concentration (≤3%); ethylenediaminetetraacetic acid (EDTA) contact time (0-5 minutes); final rinse protocols (penultimate EDTA rinse); irrigant temperature (room); and agitation techniques (manual dynamic activation;0-60 seconds). There was, however, considerable variation in NaOCl contact time and GDPs infrequently used chelating agents or agitation techniques. Compared with private practitioners, NHS GDPs used significantly lower NaOCl contact times and concentrations, less EDTA and activation techniques, and more chlorhexidine (P0.01).Conclusions Overall, irrigation teaching within the UK and Ireland is consistent and evidence-based. Furthermore, trends in irrigant usage amongst UK GDPs are now more aligned with these teaching practices. Significant differences were, however, observed between NHS and private practitioners.

Each stage of root canal treatment should be carried out to the highest possible standard. The access cavity is arguably the most important technical stage, as subsequent preparation of the root canal(s) can be severely comprised if this is not well executed. Inadequate access can lead to canals being left untreated, poorly disinfected, difficult to shape and obturate, and may ultimately lead to the failure of the treatment. This paper highlights common features in root canal anatomy and outlines basic principles for locating root canals and producing a good access cavity. It also explores each phase of the preparation in detail and offers suggestions of instruments that have been specifically designed to overcome potential difficulties in the process. Good access design and preparation will result in an operative environment which will facilitate cleaning, shaping and obturation of the root canal system in order to maximise success.

Posterior composite resin restorations are an established feature of contemporary dental practice and all new dental graduates should be competent in providing such treatments for their patients. Surveys of educational curricula in this area in the United Kingdom and Ireland, as well as North America, have demonstrated variations both within and between dental schools. Such inconsistency does not help new dental school graduates, and may lead to confusion. At the British Association of Teachers of Conservative Dentistry Annual Conference held in Birmingham in September 2005, a session was devoted to the development of guidelines for dental schools on teaching posterior composite resin restorations to dental undergraduates. The theme of the conference concerned the teaching implications for changing from amalgam to composite. Two of the principal speakers at the meeting (Joost Roeters and Niek Opdam) were from the dental school at the University of Nijmegen in the Netherlands. This school was the first in Europe to discontinue the use of dental amalgam in its undergraduate curriculum over a decade ago. This paper reports the consensus views of those present on guidelines for teaching posterior composite resin restorations to dental undergraduate students.

This article will provide an overview of the rationale behind taking a contemporary approach to obturation of the root canal system. It will outline a broad range of obturation materials including those traditionally used and newer, advanced ones that are now available that have active physical and biological properties. Obturation techniques will be described in detail, including advice for those difficult cases such as managing obturation of a canal with a wide open apex. Assessment of obturation will also be discussed, considering those factors which affect outcome of root canal treatment.