Consent Dental Implant

I understand that the treatment of my dentition involves: A dental implant: Implants differ from other tooth replacement in that a titanium stud is anchored into and supported by the bone. While there are important differences, they function like natural teeth. They may be used as a single tooth replacement or for multiple tooth replacement as anchors for bridges, partial dentures or full dentures.

First (surgical) appointment: Usually under local anesthetic, precise drilling of holes in the jawbone is performed to accommodate the implants (cylindrical metal posts). The surgical site is then closed. Second appointment: Three to eight months later the implants are evaluated for healing and successful integration with the bone. Some revisions may have to be made at this time. If the implant fails to integrate it will have to be removed and alternative treatments considered such as a change of the site of the implant. If the implant has successfully integrated, a post is placed into the implant extending through the gum tissue into the mouth. An impression is taken of this post and it is sent to a lab so that we can fabricate a restoration to be anchored to the implant. Third appointment In the final prosthetic phase a metal sleeve or abutment is threaded into the implant to anchor the crown, bridge or denture. The prosthetic is attached to the abutment (crown, bridge or denture) fee is separate from the surgical fee.

Alternatives to implants include fixed bridgework, removable partial and complete dentures. Infected teeth with sound roots and bone support may be treated by endodontic (root canal) therapy and restored with a post and crown. If presently wearing an ill fitting denture, it should be replaced with a new one or relined for a better fit to keep the supporting tissue healthy. Non replacement of missing teeth will usually cause movement of teeth, resulting in a collapsed bite, the correction of which may be difficult and costly. I understand that there is the possibility of failure to achieve the results which may be desired or expected even though my treating dentist in rendering this treatment will exercise their best care and diligence. These risks include possible unsuccessful results and/or failure, which are associated with, but not limited to the following:

Pain swelling and bleeding Systemic infection such as fever, sepsis and (in extremely rare cases) death Aspiration (inhaling) of teeth or tooth fragments or materials used during the procedure. Injury to neighboring teeth, restorations or soft tissues Long term movement of teeth neighboring the surgical site Reversible or irreversible nerve damage Adverse reactions to medications, anesthesia or substances used Perforation of the maxillary sinus or fracturing of the jaw, possibly requiring further treatment TMJ injuries, bone fracture, poor healing. I understand that it is my responsibility to notify this office of changes to my medical history and if any undue or unexpected problems occur or if I experience any problems relating to the treatment rendered or the services performed.

Prosthetic risks include but are not limited to unsuccessful integration of the implant to the bone and fracture of the implant components. If a separate surgical procedure is necessary to remove a failed implant or if a replacement is necessary due to changed prosthetic requirements, an additional fee may be charged. Nitrous Oxide (laughing gas) and Valium : I have the option of using Nitrous oxide and valium sedation for my procedure to help with anxiety, pain, gagging and medical conditions. I understand that the administration of medication and the performance of conscious sedation with nitrous oxide carries certain hazards, risks and potential unpleasant side effects which are infrequent but nonetheless may occur. They include but are not limited to excessive perspiration, expectoration, excessive talking, vivid dreaming, shivering, and nausea or vomiting. I will inform the office if I have any of these conditions. I understand that when on Nitrous Oxide the office may keep me until they feel like I can drive home safely or they will find a ride for me. I understand that when on Valium and Nitrous Oxide I am required to come to the office with a designated driver and leave the office with a designated driver.

