The 22-year-old male patient had a history of trauma to his maxillary incisors and arrived at my practice with symptoms related to tooth #21. The tooth, opened in an emergency by the patient’s mother, was tender when prodded, with a moderate level of sensitivity on the respective buccal gingiva. Sensitivity tests were negative for the other central incisor (tooth #12 was positive), and a periapical radiograph showed radiolucency in the periapical areas of both of the central incisors. The apices of these teeth were quite wide and the length of teeth appeared to exceed 25 mm.

My treatment plan was as follows: root canal therapy with two apical plugs with a calcium silicate-based bioactive cement. The patient provided his consent for the treatment of the affected tooth and asked to have the other treated in a subsequent visit.

After isolating with a rubber dam, I removed the temporary filling, and then the entire pulp chamber roof with a low-speed round drill. The working length was immediately evaluated using an electronic apex locator and a 31 mm K-type file. The working length was determined to be 28 mm.

As can be seen in the photographs, the canal was actually quite wide, so I decided to only use an irrigating solution and not a shaping instrument. Root canals are usually shaped so that there will be enough space for proper irrigation and a proper shape for obturation. This usually means giving these canals a tapered shape to ensure good control when obturating. With open apices, a conical shape is not needed, and often there is enough space for placing the irrigating solution deep and close to the apex.

I decided to use only some syringes containing 5 per cent sodium hypochlorite and EDDY, a sonic tip produced by VDW, for delivery of the cleaning solution and to promote turbulence in the endodontic space and shear stress on the canal walls in order to remove the necrotic tissue faster and more effectively. After a rinse with sodium hypochlorite, the sonic tip was moved to and from the working length of the canal for 30 seconds. This procedure was repeated until the sodium hypochlorite seemed to become ineffective, was clear and had no bubbles. I did not use EDTA, as no debris or smear layer was produced.

I suctioned the sodium hypochlorite, checked the working length with a paper point and then obturated the canal with a of 3 mm in thickness plug of bioactive cement. I then took a radiograph before obturating the rest of the canal with warm gutta-percha. I used a compomer as a temporary filling material.

The symptoms resolved, so I conducted the second treatment only after some months, when the tooth #11 became tender. Tooth #21 had healed. I performed the same procedure and obtained the same outcome (the four-month follow-up radiograph showed healing).

Editorial note: A complete list of references are available from the publisher. This article was published in roots - international magazine of endodontology No. 04/2017.

When selecting locations for the new schools, priority was given to rural and coastal areas. The University of East Anglia in Norwich and the University of Portsmouth were selected, each receiving 25 dental training places from 2027. This expansion means that, from next year, all NHS England regions will have a dental school.

In a government press release, Minister of State for Care Stephen Kinnock commented: “By bringing dental school places to [the University of East Anglia] and the University of Portsmouth for the first time, trainee dentists will put down roots in parts of the country that have for too long been left behind.”

University representatives have welcomed the government’s decision. “The South East has needed its own dental school for decades and today that ambition becomes a reality. We are ready to train the next generation of dental professionals right here in Portsmouth—professionals who will stay in the region and help end the dental desert,” said Prof. Graham Galbraith, CBE, vice-chancellor of the University of Portsmouth.

Prof. David Maguire, vice-chancellor of the University of East Anglia, said the university was pleased to support the expansion of dental training to improve oral health. “We have been working on this for several years and look forward to starting our new course in 2027,” he emphasised.

The new training places are part of an ongoing effort to rebuild NHS dentistry. Recent measures by the government include expanding capacity for professional registration examinations for overseas-trained dentists and prioritising highest-need patients.

Measures cannot substitute for fundamental NHS reform

In response to the government’s announcement, the BDA has said in a press release that the new dental training places alone “stand little chance of easing chronic workforce problems or enhancing patient access to NHS dental care without comprehensive reform”. According to the BDA, experience has shown that new schools do not have a significant local impact.

“New dental schools are a step forward but are no silver bullet for ending dental deserts,” warned Dr Eddie Crouch, BDA chair. “Keeping even this tiny number of new graduates in the NHS hinges on making the service a place dentists would choose to build a career. That means real reform, wedded to sustainable funding,” he explained.

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