Implant crown consent

A dental implant is an artificial tooth root usually made from titanium that is inserted into the jaw. This creates an anchor for the replacement artificial teeth which is then sculpted against the tissues to create a natural looking replacement tooth or teeth.

The procedure with implant placement will vary depending on individual cases either as a single stage or as a two-stage surgical procedure with or without additional bone graft/soft tissue graft. If you require a bone graft and tissue regeneration, there will be an additional cost. After the placement of the implants, the site will be covered, and the gum tissue held together by sutures. The gum tissue may fail to heal immediately after the surgery and the line of repair may open slightly. To help prevent this, you should temporarily adhere to a soft diet and avoid pressure to the tissues within the initial weeks as indicated by the dentist. Healing may take anywhere from 3-8 months after the surgery, and you can expect some discomfort during the healing phases. To promote good healing and a better outcome it is best to adhere to the instructions advised to you and inform your dentist of any soreness, ulcers, looseness, or any unexpected uncovering of the fixtures. After adequate healing, the implant is evaluated for healing and the prosthetic phase to replace teeth with crowns or bridge work begins.

The longevity of implants is dependent on many factors:

The patient’s health
Smoking or tobacco use
Nutrition
Alcohol
Drugs
Medications
Oral hygiene
The amount of quality bone
Surgical compromises
The degree of occlusal or biting forces etc

As with any restorative procedure, the potential exists for fracture of implant components and ceramics or loss of the implant from the bone. Alternatives to implants and treatment plan variations will be discussed with you if such incidences occur.

Risks

Implant surgery may not be successful in providing artificial teeth in every person. Each individual and their conditions are unique and long-term success may not occur as there is no predictable way to determine the healing and the gum response. This may include additional surgery or gum/bone grafting procedures, alternative methods if treatment fails or specialist referral if severe implications arise.

Complications that may result from implant surgery and anaesthetics include but are not limited to: (The ones which are marked are applicable to your treatment).

Surgical implications: Fracture of the bone, blood vessel damage, injury or sensitivity to the teeth or gums, sinus perforation.
Transient or on rare occasion permanent numbness of the lip, tongue, chin, or gum.
Jaw joint tenderness or restricted ability to open for a few days/weeks
Allergic reactions/ chemical injuries
Delayed healing, implants failing to integrate, failing implants, gum disease around implants.
Accidental swallowing of foreign matter
Post-surgery implications: fracture or wear of the ceramic, screw loosening, resorption surrounding the implant, adjacent teeth movement.
Post-surgery infection, bleeding, pain, swelling, bruising.

Surgical Risks

Adverse reactions to anaesthetic, drugs, medications:

On some occasions, patients may have an adverse reaction to the anaesthetic or medications that are used or prescribed. These reactions usually take place within the first two hours and can include pallor, palpitations, diaphoresis, dizziness, nausea, and a more serious anaphylactic reaction can occur. It is important to disclose all medical history including a list of allergies, medications, natural remedies, herbal, or any non-prescription medications to avoid and prevent these adverse outcomes and appropriately manage the procedure.

Sinus Perforations:

During surgery in the upper jaw, there is a potential risk of perforation into the maxillary sinus when the implants are being placed. This air space that is located usually above or at the tip of the apices of the upper molar teeth. If a perforation occurs, it is usually manageable by closing and sealing the area with sutures and instructions of home care and antibiotics. If the perforation is more extensive, this may require being seen by a specialist to manage this and may require minor surgical intervention.

Fracture of adjacent structures:

During the placement of implants, the adjacent bone, vessels, and tissues near the site of the implants are stretched out to make room for the implants and can be damaged. Minor damage will usually heal uneventfully.

Accidental Swallowing of foreign matter:

Implant placement requires a fine and small componentry and is all performed carefully under appropriate clinical isolation. As mentioned, the upmost care will be taken to prevent complications such as this. However, there is always a risk that the fine componentry can be accidently swallowed during the procedure. If this occurs, there is a requirement to have appropriate x-rays and surgical treatment to have it removed.

