The procedures associated with dental implant surgery have been discussed with me by my healthcare professionals at Toothworx, including the risks.
I was presented with other alternatives or alternate methods and treatments other than dental implant surgery. I understand that dental implant surgery and implant prosthesis( crown, bridge or denture) will be my choice to help secure or replace my missing teeth.
I am fully aware and I acknowledge that dentistry and dental surgery is not an exact science. I understand that there are no guarantee to the success of a dental implant and other associated treatments and procedures.
I understand that during treatment, certain conditions may become apparent and may warrant modifications to the intended treatment. In this case, I authorize Toothworx to complete the procedure they recommend as the best treatment.
I have been informed that there are possible risks and complications involving the treatment relating to medication, procedure, or anesthetics such as the feeling of pain, infection, swelling, numbness in parts of the mouth, including lips, tongue, or face. I understand that the estimated period of recovery from anesthetics is not guaranteed and, under rare cases, possibly irreversible. I understand that instances of inflammation, bone fractures, sinus perforation, and medical or drug allergic reactions may happen and may result in delayed healing.
I likewise understand and assume the risk that the procedure may fail, which may require other dental procedures or may require the removal of the dental implant. In these cases, another implant will be placed, at no cost to the patient, if it fails within the first 6 months of placement, and the patient is not a smoker, is medically healthy and keeps up with recommended hygiene appointments. If a dental implant fails twice, other treatment options should be reviewed and there will be no refund of previous treatment will be rendered. In these cases, an alternative treatment is required, and it shall be treated as a new procedure and shall not be covered by previous treatments made, as to fees.
I understand the possible complications associated with dental implants. These can be as follows but are not limited to: improper fitting prosthesis, improper occlusion, material failure, peri-implantitis (inflamation/infection around an implant), or breakage of an implant component or prosthesis. In these circumstances, I may need to undergo surgical removal of the implant and may need to opt for alternate methods of treatment.
I certify that I have read and understand the above information. I consent to the procedure knowing its risks and limitations. I authorize my dentist to place the dental implant(s) and prostheses and that it is my intention to have the foregoing treatment carried out in the next month.