I understand that Lifetime Family Dental is working hard to make my experience before, during and after treatment more comfortable. It is my responsibility to inform the office if I am having any adverse reactions to any of the treatments I am receiving. The resources that Lifetime Family Dental has to make this a more comfortable experience include the following:

Pain Control: Traditional OTC painkillers and narcotics may be used for mild to severe pain. Mild Pain: regular strength Ibuprofen or Tylenol can be taken excluding those who have contraindications as discussed with their physicians (liver or kidney damage etc.) Severe Pain: Tylenol and Ibuprofen used in conjunction have been shown to have more pain reduction than narcotics. For a normal healthy adult, the most powerful regimen is to take up to 800 mg Ibuprofen (usually 4 tablets otc ibuprofen) and then two hours later two regular strength Tylenol (acetaminophen) and then start over two hours later with the ibuprofen then tylenol rotating every two hours. This is a lot of pain killers for a healthy person so do this cautiously and not long term. If pain persists, consult the dentist and potentially a physician. Narcotics: Narcotics are not recommended due to the addiction tendencies that can arise due to their use. It has been found that dentists are the main cause of drug addiction because peoples first exposure to narcotics are from the dentist's office after third molar extractions. If you get a narcotic pain killer, please use caution. Do not drive or operate heavy machinery. Dispose of pills properly to prevent misuse. Follow the instructions given by your pharmacist. Narcotics can not be called into the pharmacy. If you would like a narcotic then you will need to get it during regular office hours or be prepared to pay for an after hours visit.

Infection Control: Antibiotics: Many times, pain comes from an abscess or other infection. If your tooth abscesses or becomes infected please let your dentist know. It is important that you remind your healthcare provider of any allergies to antibiotics. Unlike pain pills that should be taken until pain goes away, it is important to take the entire course of antibiotics to ensure complete destruction of the bacteria. Chlorhexidine Mouthwash: Mouth sores and cuts are susceptible to infection. Because of that we recommend keeping your mouth clean with regular brushing and flossing. Mouthwash can be an effective additional supplement. Chlorhexidine mouthwash kills bacteria and has been shown to last long after rinsing. If you use more than one bottle, it will stain the teeth superficially. Polishing can remove the stain. To prevent the staining we recommend using one bottle of prescription chlorhexidine mouthwash and then changing to Listerine if you still like using mouthwash.

Comfort: Temporary crown maintenance: Temporary crowns are made to come off. Ideally they last until the permanent crown can be seated, but they will come off early sometimes for no reason at all. We recommend being careful with the temporary. Do not eat sticky foods, and do not floss that tooth. If it does come off, carefully try to put it back on. If you can not get it back on or it comes off to easily call the office and we will get you back in. If you can not make it back in, drug stores stock temporary cement and you are welcomed to try to use new cement. There are times where the temporary will just not work and we will work that out if those situations arise . Stitches: You may have received stitches as part of your treatment. Unless otherwise instructed, your dentist has used resorbable sutures. Sutures should stay in for at least three days, after which time the stitches will dissolve and either be swallowed or you will thread them out. Notify the doctor if you have any concerns about your stitches . Gauze: Gauze may be used to help in blood clot formation. Please discard the gauze after 15 minutes. You are welcomed to replace it if you like, but It is common to have a little blood mixed with saliva. This is not an emergency and it should resolve within 24 hours. If your bleeding is abnormal, or does not slow its flow, please contact your doctor or go to the hospital. Hot and Cold: Temperature changes have been shown to decrease inflammation due to the body's increased response to flush the area. We are happy to provide hot and cold packs that can be alternated every 15 minutes. Other items that we can provide to help things be more comfortable include: Breath fresheners, chapstick, face towels and water.

By signing this form, I do acknowledge the following:

I have been informed of the common risks and benefits of my treatment and I am freely giving my consent to authorise Lifetime Family Dental to render the services they deem necessary or advisable to treatment of my dental conditions. I agree to receive the administration and/or prescribing of any anesthetic agents and/or medications as discussed with my dentist. I voluntarily assume any and all possible risks, including the risk of substantial harm, if any, which may be associated with any phase of this treatment in hopes of obtaining the desired and/or any results from the treatment to be rendered to me. The estimated fee(s) for these services have been explained to me and I accept them as satisfactory. I am aware that if my insurance does not cover the estimated portion of the procedures that I will be responsible for the payment. I have been given the opportunity to ask any questions regarding the nature and purpose of my treatment including alternative treatment options and my questions have been answered to my satisfaction.

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