NHS NW London Planned Procedures with a Threshold Policy. Version 2.1 (April 2012) Is this the latest version? Check here: http://www.northwestlondon.nhs.uk

It is recognised that non-surgical root canal treatment is the treatment of choice is most cases, however the Faculty of Dental Surgery guidance states that apicectomy is indicated in the conditions listed below. Current available evidence suggests that the success rate of apicectomy on molar teeth in acute providers is low, therefore NWL will only fund an Apicectomy on anterior teeth in the following conditions; (on an individual basis) Conditions indicating apicectomy:  Presence of adequate orthograde root canal treatment on clinical and radiographic examination And one of the following;  Presence of periradicular disease with or without symptoms in a root filled tooth, where: o non-surgical root canal re-treatment cannot be undertaken or has failed; or, o conventional treatment may be detrimental to the retention of the tooth e.g. obliterated root canals, small teeth with full coverage restorations where conventional access may jeopardise the underlying core  Presence of periradicular disease in a tooth where iatrogenic or developmental anomolies prevent nonsurgical root treatment being undertaken  Where a biopsy of periradicular tissue is required  Where visualisation of the periradicular tissues and root tooth is required where perforation, root crack or fracture is suspected  Where procedures are required that require either tooth sectioning or root amputation  Where it may not be expedient to undertake prolonged non-surgical root canal retreatment because of patient considerations. Proposed patient pathway for apicectomy:

GDP  Brent  Harrow  Ealing  H&F  Hounslow  Explain to  patient why  don’t meet  criteria.  Triage  Meets  criteria?   N  Y    No triage service  currently    Acute 
Complete  PPwT

Anterior  teeth (1‐5) Posterior  teeth 

Specialist  Service*

* Westminster only at present 
Posterior Apicectomy will only be considered via the IFR Route

IFR  (Exceptional  cases only) 

Gale TM (1999) Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals.baoms.uk . There are no RCTs comparing apicectomy to non-surgical interventions for infected root tips.uk/docs/Apicectomy.ac. Br Dent J NHS NW London Planned Procedures with a Threshold Policy. Literature shows that the success rate of apical surgery on molar teeth is low and should not be routinely undertaken (Wesson and Gale.pdf References 1. Version 2. Accessed 3rd October 2007. Available at: http://www.ROM/guidelines/Apical%20surgery. Apical surgery.northwestlondon. Evidence base Advice: Evidence (grade d) indicators that in general apicectomy may only be funded in accordance with the guidance in policy and criteria.pdf http://www.org. 1999).uk/docs/Apicectomy-diagrams. Referral guidelines. It is indicated when there is radiographic evidence that a root infection has persisted despite the removal of the dead nerve and the placement of a sound root filling. Available at: http://www.pdf.baos. Guidelines for surgical endodontics. British Association Oral and Maxillofacial Surgeons. RCS 2001.Background  An apicectomy is a surgical procedure involving the removal of an infected tip of the root or roots of a tooth and a small amount of surrounding bone or tissue. Royal College of Surgeons of England.rcseng.pdf [Accessed 1st Oct 2007] 3. Wesson CM.org.uk/fds/clinical_guidelines/documents/surg_end_guideline. 2.nhs.1 (April 2012) Is this the latest version? Check here: http://www.org.uk/CD.baos.    References                                    Patient information leaflet http://www.