Informed Consent: Dental Implants
I have been informed of the alternatives to using implants including; fabrication of a bridge, placement of a partial or complete denture, and no treatment at all. The advantages and disadvantages of each of the above procedures have been explained to me and I choose to proceed with implant insertion.
I also authorize and direct the surgeon to provide such additional services as he or they may deem reasonable and necessary, including, but not limited to, the administration of anesthetic agents; the performance of necessary laboratory, radiological (x-ray or CT scan), and other diagnostic procedures; the administration of medications orally, by injection, by infusion, or by other medically accepted route of administration.
I understand that the surgeon may require additional bone to be placed along with the dental implant(s). Additional bone may be either harvested directly from 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.
I acknowledge that even if placement of an implant(s) was planned, that this may not always be possible as dictated at the time of surgery. The surgeon may elect to place a bone graft or to provide no treatment at the time of surgery. This is more likely when extractions are performed at the same time as the planned dental implants (immediate implants).
I acknowledge that the surgeon has explained the procedure in detail, and to my satisfaction. I have been informed that the implant(s) may require 3-5 months healing time before restorative work can begin. I understand that the surgeon is responsible for surgical implant placement, not the prosthetic reconstruction. I understand that once the implant is inserted, the entire dental treatment plan must be completed on schedule. If this is not done, the implant may fail.
If any unforeseen condition arises in the course of treatment which calls for the performance of procedures in addition to or different from that now contemplated and I am under any form of sedation or anesthesia, I further authorize and direct the surgeon to perform whatever is deemed necessary and advisable under the circumstances.
I understand that there are risks associated with this procedure and these have been explained to me. They may include, but are not limited to; swelling and bruising; damage to and possible loss of other teeth; infection; pain; significant bleeding; wound breakdown; sinus exposures or infection; poor healing; jaw bone fracture; injury to nerves near the treatment site which may cause pain, numbness or tingling of the lips, chin, face, mouth, gums and tongue (which is usually temporary but may be permanent); loss of, or damage to the ability to taste; stretching of the corners of the mouth; restricted mouth opening or TMJ (jaw joint) problems such as pain and/or clicking. Although a good cosmetic result is hoped for, it cannot be guaranteed. I also understand that any of these treatment complications may necessitate additional medical, dental or surgical treatment and recuperation at home or even in the hospital.
If your surgery is done with sedation or under a general anesthetic, the following risks may occur: inflammation of the I.V. site, nose bleeds, sore throat, hoarseness, lung problems, and/or heart problems. Hospitalization after the surgery may be necessary to control medical and/or surgical complications.
In the unlikely event of a medical crisis requiring lifesaving action, our team will undertake a full resuscitative effort through to and including the arrival of Calgary Emergency Medical Services. Please tell us before treatment should you not wish this effort to be undertaken on your behalf.
I understand that these implants require regular maintenance and must be cleaned thoroughly. Occasionally, bone loss can occur around implants necessitating further treatment and expense. I understand that the more I smoke, the more likely it is that my implant treatment will fail, and I understand and accept that risk.
I understand that in the event an implant fails, it will be removed through a second surgical procedure. Any re-treatment which is considered appropriate by the surgeon due to implant failure within 1 year of initial placement will be handled as follows:
I understand that there will be no refund of the fees in the event of failure. I also understand that I will not be charged for clinical services to replace the same number of implant(s). I will pay for anesthetist, components, and laboratory costs and I will be given an estimate of the anticipated charges before re-treatment begins. I understand that this does not constitute a warranty, but rather a statement of services, and that failure to attend prescribed follow-up & hygiene appointments or follow home care instructions following the placement of the implant prosthesis means I will assume all costs for any re-treatment required.
I will also assume all costs for any necessary re-treatment due to implant, or prosthodontic failure that occurs beyond this initial 1-year period.
I further understand that this statement of services applies only to treatment provided by the surgeon and does not apply should I pursue surgical treatment elsewhere.