Informed Consent For Full And/or Partial Dentures Form printable pdf download

Informed Consent for Full and / or Partial Dentures

PATIENT NAME _____________________________________ DATE_____________

TO THE PATIENT

You have the right, as a patient, to be informed about your condition and the recommended surgical,

medical, or diagnostic procedure to be used so that you may make the decision whether or not to undergo

the procedure after knowing the risks involved. Please ask about anything that you do not understand.

MAXILLARY FULL DENTURE

MAXILLARY PARTIAL DENTURE

MAXILLARY IMMEDIATE DENTURE

MANDIBULAR FULL DENTURE

MANDIBULAR PARTIAL DENTURE

MANDIBULAR IMMEDIATE DENTURE

ABOUT THE TREATMENT

A partial denture is placed when there are missing teeth with some remaining teeth present. It is used

most frequently when a fixed bridge cannot be placed. A full denture is placed when all teeth are

missing. In certain cases a full denture can be placed when the last teeth are removed from one or both

of the halves of the mouth (immediate denture). The procedures take several steps. First an initial

impression is taken. Then the lab provides a base or the partial frame with either wax for a bite or the

teeth in wax for a bite. Then the partial or denture is processed by the lab and returned by the lab and

returned for final placement. Other steps may be employed by your doctor given the specific

circumstances of your particular mouth. If teeth were taken out when the denture is placed (immediate

denture), a reline may be necessary within the first year as the extraction sites heal and mature.

BENEFITS AND ALTERNATIVES

When there are remaining teeth available in the proper configuration, a fixed bridge can sometimes be

placed to replace the missing teeth. Another alternative in those cases is the placement of implants with

crowns or fixed bridges on top of them. The only alternative to a full denture is multiple implants and

fixed implant prosthesis.

COMMON RISKS

The Doctor has explained to that there are certain inherent and potential risks in any treatment plan or

procedure, and that in this specific instance such operative risks include, but are not limited to:

The possibility of chipping or fracturing of the partial or denture due to improper handling.

The need for periodic adjustments.

The need for periodic relines to adapt the denture/partial to the changing of the bone shape

underneath the gums.

The need for routine soft tissue exams.

Difficulty with adequate retention due to insufficient ridge support.

Difficulty chewing certain foods and the possibility that certain foods will get under the edge

of the denture/partial.

Difficulty with enunciation (speaking) of certain words.

Informed Consent For Full And/or Partial Dentures Form