Veneer, Crown & Bridge Consent

I have been informed of the nature of the veneer, crown or bridge, risks, treatment alternatives and maintenance prior to commencement of treatment.

Veneer, Crown & Bridge Procedure

Veneers:

Porcelain veneers are used to whiten the colour of a tooth and/or change or fix the shape of the teeth, fill in gaps and sometimes fix up disharmonies in relation to the occlusion, aesthetics, and positioning of the teeth.

Crowns:

Natural teeth can become chipped, broken, or weakened over time due to trauma, tooth decay, large fillings, cracks, root canal treatment, age related wear and tear, genetically weakened teeth. In these cases, an artificial crown is often the best way to keep a tooth for longer, aid in improving function, appearance and strengthen a tooth that might otherwise be lost.

Bridges:

Bridges are utilized to replace one or more missing teeth and consist of an artificial tooth anchored to the adjacent natural teeth. The adjacent teeth need to be in good shape to support a bridge. If a tooth is lost through trauma, too badly decayed to save with a crown, a bridge may be a treatment of choice to replace a gap if a tooth is lost. Teeth have multiple function’s part from chewing and biting, so missing teeth should be replaced to: (as listed below)

Improve appearance and speech
Prevent stresses that cause damage to other teeth
To prevent the teeth near the gap from moving, shifting, and tilting
To maintain a natural bite and improve chewing ability.

Crowns and bridges are often made of ceramics/ porcelain for optimum appearance and metals such as gold, for a thinner and stronger material. Crowns and bridges made entirely of gold may be more advantageous for back molar teeth that do not require porcelain for appearance. Ultimately, the most appropriate material is selected for each individual case based on the presenting condition of the tooth or space and on your personal preference if it is feasible and will provide better long- term outcome. You will require a minimum of two appointments for preparation and fitting of the veneer, crown, or bridge. Sometimes this will vary depending on if a tooth requires root canal, a post as foundation or as part of an implant abutment, or if multiple units are being placed.

If multiple veneers/crowns/bridges are to be placed expect more than two appointments as it requires extensive planning and staging of treatment to reach the final insertion stage. Generally, between the preparation and fitting appointments a temporary crown that is cemented is placed. The temporary crown is not as strong as the final crown and is more prone to coming off, breaking, or fracturing. Hence, the upmost care must be taken and avoid eating hard, sticky foods and notify the dentist if the temporary has any issues, such as looseness or breaking.

Following this, the dentist will liaise and try in the final crown until all parties are happy with the colour, shape and fit. Once approval has been given then the crown will either be bonded or cemented. If at a later date, the patient then decides to change or alter the veneer, crown, or bridge after all the approvals previously, then it will be remade, at your expense. Costing you the total fee of the veneer, crown, or bridge to be remade.

Additional costs will be required if complications arise such as the tooth requires root canal treatment, soft tissue surgery due to recession, has decay, becomes loose or the ceramic work chips, fractures, or wears. These can range in prices depending on what is required.

Risks

As with every dental procedure, veneers, crowns, or bridges may not be successful in every case as each individual and their conditions are unique and long-term success may not occur. All of which, we will discuss with you.

Complications that may result from these procedures include but are not limited to: (the ones that are marked are applicable to your treatment)

Tenderness and discomfort
Transient or on rare occasion permanent numbness of the lip, tongue, chin, gum
Jaw joint tenderness or restricted ability to open for a few days/weeks
Tooth sensitivity/injury/fracture or gum sensitivity/tenderness
Infection of the pulp or gums
Gingival recession
Loss of the crown/bridge
Allergic reactions/chemical injuries

Procedural and Post Procedural Risk

Adverse reactions to the anaesthetic, drugs, medications:

On some rare 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 lists of allergies, medications, natural remedies, herbal, or any non-prescription medications to avoid and prevent these adverse outcomes and appropriately manage the procedure.

Post procedural care (bleeding, swellings, pain, bruising, joint pain, prolonged numbness):

Patients may feel quite sore and tender over the next couple of days and may notice minor swelling, tenderness, sensitivity, joint pain, or prolonged numbness from the anaesthetic. All of which 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 in order 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.

Reduction or roughening of tooth structure:

In preparation of the teeth for the reception of the ceramic, porcelain, porcelain, or metal, it is necessary to reduce or roughen the surface of the tooth to which they may be bonded or cemented. This preparation will be done as conservatively as possible; however, on some occasions the insult to the tooth can cause the pulp or gums to become inflamed. This may settle over a couple of days or weeks, however there is a small risk that the underlying pulp may die and become infected requiring root canal treatment to save it or removal of the tooth.

