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

 Principles for restoration of youthful eyes

• Control of periorbital aesthetics by proper brow positioning, corrugator muscle removal, and lid fold invagination when beneficial. • Restoration of tone and position of the lateral canthus and, along with it, restoration of a youthful and attractive intercanthal axis tilt. • Restoration of the tone and posture of the lower lids. • Preservation of maximal lid skin and muscle (so essential to lid function and aesthetics) as well as orbital fat. • Lifting of the midface through reinforced canthopexy, preferably enhanced by composite malar advancement. • Correction of suborbital malar grooves with tear trough (or suborbital malar) implants, obliterating the deforming tear trough (bony) depressions that angle down diagonally across the cheek, which begin below the inner canthus. • Control of orbital fat by septal restraint or quantity reduction. • Removal of only that tissue (skin, muscle, fat) that is truly excessive on the upper and lower lids, sometimes resorting to unconventional excision patterns. • Modification of skin to remove prominent wrinkling and excision of small growths and blemishes

Healing of the Extraction Site

1. Day 1 – Clot formation
2. Day 2-7 – Granulation tissue fills socket
3. Day 4-20 – Connective tissue replaces granulation tissue; spindle cells, collagen fibers, and early vascularity is seen
4. Day 7 – Bone formation begins with uncalcified spicules and osteoid at the socket base and periphery
5. Day 20 – Mineralization begins
6. Day 40 – two-thirds socket filled with immature bone, lamina dura becomes lost
7. Day 50-90 – Bone matures into trabecular pattern resembling alveolus
8. Day 100 – Socket density comparable to surrounding bone, minimal residual osteogenic activity

                                                                                                                                   (Admin)

 Management of frontal sinus fractures