Informed Consent:  Bone Grafting

This is my consent for Bone Grafting, as previously explained to me, or other procedures deemed necessary or advisable to complete the planned operation. I also agree to the use of a general anesthetic or intravenous sedation, depending on the oral and maxillofacial surgeon(s) and anesthesiologist involved in my care.

The doctor has reviewed the surgical procedure, the risks and the benefits, and alternative treatment options. I have had the opportunity to ask questions and understand the proposed surgery/treatment.

I acknowledge that the surgical procedure involves the grafting (augmentation) of bone to my oral and maxillofacial area. Additional bone may either be harvested directly from the myself, the patient (autograft) and/or substituted with a commercially available human bone graft product (allograft). I understand that any type of bone graft may increase the risk of infection, may require further diagnostic tests, and may require further treatment including possible hospitalization.

I have been informed and understand that there are symptoms (sequelae) from surgery including: pain; swelling; bruising; bleeding that may be heavy or prolonged; late postoperative bleeding; the possibility that facial muscles may not function following the surgical procedure for an indefinite time; temporomandibular (jaw) joint difficulty, such as pain, clicking or decreased mouth opening; injury to adjacent teeth or dental restorations, or possible future loss of adjacent teeth, or injury to adjacent soft tissues; and/or referred pain to the ear, neck and head.

I accept that due to the bone graft harvest and/or surgery, numbness, tingling, and/ or a painful altered sensation of the lip, tongue, chin, gums, cheeks and teeth may result and that this may be temporary or permanent.

I understand that a bone graft harvest from the anterior or posterior ilium(hip) and/ or tibia(lower leg) may result in unsightly scar formation, wound dehiscence (opening), bleeding that may be trapped (hematoma) requiring drainage, difficulty with walking, and/or bone fracture requiring additional treatment or immobilization.

Other potential complications could include nausea, vomiting, allergic reaction, unfavorable bone graft healing, delayed healing or non-healing of bony segments, sinus complications, loss of bone and the invested teeth, devitalization (nerve damage which may require root canal treatment) of teeth, and prolonged depression from the anesthesia/surgery.

I agree to cooperate completely with the recommendations of the Doctors of South Calgary Oral & Maxillofacial Surgery while I am under their care, realizing that any lack of cooperation could result in a less than optimum result.