Sensitivity of teeth:

Even though there is usually no appreciable sensitivity, this type of treatment may cause teeth to become sensitive. Should sensitivity occur and persist for any length of time, please contact the surgery for an examination.

Wear, chipping, breaking, or loosening:

No matter how well done, this could occur. Many factors may contribute to this happening such as: chewing of hard materials; changes in occlusal (biting) forces; traumatic blows to the mouth; break down of the bonding agents; and other such conditions over which the dentist has no control. If the damage is quite minor it may be repairable however, if the damage is more extensive replacing or construction of a new veneer, crown or bridge may be required.

Effects of bruxism/grinding/clenching:

Most occasions, especially with extensive work or multiple units of ceramics/metal/gold veneers, crowns or bridges it is highly recommended to protect the work with a guard to wear every night. The greatest amount of force causing wear of dental work is from occlusal (biting, grinding, clenching) forces. It would be disheartening. If all the dental work that has been completed becomes worn over the months or years resulting in them having to be replaced at the patient’s own expense at an earlier stage. These guards depending on the amount of wear overtime, will need to be replaced every 1-2 years at your own expense. It is strongly recommended that you have an occlusal splint due to the excessive force you are putting on your teeth when grinding and clenching. This has been discussed as you have signs and symptoms of bruxism.

Decay:

As with any dental restorations and with natural teeth, decay can occur. It is important to maintain optimal oral hygiene and home care, reduce significant decay causing risk factors and attend regular appointments to maintain the teeth and dental restorations for a lifetime. If decay is left and extensive, this can result in the loss of the crown or tooth and possibly having to redo restorations, root canal therapy or result in removal of the tooth and having to plan to replace the space.

Aesthetics and appearance:

Every effort possible will be made to match and coordinate both the form and shade of veneers, crowns and bridges which will be placed to be cosmetically pleasing to the patient with approval before finalizing. However, there are some differences which may be exist between the natural dentition and the materials which are artificial, making it impossible to have the shade and/or form perfectly match your natural dentition. Overtime, natural teeth may slightly change colour which is a normal process of aging or lifestyle factors causing them to stain. This may warrant for patients to consider bleaching the natural teeth to match the porcelain work which stays a permanent shade. The porcelain or ceramic work still has the potential to be stained usually at the margin between the natural teeth to the ceramic. This can occur due to dietary factors, smoking, lack of oral hygiene, decay, and gum recession which may require soft tissue surgery to correct the recession at the patient’s own expenses.

Longevity:

It is impossible to place any specific time criteria on the length of time that veneers/crowns/bridges should last for. These time periods may vary from a very short time to a very long time depending upon many conditions existing from patient to patient, and/or upon each patient’s individual habits or circumstances, which may be either internal, external or both. It is the patient’s responsibility to immediately inform the dentist and seek attention from him/her should any under or unexpected problems occur, or if the patient is dissatisfied.

Also, all instructions must be diligently followed, including scheduling, and attending all appointments.

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 veneer/crown/bridge procedure. This ensures the optimum care for teeth, implants, prosthesis, and gums.

In essence, for long term success of implant treatment you have the following responsibilities:

Follow all the instructions regarding a soft diet, denture/prosthesis wear, gum, and teeth management.
Clean all the teeth/denture/implants/gums carefully and thoroughly as instructed.
Appear for periodic examinations and cleans/periodontal management 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 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.

Acknowledgement & 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 veneers/crowns/bridges. 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 to proceed with veneer/crown/bridge treatment.
I have further been informed of the possible risks and complications involved. I understand that such complications include pain, swelling, infection, discolouration, and acute or chronic pain or dysfunction associated with my jaw joint(s) or muscles. Numbness of the lip, tongue, chin, cheek, or teeth my occur.
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, necessity of extraction. Also possible is temporomandibular joint (jaw) problems, headaches, referred pains 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 the overall success of the veneer/crown/bridge treatment following final insertion.
It has been explained that in some instances veneer/crown/bridge treatment can fail. If this occurs, first line is to remove the veneer/crown/bridge and assess the underlying cause and replace or remove, as necessary. Alternatively, the option still exists to have the tooth removed at an earlier stage. I have been informed and understand that the practice of dentistry is not an exact science; no guarantee or assurance as to the outcome of results of treatment or surgery can be made.
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.
To my knowledge I have given an accurate report of 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 contemplated procedure, surgery, or treatment, conditions may become apparent which warrant, in the judgement 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 practise 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 be successful of that any risk, complication or injury will not occur.