Magnification and improved illumination are advised.

Pre-op mouthrinse with 1%–1.5% hydrogen peroxide or 0.2% povidone-iodine for one minute.

Local anaesthesia as indicated – consider use of Articaine or Mepivicaine in cases of pulpitis

Isolation – Use of dental dam mandatory, ideally single tooth, and placed prior to access in such a way that the entire oral cavity is covered. Use of caulking cement to improve seal (Oraseal/Opaldam)

Decontamination of the operative field (both dental dam and tooth to be treated) with 3% NaOCl or 1.5% Hydrogen Peroxide

• If possible, limit AGPs to the start of the appointment to minimise fallow period.
• Removal of restorative material / access through enamel with high speed electric or turbinehandpiece, reduced coolant can be used.
• High volume aspiration (HVA) is mandatory.
• Removal of dentine to refine access cavity can be undertaken with slow speed handpiecewith minimal or no coolant required.
• Avoid use of 3 in 1 syringe, use of NaOCl in Monoject syringe to remove debris favourable.

• Initial coronal flare with Gates-Glidden burs or NiTi orifice shapers.
• Where the tooth has been root treated previously, Gates-Glidden burs and specificretreatment files may be used to remove existing root filling material, with or withoutsolvent.
• Assessment of working length with electronic apex locator.
• Completion of root canal preparation with preferred file system. Irrigation with 1%–5.25%NaOCl throughout chemo-mechanical preparation phase, with activated irrigation once mechanical preparation complete (avoid use of sonic or ultrasonic activation, manual dynamic GP pumping preferred).

• Dry pulp chamber using high volume aspiration and cotton wool pledget and canal using paper points.
• Place dressing material (preferably Ca(OH)2 into canals, place cotton wool / sterile sponge or PTFE into pulp chamber and hard wearing temporary restorative material (RMGIC / IRM).

0. Obturation – dry pulp chamber with cotton wool pledget, dry canals with paper points and use preferred obturation materials and technique of choice. Remove obturation material at orifice level and restore with permanent core restoration.