Implant Consent Form printable pdf download

Implant Consent form

All patients receiving dental implants will be asked to sign consent forms

English law requires that you be given certain information and that we obtain your consent prior to

any implant treatment. You are being asked to sign and confirm that we have discussed the

nature and purpose of the treatment, the known risks associated with the treatment, and the

feasible treatment alternatives; that you have been given an opportunity to ask questions; that all

your questions have been answered in a satisfactory manner. Please read this form carefully

before signing. If you have any further questions please ask before your surgery.

Nature and Purpose of the Procedure

I understand incision(s) will be made inside my mouth for the purpose of placing one or more

titanium implants into the bone of my jaw(s). The implant will serve as an anchor(s) for a crown

(cap), bridge or a denture. I acknowledge that Mr Lewns has explained the procedure, including

the expected number and location of the implants to be placed. I understand that the crown (cap),

denture or bridge, will later be attached to this implant after an appropriate healing period.

Alternatives to Dental Implant

The alternatives to the use of a dental implant, may include no treatment at all or construction of a

dental prosthesis including a bridge supported on natural teeth or a denture. I have had the

relative advantages and disadvantages of each procedure explained to me at my initial

consultation and I have chosen to proceed with placement of the dental implant(s).

Unforeseen Conditions that develop after treatment has started

During treatment, previously unknown oral conditions may modify or change the original treatment

plan such as discovery of changed prognosis for adjacent teeth. If this occurs Mr Lewns agrees to

inform me and discuss the alternative treatments as may be required by proper dental care in his

best judgement.

Long term risks

There is a small chance that over time the bone supporting the implant, just as bone supporting

teeth may be lost and the implant may then fail. You will be shown how to maintain your implants

and asked to return for recall 12 and 36 months after completion of treatment. Smoking is a known

risk to bone loss around implants as well as teeth. You will become a higher risk patient if you

develop periodontal disease, diabetes or are a smoker.

Surgical risks

Swelling bruising and discomfort may be experienced following the procedure.

Some irritation can occur from the sutures.

Implant Consent Form