Printable Consent Form

A bone graft or ridge preservation procedure is recommended to rebuild or maintain bone volume in an area where a tooth has been lost or extracted. This helps preserve the site for future dental implant placement or to support adjacent teeth and gums.

DESCRIPTION OF TREATMENT

The procedure involves placing bone graft material (synthetic, bovine, human donor, or your own bone) into the extraction socket or deficient area. A membrane or protective dressing may be placed over the graft. Sutures are typically used to close the site. The area is allowed to heal for several months before any implant or further restorative work.

BENEFITS

Helps maintain or rebuild bone volume after tooth loss or extraction

Increases the likelihood of successful future dental implant placement

Helps prevent shifting of adjacent teeth and collapse of the gum and bone ridge

Can improve the long-term functional and aesthetic outcome of restorations

RISKS AND POSSIBLE COMPLICATIONS

As with any surgical procedure, risks exist. These include, but are not limited to:

Pain, swelling, bruising, and discomfort (usually temporary)

Infection at the surgical site

Bleeding or hematoma formation

Graft failure, partial loss, or need for additional grafting

Allergic reaction or rejection of graft material (rare)

Injury to adjacent teeth, nerves, or sinus (for upper jaw procedures)

Prolonged numbness or altered sensation (usually temporary)

Delayed healing or exposure of graft material

Need for additional surgery or alternative treatment

I understand that bone grafting is not a guarantee of future implant success or perfect bone volume.

ALTERNATIVES

No grafting and allowing the site to heal naturally (may result in significant bone loss)

Proceed directly to a bridge or removable partial denture (if applicable)

Delay treatment and reassess at a later time

Use of alternative graft materials or techniques

PATIENT ACKNOWLEDGEMENT

• I have read and understand this consent form and have had the opportunity to ask questions.

• I understand there are no guarantees regarding the outcome of this procedure.

• I consent to the use of local anesthesia and any other medications deemed necessary.

• I agree to follow all pre- and post-operative instructions provided by Indy Smile Group.

• I understand that smoking, certain medical conditions, and poor oral hygiene increase risks and may compromise results.

PATIENT / GUARDIAN ACKNOWLEDGEMENT AND CONSENT

I have read (or had read to me) and understand this consent form. I have had the opportunity to ask questions, and all of my questions have been answered to my satisfaction. I understand the risks, benefits, and alternatives of the proposed treatment. I voluntarily consent to the treatment described above.