IMPLANT CONSENT FORM WHAT ARE DENTAL IMPLANTS?

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1 IMPLANT CONSENT FORM WHAT ARE DENTAL IMPLANTS? Dental implants are a very successful and accepted treatment option to replace lost or missing teeth. A dental implant is essentially an artificial tooth root which can be used to support a number of dental prostheses, such as crowns, bridges or dentures. The implant fixture, or artificial root, is commonly connected to a supporting structure by way of a screw that then supports the replacement tooth/teeth. The implant is constructed of a strong, biocompatible material called titanium which becomes integrated with the jaw bone a process called osseo-integration. WHAT ARE THE ADVANTAGES OF DENTAL IMPLANTS? Dental implants are essentially a third set of teeth. Implants are a flexible treatment option that can be used to replace one or multiple teeth. They often remove the need for bridges, partial or full dentures. They provide much more confidence, and in most cases the aesthetic result is superior to that of dentures and bridges. Implant dentistry can allow teeth to be replaced without the need to remove tooth structure from adjacent teeth. Dental implants are not susceptible to dental decay. They do not predispose your remaining teeth to dental decay and periodontal disease, as is the case with dentures. The implant helps to preserve the bone and gum tissue that can be lost after tooth loss. Replacement of teeth with implants provides an improvement in speech and ability to chew foods, improves taste and temperature perception, self-confidence and overall quality of life. Generally dental implants are easily maintained but good oral hygiene is crucial and it is important that implants are are reviewed regularly by your dental team. WHO CAN BENEFIT FROM AN IMPLANT? People who have lost teeth through trauma, dental decay, failed root canal treatment, fractured teeth or have congenitally absent teeth are good candidates for dental implants. People who have loose, uncomfortable dentures or who would like to get rid of their denture can benefit from implants. Those who find cleaning around dental bridges difficult can benefit from implants. Adolescents and children who are still developing physically are not suitable patients for dental implants.

2 HOW DO I KNOW IF I AM SUITABLE FOR IMPLANTS? A detailed medical history, dental examination and appropriate radiographs/scans are required to assess suitability for this treatment. Various factors such as your bite, overall dental and medical health can influence the success of dental implants. Certain medical conditions such as severe heart disease, uncontrolled diabetes, immunosuppression, psychiatric disorders, osteoporosis and cancer are absolute or relative contra-indications to implant treatment. WHAT PROCEDURES ARE INVOLVED IN DENTAL IMPLANT TREAMENT? PATIENT ASSESSMENT Prior to treatment each potential implant recipient must be carefully evaluated. Overall medical health, psychological conditions, oral and social habits such as smoking and alcohol consumption; availability of bone and soft tissue; available space and the relationship of the teeth and jaws; and patient expectations are all important factors in determining suitability for implants. The assessment of suitability for implant treatment will usually consist of all or some of the following: Patient interview, review of medical history, clinical examination, intra-oral and extra-oral photographs, impressions for study models, diagnostic imaging with digital radiographs, CT scans or icat scans, radiographic guide construction and 3D computer modelling of the patient s jaws. These records are also used to determine and plan precise placement of the implant fixture(s). IMPLANT TREATMENT Traditionally this is divided into 3 phases. Stage 1 This is the surgical phase where the implant is placed in the jaw. This is usually carried out as a local anaesthetic procedure and will be undertaken under strictly sterile conditions. Digital radiographs will be taken during this procedure to confirm positioning. Depending on the stability of the implant at this stage, a healing cap (also called an abutment) may be able to placed directly on the implant and this can reduce or remove the need for stage 2 surgery. You will be provided with an information sheet outlining the pre and post-operative instructions for this stage at your pre-operative implant appointment. A post-operative review appointment is usually scheduled for 10 to 14 days post- surgery to remove any stitches and review your healing. The healing period required for osseointegration is usually 3 to 6 months.

3 Stage 2 Surgery to expose the implant is often required and again is a relatively simple procedure performed under local anaesthetic. A different healing abutment is placed on the implant and the area is allowed to heal prior to placement of the final restoration. Occasionally, soft tissue manipulation with a temporary prosthesis is required before proceeding to the definitive restoration. Once again, digital radiographs will be taken to confirm healing. Stage 3 This is very similar to conventional crown and bridgework treatment. An extremely accurate impression is taken and usually at least 3 weeks is required before the final crown/bridge is placed. Digital radiographs will be taken to confirm the fit of your prosthesis. The timings for this stage can be quite different for those patients with dentures. HOW SUCCESSFUL IS IMPLANT TREATMENT? No guarantee for success can be given. The success rates for implant treatment however are very high but vary from individual to individual. The success rate in the lower jaw may, depending on individual circumstances be as high as 98%, and 90 95% in the upper jaw. Success rates are lower further back in the mouth, as bone quality and quantity is not as good, but generally the chances of a successful outcome is over 90%. Smoking is a major risk factor for the failure of implants, and patients are strongly encouraged to cease smoking at least 3 months prior to implant placement. As each patient is different it is impossible to predict how long a dental implant will last. Factors that can affect the long term outcome of implants are overall health and nutrition; oral hygiene and maintenance regimes, periodontal disease, occlusion and tobacco use. POSSIBLE COMPLICATIONS FROM DENTAL IMPLANTS As with any form of surgery there are inherent risks and limitations. Although rare, these possibilities should be considered in making an informed decision prior to proceeding with treatment. The utmost care is undertaken to avoid these adverse outcomes. 1. Infection This is a risk with any surgery. Through the use of prescribed antibiotics, appropriate use of mouth rinses and a sterile surgical technique, this is complication is infrequent. However, the mouth harbours many different strains of bacteria, and if the surgical site becomes infected it can delay or compromise healing. This can affect treatment duration. 2. Inferior Dental and Lingual Nerve Damage These are major nerves in the lower jaw that supply sensation to the lower teeth, lower lip and tongue. These nerves would normally only be of concern when replacing teeth in the posterior region of the lower jaw. The possibility of damage to these nerves is remote as most often digital

