DENTAL AND MAXILLOFACIAL IMPLANTS
REVISED DECEMBER 2004
The purpose of this document is to provide written information regarding the risks, ben-
efits and alternatives of the procedure named above. This material serves as a supple-
ment to the discussion you have with your physician. It is important that you fully un-
derstand this information, so please read this document thoroughly.
The Procedure: To provide implants into the bone to support crowns, bridges, den-
tures and other prostheses.
You might receive the following benefits. 1. Provide a stable base for dental or
The doctors cannot guarantee you will re- maxillofacial rehabilitation
ceive any of these benefits. Only you can 2. To improve function
decide if the benefits are worth the risk. 3. To improve appearance
I have been informed about and had an 7. That no guarantees or assurances
opportunity to discuss the following: can be made as to the outcome of this
1. The alternative treatments which can or any related procedure.
be performed instead of implants. 8. That implants are occasionally placed
2. The nature of the surgical procedure and not used.
and what is needed to place dental 9. That multiple surgeries may be re-
implants. quired for this procedure.
3. That without treatment my condition 10. That a waiting period of at least three
may remain the same or become to six months will be necessary before
worse. the implant can be utilized to restore
4. That without proper restoration of the teeth.
teeth and function, loss of bone or 11. That I may be unable to wear a den-
gum tissue, inflammation, infection, ture for a period of time after each
sensitivity, looseness of teeth, stiff- surgical procedure.
ness of jaw muscles, temporo- 12. That speech, chewing, and appear-
mandibular joint problems, headaches ance may be affected by the use of
and other problems could occur. implants.
5. That there is no method to accurately 13. That implants which fail and are re-
predict the soft tissue and bone heal- moved may be replaced after a suffi-
ing following the use of implants. cient period of time for healing.
6. That implants fail and have to be re- 14. That maintenance of adequate oral
moved on occasion. hygiene is critical to the success of
this procedure and that I will be re-
sponsible for this phase of my treat- 3. Bleeding
ment. 4. Swelling
15. That periodic visits to the dentist will 5. Failure of the implants
be required for the life of the implant 6. Facial discoloration
for maintenance of its function. 7. Numbness of the lips, chin, teeth,
16. That the implant may be visible. gums or tongue-temporary or perma-
17. That certain materials ( e.g. mem- nent
branes, artificial bone, screws) may 8. Inflammation of veins from medica-
be used to supplement the implant tions
surgery and that the cost of these ma- 9. Muscular injury and stiffness
terials is separate from the cost of the 10. Changes in occlusion
implants. 11. Changes in TMJ function
Before undergoing one of these proce- 12. Scarring
dures, understanding the associated risks 13. Damage to adjacent teeth, bone or
is essential. No procedure is completely gums
risk-free. The following risks are well rec- 14. Jaw fracture
ognized, but there may also be risks not 15. Sinus or nasal inflammation,
included in this list that are unforeseen by drainage, communication or infection
your doctors. 16. Need for additional surgeries such as
1. Pain soft or hard tissue grafting
The alternatives to this procedure include If you decide not have this procedure,
1. No treatment there are associated risks to this deci-
2. Alternative means of dental or max- sion. Please discuss this with your doc-
illofacial restoration tor.
If you have any questions regarding the procedure, risk, benefits or alternatives to this
procedure, ask your physician prior to signing any consent forms.