Sir, regarding Mr Raftery's letter,1 the British Association of Oral Surgeons (BAOS) share the author's concerns regarding provision of potentially substandard apicectomies and we agree that in an ideal world all these procedures should follow the national guidelines. The guidelines for this procedure by RCSEng (which our president, Professor Renton, was involved in writing) demonstrate the importance magnification and ultrasonic preparation have in achieving higher success rates. We are disappointed to learn some of Mr Raftery's local colleagues do not have access to the equipment required to comply with guidelines.

Periapical surgery appears on the specialist training curriculum of both oral surgery and endodontics and indeed, many of our oral surgery trainees undertake this training with guidance from both oral surgeons and endodontists in a hospital setting. We of course agree that in line with recommendations for commissioning of dentistry, the procedure should be completed in the most appropriate setting, by the professional with the required skill set and at best value for money.

Unfortunately, the reality is that many patients are not able to access routine RCT and trends in NHS dentistry demonstrate a reduction in complex treatments, such as root canal treatments (45% according to Health Committee Enquiry), and an increase in extractions, since the introduction of the contract in April 2006. As we're sure Mr Raftery agrees, we must work together to achieve the best possible outcomes for patients using the available evidence in the environment of the National Health Service and within the remit of both specialties. Hopefully, the future will provide access for all NHS patients to evolving endodontic therapies, thus reducing the need for RCT and subsequent periapical surgery and unnecessary extractions.