Dental Implant Consent Form

Dental Implant Consent Form



What Are Implants?
Implants differ from other replacements in that they are anchored in and supported by the jawbone. While there are important differences, they function more like your natural teeth. They may be used as a single tooth replacement or for multiple tooth replacement as anchors for fixed bridges, for removable partial and full dentures. The implants are placed surgically. Usually under local anesthetic, the gum tissue is reflected, precise drilling of holes in the jawbone is performed to accommodate the implants (cylindrical metal posts) which are immediately placed in them. The surgical site is then closed. If the implant failed to integrate, it will have to be removed and alternative treatments considered, such as a change of the site or implant. If the implant has successfully integrated, a post is placed into the implant, extending through the gum tissue into the mouth. In the final prosthetic phase, a metal sleeve is threaded into the implant to anchor the crown, bridge, or denture.

Alternatives To Implants
As implied above, alternatives to implant replacement may be fixed bridgework, removable partial, and complete dentures. 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.

Surgical risks include, but are not limited to: post-surgical infection; bleeding; swelling; pain; facial discoloration; sinus or nasal perforation; TMJ injuries; spasms; bone fracture; poor healing; numbness (paresthesia) of the lip, chin, and tongue, which is usually temporary, but, on occasion, may be permanent. The prosthetic risks include, but are not limited to: unsuccessful integration of the implant to the bone; 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.

Location and Type of Dental Implants

Patient Signature


Dentist Signature

Kwan M. Lee DDS

Witness Signature

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