Following your recent referral for Endodontic treatment, and review of the available information, my advice for treatment is as follows.  An estimate details the sequence of treatment and the requisite appointments to ensure a successful outcome. Based on the available information, I expect to be able to complete your treatment in 1 appointment spanning approximately 2 hours. Should I however require more time, an additional appointment may be arranged. Our treatment will only focus on the root canal treatment and stabilizing the tooth with a permanent filling. The final restoration being a post, core and crown, should be completed within 6 months after a successful outcome of the endodontic procedure. A separate quote will be provided at this time.

General information regarding endodontic treatment and its associated risk factors:

Root canal treatment is performed when a tooth has an existing infection such as an abscess, acute pain, damage to the nerve chamber, etc. The aim of a root canal treatment is to remove any dead or infected tissue inside the tiny root canal system inside the tooth roots and to then seal this in order to avoid future infection.

Due to the macroscopic structure of the roots of the tooth and the limitations associated with 2-dimensional radiography in visualizing all aspects of the topography of the root structure, I recommend the need for a CBCT (cone beam computer tomography = 3D xray). This however has additional financial constraints.

To limit post-treatment discomfort, it is advisable to take anti-inflammatory medication such as Myprodol (2 tablets 1hr pre-op) prior to treatment. Following the treatment, it is normal to have some pain and discomfort for 1-2 weeks. This should also me managed with anti-inflammatories such as Myprodol.

Due to the extreme technical demands of working in a microscopic environment, complications may occur.

The most common complications include:

1. Re-occurrence of infection due to the possibility of bacterial and/or organic remnants around the root tip, presence of lateral or accessory canals, complicated macro and micro-anatomy of the root canal system: this can usually be treated by re-doing the root canal treatment or by a surgical procedure called an apicectomy.
2. Filling the root canal too short or too long: depending on the exact clinical circumstances at the time, this can be acceptable, or may require further treatment.
3. Instrument separation inside the root canal: most of the instruments used are very fine metal instruments. Due to various factors, metal fatigue can lead to separation or fracture of an instrument. In most instances it is completely safe to leave this in place. If it can however be safely removed, this will be done by referring you to a specialist endodontist who specializes in broken instrument removal. The costs associated with this procedure will be borne by the patient. If not and a decision is made to leave it in place, regular follow ups will be done to confirm proper healing. In some instances, a minor surgical procedure might be indicated to correct this.
4. Perforation of the root system: this means an opening formed between the root canal and the surrounding tissues outside the root. This can sometimes be successfully sealed with no problems, but can sometimes again lead to the loss of the tooth.
5. The root canal system is sterilized with different chemical solutions to neutralize any microorganisms. The most common liquid used for this is Sodium-Hypochlorite, commonly known as household bleach. The reason for using this is that it is the only fluid known to kill all known bacteria and other microorganisms. Because it is a material that can lead to irritation of other tissues should it come in contact with it, a specialized suction system is used to safely rinse out the inside of the root canal system and suction out all of the liquid at the same time.

Due to the nature of the treatment, it is normal for a root treated tooth to be tender for at least a week following treatment and to possibly stay tender to pressure for a while afterwards. Sometimes an underlying infection can flair up and may need treatment with antibiotics.

If properly restored, preferably with a crown, the long-term prognosis of root canal treated teeth are very good.

Expected costs

A word about fees: Endodontic treatment requires highly specialized equipment, instruments, materials and more especially prolonged treatment times. It is therefore a costly service to provide. Taking this into account, we try to keep our fees as reasonable as possible while providing highly specialized care. The quoted fees are therefore based on the costs of providing such a service and also include 15% VAT. Medical Aid rebates usually offset some of the costs for the more expensive procedures, but restrictive fund rules often preclude payment for required treatment. As a result, many people find these funds inadequate when it comes to this type of treatment. This is unfortunately out of our control.

The estimate of root canal treatment typically includes:

1. Infection control
2. Sterilized instruments
3. Local anaesthetic
4. Rubberdam
5. Use loupes or microscope
6. Periapical radiographs
7. CBCT
8. Root canal treatment first canal
9. Root canal treatment each Additional canal
10. Core build up
11. Cost of Endodontic instruments
12. Use of Waterlase Dental Laser 13. Composite Filling

Medical Aid codes

Medical Aid code	Description	Medical Aid Fee
8332          1st  visit	Debride Single canal tooth /visit	151.70
8333          1st  visit	Debride Multi-canal tooth  /visit	212.10
8334	Re-prep- previous RCT	224.20
8335          2nd visit	Obturate 1st canal Anteriors & Premolars	689.10
8336          2nd visit	Debride 1st canal Molars	948.20
8337          2nd visit	Debride /additional  canal Molars	281.70
8338           One visit	Debride & Obturate 1st canal Anteriors & Premolars	1054.20
8339           One visit	Debride & Obturate 1st canal Molars	1448.60
8340           One visit	Debride & Obturate /additional canal Molars	352.10
8132	Emergency RCT	R 267.80
8194	Sectional           ICD 10 Code: Z01.2
8196	mandible
8199	maxilla
8200	Maxilla & Mandible

Important

Whilst every precaution is taken to avoid any complications associated with any treatment, it is important to accept and understand that these do sometimes occur and will be managed accordingly.

Additionally, where clinical circumstances dictate a change to the planned treatment, this will be discussed prior to proceeding. Where unforeseen additional treatment is necessary, this will be discussed and additional costs may apply.

Payment

Payment for the balance of treatment is due at the end of each appointment for that specific appointment. This can be done by means of cash, credit or debit card. Should you wish to pay via EFT, this must be done before the appointment.

Please arrange the appointments as set out above with the reception staff as a sequence to commence as soon as possible. You can send this letter and estimate to your medical aid before you decide to go ahead with your treatment.  Our accounts and estimates are not submitted to your medical aid.  You are solely responsible for any claims to your medical aid. Also make sure that if you submit to your medical aid that they reimburse you and not us.

Please note

Our fee structure is based on guidelines from the South African Dental Association and reflect the cost of providing the service to the highest possible standard. Our fees do not correlate with the recommended fees of the HPCSA and the Medical Aids as these are based on outdated data and do not take into account the costs of running a dental practice. It is therefore important that you confirm with your medical aid how much of the quoted fees they will cover. As there are numerous medical aid schemes with different rules and fee structures, it is not possible for us to do this.

Maintenance

Your general oral health should be checked every 6 months by your normal dentist. In addition to this, where appropriate follow up appointments will be arranged with us to evaluate the healing of the tooth/teeth worked on.

Cancellations

Appointments that are cancelled with less than 24 hours’ notice or missed altogether, will be charged at R1200 for each half an hour to cover surgery expenses Should you have any questions, please do not hesitate to contact the practice in this regard. Also, please return a signed copy of the consent form prior to your first appointment.