Dental Implant Consent

You have the right and the obligation to make decisions regarding your healthcare. Your dentist can provide you with the necessary information and advice, but as a member of the healthcare team, you must participate in the decision-making process. This form will acknowledge your consent to treatment recommended by your dentist.

1. Request and authorise Dr. Gareth Lewell to perform the surgical placement of dental implants upon me. This procedure has been recommended to me by my dentist as an option to replace my natural teeth.

Dental implants are metal anchors put inside the jawbone underneath the gumline. Small posts are attached to the implants, and artificial teeth or dentures are fastened to the posts.

One or two surgical procedures are performed to install the implants. The first procedure involves drilling small holes into the jawbone and placing the anchors. A temporary denture may be worn for a few months while the anchors bond with the jawbone and allow the gums and bone to heal. A second procedure to uncover the implants may be needed.

The potential benefits of this procedure include the replacement of missing natural teeth or supporting dentures.

2. I have chosen to undergo this procedure after considering the alternative forms of treatment for my condition, which include no treatment at all, complete or partial dentures, or fixed or removable bridges. Each of these alternative forms of treatment has its own potential benefits, risks, and complications.

3. I understand that there are potential risks, complications and side effects associated with any dental procedures. Although it is impossible to list every potential risk, complication, and side effect, I have been informed of some of the possible risks, complications and side effects of dental implant surgery. These could include but may not be limited to the following:

• Postoperative discomfort and swelling

• Bleeding

• Postoperative infection

• Injury or damage to adjacent teeth or roots of the teeth

• Injury or damage to nerves in the lower jaw, causing temporary or permanent numbness and tingling of the chin, lips, cheek, gums, or tongue

• Fracture of the jaw

• Bone loss of the jaw

• Restricted ability to open the mouth because of swelling and muscle soreness or stress on the joints of the jaw – temporomandibular joint (TMJ) syndrome

• Penetration into the sinus cavity

• Mechanical failure of the anchor, posts or attached teeth

• Failure of the implant itself

• Allergic or adverse reaction to any medications
  

Most of these risks, complications and side effects are not serious or do not happen frequently. But although these risks, complications and side effects may occur very rarely, they do sometimes occur and cannot be predicted or prevented by the dentist performing the procedure. Although most procedures have good results, I acknowledge that no guarantee has been made to me about the results of this procedure or the occurrence of any risks, complications, and side effects.

These potential risks and complications could result in the need to repeat the procedures; remove the implants; or undergo additional dental, medical or surgical treatment or procedures, hospitalisation, or blood transfusions. I recognise that during treatment, unforeseeable conditions may require additional treatment or procedures as required.

I understand that poorly managed gum disease and smoking both in the past and future may increase the likelihood of implant failure. I acknowledge that implants require ongoing professional maintenance and the ongoing maintenance of excellent home oral hygiene.

4. I consent to the administration of anaesthesia or other medications before, during or after the procedure by qualified personnel. I understand that all anaesthetics or sedation medications involve very rare potential risks or complications such as damage to vital organs and/or death from both known and unknown causes.

5. Bone Augmentation / Bone Graft

I understand that during the implant surgery, it may become apparent that the quality and quantity of my bone may not be adequate and Dr Gareth Lewell may need to augment bone. I consent for this to be done at the same time as the implant surgery. Some bone graft and membrane material commonly used are derived from synthetic or bovine sources. These grafts are thoroughly purified by different means to be free from contaminants. Signing this consent form gives your approval for Dr Gareth Lewell to use such materials according to his knowledge and clinical judgement for your situation. I understand bone augmentation may require venepuncture and Platelet Rich Fibrin.

6. Venepuncture and Platelet Rich Fibrin (PRF)

I understand this procedure involves placing Platelet Rich Fibrin (PRF). I understand PRF is a component of my own blood and involves withdrawing 20-50ml of blood from one of my veins into vacuum sealed vials for process. I understand PRF may or may not contain surgical grade foreign synthetic bone regeneration material. Risks and complications of the draw for PRF include discomfort from the draw on entry, bruising, inflammation of the vein and rare risk of infection.

7. Sinus Lift

I understand if there is not enough bone in the upper molar area, a sinus lift procedure may be required. I understand that because the sinus membrane has been exposed, there is a risk of tearing of the membrane and foreign bodies entering the sinus causing sinusitis and a risk of the implant entering the sinus, requiring referral to an Oral Surgeon to manage. I understand a sinus lift may require venepuncture and PRF.

8. I certify that I have read or had read to me the contents of this form. I have read or had read to me and will follow any patient instructions related to this procedure. I understand the potential risks, complications and side effects involved with any dental treatment or procedure and have decided to proceed with this procedure after considering the possibility of both known and unknown risks, complications, side effects and alternatives to the procedure. I declare that I have had the opportunity to ask questions and all my questions have been answered to my satisfaction.