Post–Surgical Risks

Post-surgical care (bleeding, swelling, pain, bruising, joint pain, prolonged numbness):

After implant placement, patients may feel quite sore and tender over the next couple of days and may notice minor bruising and swelling. The swelling, tenderness, pain, bruising and prolonged numbness from the anaesthetic should settle over the next couple of days and weeks but the exact duration of these complications may not be determinable. There is a slight chance they may become permanent and irreversible. It is important to attend follow-up appointments to provide and manage the healing and to let the dentist know if the pain, tenderness, or prolonged numbness is still present or has increased over time.

Delayed Healing:

The ability to heal after treatment varies between individuals so do not be alarmed if the area is healing quickly or slower than expected. During the follow-up visits, the healing of the Implant will be assessed and managed appropriately if the healing process is not going as expected.

Peri- Implant mucositis and Peri-Implantitis (gum disease associated with implants):

Peri-Implant mucositis is a reversible inflammation of the soft tissue and around the implant that is induced by bacteria from plaque build-up. It is described to be confined to the soft tissue alone and without loss of supporting bone around the implants. If detected early, it can be managed with optimizing daily oral hygiene and anti-microbial therapy at the dental surgery.

Peri-Implantitis is a more severe and destructive inflammatory response of the soft and hard tissues surrounding the implants. This involves gingival inflammation, progressive loss of the alveolar bone and loss of the connective tissue attachment supporting the implant. The treatment for the more severe complications of Peri-Implantitis may require a combined anti-microbial and surgical therapy to manage this and promote regeneration of the supporting tissues.

Unfortunately, not all peri-implantitis lesions are favourable to regenerate resulting in the loss of the implant. These can be attributed to risk factors found in periodontal disease (gum disease) such as overall medical health, smoking status, stress, hormonal imbalances, poor plaque control, occlusal overload, sub-optimal surgical or prosthetic execution and/or improper maintenance care.

To manage these complications, it will require ongoing maintenance with 3-6monthly check ups and daily home maintenance to prevent, monitor and treat these complications in the initial stages.

Bone Loss:

Progressive bone loss can occur overtime with implants and can be related to surgical, occlusal, periodontal implications associated with implants. An implant is an artificial tooth and does not have the natural supporting periodontal ligament and anatomical architecture of a natural tooth. It relies solely on the surface of the implant screw to be fixated into bone which means implants are more prone to minor or progressive bone loss than compared to a natural tooth.

Fracture and/or loosening of screws and components:

Fracture of the abutment fixtures, screws and associated parts are rare but can happen. This could lead to removal of the fixture; in which case you may need to have a different prosthesis constructed and placed.

In terms of loosening of the screws and components, this can be attributed to periodontal or occlusal (grinding, clenching) problems individually or a combination of them both. If any componentry or screws become loose, it is best to contact us and see us immediately so we can manage this effectively and if the componentry or screws have fallen out then keep them and bring them in with you to the appointment.

Wear of the Ceramics:

Overtime, the ceramic may become worn, chipped, fracture or break from functional forces of eating, grinding, and clenching. If the fracture is small then it may be repairable, but on most occasions, this will need to be replaced and a new ceramic crown/bridge will be constructed.

Maintenance

To improve the chances of success, there is a requirement to attend follow-up appointments so that healing can be monitored and assessed. Following treatment, there is a need for ongoing and lifelong maintenance daily at home and with regular check-ups every 3-6months which is not included in the costs of the implant procedure. This ensures the optimum care for teeth, implants, prosthesis, and gums.

For long term success of implant treatment you have the following responsibilities:

Follow all the instructions regarding a soft diet, denture wear, gum, and teeth management during the healing after each phase of surgery.
Clean the implant componentry, denture and/or teeth carefully and thoroughly as instructed.
Appear for periodic examinations and cleans every three to six months as advised by your dentist. There is an additional fee for these services.
Exercise care in not abusing the prosthesis and advise your dentist immediately if any problems are noticed.