4 radiographs, CT scans or icat scans will allow for proper assessment and positioning so that there is no direct trauma to these important structures. Trauma can lead to either partial or complete numbness, however even with complete numbness it is possible for the nerves to recover. Indirect trauma caused by inflammation around the surgical site can also lead to a transient paraesthesia (tingling) of these nerves that will recover once the inflammation has recovered. 3. Damage to Adjacent Teeth Roots of teeth adjacent to the implant site can be damaged during placement of the implant. Once again, the possibility of damage to adjacent teeth is remote as digital radiographs, CT scans or icat scans will allow for proper assessment and positioning. Digital radiographs may be taken during your implant surgery to confirm positioning. 4. Implant Failure- This can still occur irrespective of the skill, care and experience of the dentist and the care and attention to maintenance taken by the patient. It can be immediate or delayed, even after the implant has osseo-integrated with the jawbone. Some possible causes can be micro-movement during healing, lack of initial stability, infection, excessive forces on the implant, poor bone quality or metabolism, systemic disease, smoking, abnormal inflammatory response, poor oral hygiene and preexisting periodontal disease. The success rate of implants in our practice is between 90 and 98 % which is a very predictable result in any medical procedure. Almost all failures will be evident after stage 1. If the implant does fail, then it needs to be removed. The bone and soft tissue will repair and in most cases it is possible to then place another implant. 5. Sinus Involvement In the posterior region of the upper jaw the sinus floor can drop down when teeth are lost. Therefore, the amount of available bone is reduced and it is possible that the sinus can become involved. If the sinus appears to be too close for implant placement there are procedures available to improve the situation prior to implant placement. 6. Aesthetics and Gum Profile - You may notice that the gum levels may be slightly higher or lower. Perfect aesthetics cannot be guaranteed, however, the ability to function normally is retained. All efforts will be made to minimise the display of metallic components, but some metallic components may become visible due to recession which may occur as a part of the ageing process. Excellent oral hygiene will help to minimise recession. 7. Smoking - Recent studies show that the failure rate may be as high as 38%. No responsibility can be taken if you smoke.

5 FEE STRUCTURE WHAT THE FEES COVER The fees cover all of the above stages of treatment, and immediate post-operative care. Prior to commencement of treatment you will provided with an estimate for your implant treatment. This will include both the surgical and restorative phases. WHAT THE FEES DO NOT COVER It is impossible for even the most experienced clinician to foresee all eventualities. As a matter of principle, it is not our wish to profit from the unexpected, however, there may be unexpected additional costs. These costs may be incurred through: 1. Emergency treatment with other dentists 2. Unforseen or additional treatment 3. Delay to treatment due to patient circumstances. MAINTENANCE Preventive care appointments with both your dentist and dental hygienist are essential to monitor the health of your implants and teeth, and to assist you with your oral hygiene and home maintenance procedures. The occlusion (bite) on your implant may change over time and may lead to excessive and detrimental forces being placed on your implant which can contribute to eventual implant failure. Your dentist will check the occlusion on your implant at your preventive care appointment. These preventive care appointments should not be any more than 6 months apart. Radiographs taken 1 year after surgery and then every 2 years thereafter to monitor bone support are very important. If you take up a contact sport then a well fitting mouthguard needs to be constructed by your dentist to protect your implants. If your teeth or implant prosthesis show evidence of bruxism (grinding) then an occlusal splint needs to constructed to prevent excessive and damaging forces from being placed on your implants which can contribute to eventual implant failure.

6 CONSENT FOR IMPLANT TREATMENT If you have any questions after reading this document, or during treatment do not hesitate to question us on any concerns you may have. I,, acknowledge that I have read the attached document Implant Consent Form and understand the benefits, procedures, possible complications and risks and the maintenance involved. I also consent to the taking of photographs and radiographs before, during and after implant treatment to allow for proper treatment planning and maintenance. Signature: Date: For the purpose of education, publication in professional journals and/or staff training we sometimes use de-identified photographs, radiographs and records from our implant procedures. We are not permitted to use these photographs or radiographs without your consent. Whether you provide or withhold consent to the use of your records, will not affect your treatment at Medland Dental Centre. I do/do not consent to these photographs, radiographs and records being used for the purpose of education or publication in professional journals. Signature: Date: