GENERAL RISKS ASSOCIATED WITH ENDODONTIC TREATMENTS
I understand that every dental procedure, including endodontic treatment, involves risks that may occur even when proper professional practices are followed and quality materials are used. These risks include, but are not limited to:
Postoperative pain or discomfort: Sensitivity when biting, gum discomfort, or moderate pain may commonly occur during the days following treatment.
Persistent or recurrent infection: Due to complex anatomy or severe infection, pain or swelling may occur, and retreatment, drainage, or even extraction of the tooth may be necessary.
Tooth fracture: Teeth that have undergone endodontic treatment may become weakened and fracture, particularly if a definitive restoration (crown or inlay/onlay) is not completed.
Perforations or anatomical complications: Roots may have curvatures or anatomical variations that make the procedure more difficult. Perforation of the tooth or root canal may occur.
Separation of endodontic instruments: Even when proper techniques are used, an instrument may fracture inside the root canal due to the anatomy of the tooth or the characteristics of the canal.
Internal or external resorption: Pre-existing conditions or conditions associated with trauma may affect the prognosis of the treatment.
Reactions to medications or anesthetics: These may include allergies or drug interactions. Women who use oral contraceptives should be aware that certain antibiotics may reduce their effectiveness, and alternative contraceptive methods should be used during treatment.
Need for additional treatment: Additional procedures such as retreatment, apical surgery (apicoectomy), or extraction may be necessary if the tooth does not respond adequately.
PAYMENT FOR TREATMENT THAT HAS BEEN STARTED BUT CANNOT BE COMPLETED
I agree that if the endodontic treatment must be discontinued after it has begun for reasons beyond the clinic's control—including inability to achieve adequate anesthesia after several attempts, extreme anxiety, undisclosed medical conditions, unexpected reactions, or inability to visualize or gain access to the root canal(s) due to conditions specific to the tooth or patient—I will be responsible for payment equivalent to 50% of the total treatment cost. This amount corresponds to anesthesia, disposable materials, access preparation, clinical time, and the procedures performed up to the time treatment is discontinued.
PATIENT'S OBLIGATION TO ATTEND FOLLOW-UP APPOINTMENTS AND/OR POSTOPERATIVE RESTORATIONS
I understand and agree that my recovery and the success of the treatment depend not only on the procedure performed but also on proper follow-up care, and that it is my responsibility to attend the appointments indicated by the treating professional.
I understand that failure to attend these follow-up appointments significantly increases the risk of treatment failure and may affect the final outcome without liability to the clinic or the treating professional.
DECLARATION FOR PATIENTS WITH HYPERTENSION, DIABETES AND/OR ASPIRIN USE
I declare the following:
If I have hypertension , I confirm that I have obtained authorization from my physician to undergo the procedure and that I have taken my antihypertensive medication as normally prescribed on the day of the procedure.
If I have diabetes , I confirm that my condition is under control , that I have the approval of my treating physician , and that I have taken my usual medication according to my medical instructions on the day of the procedure.
If I regularly take aspirin (acetylsalicylic acid) or any other medication that affects blood clotting, I declare that I have discontinued its use at least three (3) days before the procedure , as recommended by my physician, in order to reduce the risk of bleeding.
I declare that I have accurately disclosed my medical conditions and the medications I take, understanding that failure to provide this information may result in complications during or after the procedure.
SPECIFIC CONSIDERATIONS REGARDING THE PROGNOSIS OF ENDODONTIC TREATMENT
I have been informed that the success of endodontic treatment depends on both clinical and biological factors specific to each patient.
I understand that:
There is no absolute guarantee of success in every case.
Individual biological response, the extent of infection, tooth anatomy, and the pre-existing condition of the tooth may affect the outcome.
Treatment failure or the need for retreatment does not necessarily constitute a clinical or material-related error.
The costs of any additional treatments, if required, shall be the responsibility of the patient.
MANDATORY RESTORATION FOLLOWING ENDODONTIC TREATMENT
I have been informed that endodontic treatment does not conclude with the cleaning, preparation, and filling of the root canal. The endodontic treatment is considered complete only after the definitive restoration recommended by the treating dentist has been performed. This restoration may consist of:
I understand and agree that I must complete the final restoration within a maximum period of ten (10) days following the endodontic treatment.
I understand that delaying the definitive restoration may allow contamination of the treated root canal, compromising the outcome of the procedure and potentially resulting in infection, tooth fracture, or loss of the tooth.
CONSENT
I declare that: I have received sufficient information regarding the procedure, its risks, alternatives, and postoperative care.
I have had the opportunity to ask questions and have received satisfactory answers.
I understand that there are no absolute guarantees and that treatment outcomes depend on clinical and biological factors.
I accept my responsibility to attend all required follow-up appointments.
I voluntarily authorize the performance of the endodontic treatment.
