Consent Issues

Please PRINT and sign the consent form and Medical history form below and bring both of these along to the surgery for your appointment.

PRINTABLE Consent Form for Implant Therapy (opens in a new window)

PRINTABLE Medical History Form (opens in a new window)

Consent for Implant Therapy

It has been explained and I understand that:

• The implant may not integrate within the bone and may need replacing or that I may not be able to support an implant at all.
• In the event of implant failure, no money will be returned. Insurance can be taken out to insure free replacement.
• There is a small chance that over time the bone supporting the implant, just as the bone supporting the teeth, may be lost and the implant may then fail. Similarly, recession around the adjacent teeth can occur following implant placement.
• Swelling and discomfort may be experienced following the procedure.
• There is a risk of permanent nerve damage or damage to adjacent structures such as nearby teeth.
• The prosthetic components on top of the implants (crowns or bridges) may need replacement after a period of time.
• Due to the nature of bone being lost following the loss of teeth the implant and associated crown may not look identical to the teeth previously present.
• Antibiotics and analgesics are commonly used as part of this treatment and I am not allergic to these drugs.
• In the event that the quantity of bone available is insufficient to support an implant placed in the correct position it may be prudent to use a bone substitute and membrane to promote bone growth around said implant. This will incur an extra cost of £359.94 and is of bovine (cow) derivative.
• If there is insufficient bone volume to support an implant it may be necessary to perform a two-stage procedure with bone augmentation as the first stage and implant placement at a second stage three months later. Additional cost will obviously be incurred.
• Any photos taken during the procedure may be used to demonstrate techniques, etc.