Consent for Dental Implants
The gum and soft tissue will be stitched closed over or around the implants. A periodontal bandage or dressing may be placed.
Healing will be allowed for a period of three to six months. I understand that dentures usually cannot be worn during the first
one to two weeks of the healing phase.
I further understand that if clinical conditions turn out to be unfavorable for the use of this implant system or prevent the
placement of implants, my dentist will make the professional judgment on the management of the situation. This procedure
also may involve supplemental bone grafts or other types of grafts to build up the ridge on my jaw and thereby assist in
placement, closure, and security of my implants.
For implants requiring a second surgical procedure, the overlying tissues will be opened at the appropriate time, and stability of
the implant will be verified. If the implant appears satisfactory, an attachment will be connected to the implant. Plans and
procedures to create an implant prosthetic appliance can then begin.
I understand that complications may result from the implant surgery, drugs, or anesthetics. These complications include, but
are not limited to post-surgical infection, bleeding, swelling and pain, facial discoloration, transient but on occasion permanent
numbness of the jaw, lip, tongue, teeth, chin or gum, jaw joint injuries or associated muscle spasm, transient but on occasion
permanent increased tooth looseness, tooth sensitivity to hot, cold, sweet or acidic foods, shrinkage of the gum upon healing resulting in elongation of some teeth and greater spaces between some teeth, cracking or bruising of the corners of the mouth,
restricted ability to open the mouth for several days or weeks, impact on speech, allergic reactions, injury to surrounding teeth,
bone fractures, nasal sinus penetrations, delayed healing, and accidental swallowing of foreign matter. The exact duration of
any complications cannot be determined, and they may be irreversible. In rare cases, it may be necessary to refer some postoperative
complications to another doctor. The costs associated with any consultation or treatment with other doctors will be
the patients responsibility.
Implants themselves and the prosthesis supported by implants can break and may require additional treatment. Habits and
health conditions such as smoking, grinding of teeth, certain diseases, and medications can negatively effect the long term
success of implants and should be discussed with your dentist.
Patient Consent
I have been fully informed of the nature of root form implant surgery, the procedure to be utilized, the risks and benefits or
implant therapy, the alternative treatments available, and the necessity for follow-up and self-care. I have had the opportunity
to ask questions I may have in connection with the treatment and to discuss my concerns with my dentist. I affirm that I have
had all my questions or concerns addressed to my satisfaction. After thorough deliberation, I hereby consent to the
performance of dental implant surgery by Brent Call D.M.D, a general dentist, as presented to me during consultation and in
the treatment plan presentation as described in this document. I also consent to the performance of such additional or
alternative procedures as may be deemed necessary in the best judgment of my dentist and Dr. Call
If clinical conditions prevent the placement of implants or require an alteration in the planned restorative procedures, I defer to
my dentist’s judgment on surgical and restorative management of that situation. I also give my permission to receive
supplemental bone grafts or other types of grafts to build up the ridge of my jaw and thereby to assist in placement, closure,
and security if my implants.
I understand that if at anytime I develop complications, concerns, or changes occur in the way my implant feels I must contact
my dentist immediately.
I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THIS DOCUMENT.