Printable Consent Form

DENTAL IMPLANT PLACEMENT

A dental implant is a titanium (or zirconia) post that is surgically placed into the jawbone to replace a missing tooth root. After healing (osseointegration), an abutment and crown, bridge, or denture attachment is placed on the implant. This consent covers the surgical placement of the implant fixture(s).

DESCRIPTION OF TREATMENT

The gum tissue is opened, a precise hole is prepared in the bone, and the implant is placed. A healing cap or cover screw may be placed. In some cases, bone grafting is performed at the same time. The site is sutured and allowed to heal for 3-6 months (or longer) before the restorative phase begins. Multiple appointments are required.

BENEFITS

• Provides a fixed, natural-looking tooth replacement that does not damage adjacent teeth
• Helps preserve jawbone and facial structure
• High long-term success rate when properly maintained
• Improved chewing ability, speech, and confidence compared to many alternatives

RISKS AND POSSIBLE COMPLICATIONS

Implant surgery carries specific risks in addition to general surgical risks:

• Failure of the implant to integrate with bone (osseointegration failure) - may require removal and possible re-placement
• Infection, peri-implantitis (inflammation/infection around the implant)
• Nerve injury resulting in temporary or permanent numbness, tingling, or pain in the lip, chin, tongue, or gums
• Sinus membrane perforation or sinus complications (upper jaw implants)
• Damage to adjacent teeth, roots, or restorations
• Fracture of the implant, abutment, or prosthetic components
• Bone loss around the implant over time
• Need for additional bone grafting or corrective procedures
• Prosthetic complications (loosening, chipping, poor esthetics)
• Allergic reaction (extremely rare)

I understand that implants can fail even with ideal care, and that long-term success requires excellent oral hygiene and regular professional maintenance.

ALTERNATIVES

• Traditional fixed bridge (requires preparation of adjacent teeth)
• Removable partial or full denture
• No replacement (may lead to shifting teeth, bone loss, and bite problems)
• Resin-bonded (Maryland) bridge (limited applications)

PATIENT ACKNOWLEDGEMENT

• I understand the multi-stage nature of implant treatment and the need for healing time before final restoration.
• I have been informed of the expected timeline, number of visits, and costs involved.
• I consent to bone grafting or sinus lift procedures if deemed necessary during surgery.
• I agree to maintain excellent oral hygiene and attend all follow-up and maintenance appointments.
• I understand that smoking, diabetes, and certain medications can significantly increase failure risk.

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.