Informed consent elements before root end surgery

INDICATIONS
•           Periapical cyst / granulomata (occurring as result of necrotic pulp due to trauma / dental carries)
•           Failure of orthograde root canal treatment
            Inaccessible apical third of the root
            Post / crown, tooth at risk of fracture with removal
•           Undiagnosed pathology around apex of tooth root filled / not root filled requiring biopsy

RATIONALE
•           Removal of tissue / cyst / pathological tissue, around apex of tooth
•           Amputation of root apex and placement of apical seal to prevent further infection
•           Pain relief

METHOD
•           Local or General Anaesthetic
•           Incise around neck of affected tooth with one or two vertical incisions diverging   into buccal sulcus
•           Reflect muco-periosteal flap to expose bone over apical third of root
•           Use rose head burr to expose root
•           Use fine rose head burr to divide apical third of root cutting flush with alveolar bone, bevelled to allow retrograde access to root canal.
•           Application of retrograde root filling
•           Irrigation and closure of flap (absorbable sutures)

BENEFITS AND ANTICIPATED OUTCOME OF PROCEDURE
•           Resolution of dental infection
•           Diagnosis of pathological lesions
•           Pain relief
•           Preservation of tooth
•           Restoration of normal function / form

RISKS / COMPLICATIONS ASSOCIATED WITH TREATMENT
•           Pain
•           Swelling
•           Bleeding
•           Failure of procedure with recurrent infection. 5-10% for anterior teeth. The risk of failure increases with multiple root teeth
•           Loosening / loss affected tooth
•           Damage / exposure of roots of neighboring teeth
•           Upper teeth: entry into maxillary antrum

ALTERNATIVES TO TREATMENT
•           No treatment
CONSEQUENCES OF PROPOSED TREATMENT

•           Removal of infection / source of infection
•           Diagnosis of disease – undiagnosed pathology
•           Pain relief
•           Retention of affected teeth
•           Return to normal function / form

CONSEQUENCES OF NOT ACCEPTING PROPOSED TREATMENT
•           Dental extraction

EXTRA ISSUES THAT PATIENTS MAY RAISE
•           GA: the procedure is usually undertaken as day case surgery, the patient being discharged the same day
•           Antibiotics, analgesia
•           Advice regarding oral hygiene/ mouthwash
•           Advice regarding time off education / employment
•           Healing in 7 - 10 days
•           No follow up appointment unless histology review required

ADVICE LEAFLET
•           Apical bone cyst