Printable Consent Form

CROWN AND / OR BRIDGE TREATMENT

A crown (cap) is a custom-made restoration that covers an entire tooth to restore strength, function, and appearance. A bridge replaces one or more missing teeth by using crowns on the adjacent teeth (abutments) to support an artificial tooth (pontic) in between.

DESCRIPTION OF TREATMENT

The tooth (or teeth) is prepared by removing outer tooth structure to create space for the crown/bridge. An impression or digital scan is taken. A temporary crown or bridge is placed to protect the teeth while the permanent restoration is fabricated in a dental laboratory (usually 1-3 weeks). At the final appointment, the temporary is removed and the permanent crown or bridge is tried in, adjusted, and permanently cemented or bonded.

BENEFITS

• Restores strength and function to heavily damaged, fractured, or root-canal-treated teeth
• Improves appearance, alignment, and bite
• A bridge provides a fixed (non-removable) replacement for missing teeth
• Protects the remaining tooth structure and helps prevent further breakdown

RISKS AND POSSIBLE COMPLICATIONS

• Tooth sensitivity or pulp irritation - may require root canal treatment (even if not needed initially)
• Fracture or chipping of the crown/bridge material (porcelain, zirconia, etc.)
• Loosening or loss of the restoration requiring re-cementation or replacement
• Decay developing under the crown/bridge if oral hygiene is inadequate
• Gum irritation or recession around the margins
• Bite changes or discomfort requiring adjustment
• Aesthetic limitations (color match, translucency, metal show-through on some designs)
• Need for replacement of the crown or bridge over time (typically 10-15+ years with good care)
• Risk to abutment teeth of a bridge (they become more susceptible to problems)
• Temporary restorations are fragile. Breaking or loss of a temporary may require additional visits and fees.

ALTERNATIVES

• Large fillings or onlays/inlays (may be less durable for high-stress areas)
• Extraction and implant (if the tooth is not restorable)
• Removable partial denture
• No treatment (may lead to further damage, pain, or tooth loss)

PATIENT ACKNOWLEDGEMENT

• I understand that teeth prepared for crowns or bridges are permanently altered.
• I understand that root canal treatment may become necessary after crown placement.
• I will care for my temporary restoration and contact the office immediately if it breaks or comes off.
• I agree to return for the permanent placement appointment and all follow-up care.

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.