Informed Consent For Dental Implants printable pdf download

Renée Laurion Goodspeed, D.D.S. • Puneet Kochhar, D.M.D. • Michael Ambra, D.M.D.

40 Winter Street, Suite 201, Rochester, NH 03867-3194 •

• (603) 332-7300 • Fax (603) 332-7331

INFORMED CONSENT FOR DENTAL IMPLANTS

Diagnosis. After careful oral examination and study of my dental condition, my doctor has advised me that my

missing tooth or teeth may be replaced with artificial teeth supported by an implant.

Recommended Treatment. In order to treat my condition, my doctor has recommended the use of root form

dental implants.

I understand that the procedure for root form implants involves placing implants into the

jawbone. This procedure has a surgical phase followed by a prosthetic phase.

Surgical Phase of Procedures. I understand that sedation may be utilized and that a local anesthetic will be

administered to me as part of the treatment. My gum tissues will be opened to expose the bone. Implants will

be placed by tapping or threading them in to holes that have been drilled into my jawbone. The implants will

have to be snugly fitted and held tightly in place during the healing phase.

The gum and soft tissues will be stitched closed over or around the implants. A periodontal bandage or dressing

may be placed. Healing will be allowed to proceed for a period of four to six months. I understand the dentures

usually cannot be worn during the first one to two weeks of the healing phase.

I further understand that if clinical conditions turn out to be unfavorable for the use of this implant system or

prevent the placement of implants, my doctor will make a professional judgment on the management of the

situation. The procedure also may involve supplemental bone grafts or other types of grafts to build up the

ridge of my jaw and thereby to assist in placement, closure, and security of my implants.

For implants requiring a second surgical procedure, the overlying tissues will be opened at the appropriate time,

and the stability of the implant will be verified. If the implant appears satisfactory, an attachment will be

connected to the implant. Plans and procedures to create an implant prosthetic appliance can then begin.

Prosthetic Phase of Procedure. This phase is just as important as the surgical phase for the long-term success

of the oral reconstruction. During this phase, an implant prosthetic device will be attached to the implant.

Expected Benefits. The purpose of dental implants is to allow me to have more functional artificial teeth. The

implants provide support, anchorage, and retention for these teeth.

Principal Risks and Complications. I understand that some patients do not respond successfully to dental

implants, and in such cases, the implant may be lost. Implant surgery may not be successful in providing

artificial teeth. Because each patient’s condition is unique, long-term success may not occur.

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Informed Consent For Dental Implants