Endodontic retreatment involves but is not limited to, the removal and treatment of the affected/infected root canal material. Complications from endodontic retreatment may include pain that comes and goes and swelling which may require medication(s). Endodontic retreatment may be the only possible treatment option to save your natural tooth. Other treatment choices may include no treatment or tooth extraction.
Depending on my diagnosis, there may be alternatives to root canal treatment that involve other types of dental care. I understand the most common alternatives to root canal treatment are:
Endodontic Re-Treatment Risks:
By signing below, I acknowledge that I have read and understand the recommended treatment, the risks of such treatment, and the alternatives including doing nothing. I have had the chance to have all of my questions answered. I understand that success is not guaranteed. I give my full consent to the treating Dentist to perform this re-root canal procedure for me.
I acknowledge that I have provided an accurate medical history, and will follow treatment recommendations as well as post-procedural instructions.
My treatment options have been explained to me as well as the indications and possible complications of endodontic retreatment and I offer my consent for treatment. Regardless of the outcome, once treatment is initiated the full fee has been incurred whether the case is completed or not due to whatever circumstances of the tooth. The Doctor will use his/her best skill and judgment to try to save the tooth but the outcome cannot be guaranteed.
Before treatment is initiated, be certain to have the doctor answer any questions you may have. All signatures must be by a parent or guardian if the patient is under the age of 18.
Tooth Number:
Alternatives to the above treatment