If you fail to maintain the work that has been done and do not attend regular appointments, complications can arise and become untreatable, difficult, and costly to manage. You will be liable to incur the total costs for treatment to correct implications or failures if you do not attend follow up appointments and maintain regular appointments.

Acknowledgment & Consent

I certify that I have been fully informed by my dentist and have carefully read all the information provided on this form and the proposed treatment and the alternatives have been explained to me by the dentist to my satisfaction. I understand the purpose and nature of the implant(s) surgery procedure. I understand what is necessary to accomplish placement on the implant(s) under the gum or in the bone. I understand the implications and consent to the proposed treatment. I agree to the fees and accept the general and special conditions.
The dentist has carefully examined my mouth. Alternatives to this treatment have been explained. I have tried or considered these methods, but I desire an implant(s) to help secure the replaced missing teeth.
I have further been informed of the possible risks and complications involved with surgery, drugs, and anaesthesia. I understand that such complications include pain, swelling, infection, discolouration and acute or chronic or dysfunction associated with my jaw joints/ or muscles. Numbness of the lip, tongue, cheek, or teeth may occur. The exact duration of these complications may not be determinable, and I am aware that there is a slight chance they may become permanent or irreversible. Also possible, is inflammation of the vein, injury to existing or surrounding teeth, bone fractures, sinus penetration, delayed healing, allergic reactions to drugs or medications used.
I understand that if I do not proceed with the proposed treatment, any of the following could occur; bone disease, loss of bone, gum tissue inflammation, infection, sensitivity, abscesses, pain, looseness of teeth, and necessity of extraction. Also possible is temporomandibular joint (jaw) problems, headaches, referred pain in the back of the neck and facial muscles, and tired muscles when chewing.
The dentist has explained that there is no method to accurately predict gum and bone healing capabilities in each individual following the placement of the implant(s) or bone grafting.
It has been explained that in some instances implants fail and must be removed. I have been informed and understand that the practice of dentistry is not an exact science; no guarantees or assurance as to the outcome of results of treatment or surgery can be made.
I understand that excessive smoking, alcohol, or sugar may affect gum healing and may limit the success of the implant(s).
I agree to follow the home care instructions. I agree to report to the dentist for regular examinations and cleans as instructed.
I agree to the type of anaesthesia, depending on the choice of the dentist and follow the instructions that are given to me by the dentist. I understand that I must not operate a motor vehicle or hazardous device for at least 24 hours or more until fully recovered from the effects of the anaesthesia or drugs administered for my care depending on the proposed anaesthesia.
To my knowledge I have given an accurate report of my physical, mental health and medical history. I have also reported any prior allergic or unusual reactions to drugs, food, insect bites, anaesthetics, pollens, dust, blood or body diseases, gum or skin reactions, abnormal bleeding or any other conditions related to my health.
I consent to photography, filming, recording and x-rays of the procedure to be performed for the advancement of dentistry, provided my identity is not revealed.
I request and authorise medical/dental services for me. I fully understand that during and following the completed procedure, surgery, or treatment, conditions may become apparent which warrant, in the judgment of the dentist, additional or alternative treatment pertinent to the success of comprehensive treatment. I also approve any modifications in design, material, or care, if it is felt this is in my best interest. I understand that regardless of what had been explained to me or my expectations, results and experiences vary from patient to patient.

No Warranty or Guarantee?

I hereby acknowledge that no guarantee, warranty, or assurance has been given to me that the proposed treatment will be completely successful to my complete satisfaction or appearance. Each individual and their conditions are unique, thereby it is anticipated that the long-term success cannot be promised.

Disclaimer: the practice of dentistry is not an exact science and therefore, reputable practitioners cannot guarantee results. Please understand that no one can promise that any treatment or dental procedure will b successful of that any risk, complication or injury will not occur.