Aziz Bohra, DMD, MS

13065 W. McDowell Suite A101, Avondale, Arizona 85392


Consent for Ridge Augmentation Bone Regenerative Surgery

Dr. Aziz Bohra/ Dr. Trever Siu

Patient Name:
Cell Phone

Diagnosis: After a careful examination and study of my dental condition, I have been advised that I have bone loss where some missing tooth/teeth are. This lack of bone does not allow the placing of dental implants or leaves an unaesthetic/poor functioning area for dental bridgework.

Recommended Treatment: In order to treat this condition, it has been recommended that my treatment include bone regenerative (ridge augmentation) surgery. Local anesthetic will be administered to me as part of the treatment. Antibiotics and other medications may be given. During this procedure, the gums will be opened to permit better access to the eroded bone. Bone irregularities may be reshaped with a dental drill. Bone graft material will be placed in the areas of bone loss. Various types of graft materials may be used. These materials may include my own bone, synthetic bone substitutes, animal bone material (cow or pig) or bone obtained from tissue banks (human donors). Synthetic membranes made of PTFE (a derivative of what GoreTex® is made from) or collagen wafer membranes made from the Achilles tendons of animals (cow or pig) may be used, depending on the type of bone defect present. Membranes tend to hold the bone graft material in place while it heals. My gum will be sutured back into position over the above materials. I understand that unforeseen conditions may call for a modification or change from the anticipated surgical plan. These may include, but are not limited to,

  1. Placing the dental implant(s) at the same time the ridge augmentation bone regeneration surgery is done
  2. Termination of the procedure prior to completion of all of the surgery originally outlined

Expected Benefits: The purpose of ridge augmentation bone regeneration surgery is to “grow” bone back to hopefully allow dental implant placement either at the same time as this surgery or 6 to 9 months later. Another purpose of ridge augmentation surgery may be to build a resorbed ridge for better esthetics and function where a fake tooth will go as part of doing a dental bridge.

Principal Risks and Complications: I understand that some patients do not respond successfully to bone regenerative procedures. The procedure may not be successful in preserving function or allowing a dental implant to be placed. Because each patient’s condition is unique, long-term success may not occur. Complications that may result from surgery could involve bone regenerative materials, drugs, or anesthetics. These complications include, but are not limited to, post-operative infection, bleeding, swelling, pain, facial bruising, numbness of the jaw, lip, tongue, teeth, chin or gum, jaw joint injuries or muscle spasm (both normally temporary but on rare occasions permanent), increased tooth looseness, tooth sensitivity to hot, cold, sweet or acid foods, shrinkage of the gum upon healing resulting in elongation of some teeth and greater spaces between some teeth, temporary 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, and accidental swallowing of foreign matter. The exact duration of any complication cannot be determined and may be irreversible. There is no method that will accurately predict or evaluate how my gum and bone will heal. There may be a need for a 2nd procedure if the initial results are not satisfactory. In addition, the success of oral surgery and dental implant procedures can be affected by medical conditions, dietary and nutritional problems, smoking, excessive alcohol consumption, snuff and chewing tobacco, clenching and grinding of teeth, inadequate oral hygiene, and medications that I may be taking. To my knowledge, I have reported to my periodontist any prior drug reaction, allergies, diseases, symptoms, habits or conditions that might in any way relate to this surgical procedure. I understand that my diligence in providing the personal daily care recommended by my periodontist and taking all medications prescribed are important to the success of the procedure.

Alternatives to suggested Treatment: I understand that alternatives to ridge augmentation surgery may include:

  1. No treatment
  2. Dental bridgework
  3. Removable partial dentures
  4. No teeth replacement

Necessary Follow-up Care and Self-Care: It is important for me to continue to see my regular dentist for routine dental care and to get the missing tooth/teeth replaced as recommended. I understand smoking and smokeless tobacco may adversely affect healing and may cause pain and/or a poor result, especially if used during the 1st month, If you must smoke, keep it under 5 cigarettes a day and only smoke the 1st half of the cigarette and discard it. No smokeless tobacco. I should not use a water-pik for 3 months. I have told Dr. Bohra/ Dr. Siu about any pertinent medical conditions I have, known allergies (especially to medications or sulfites (many local anesthetics have sulfite preservatives), and medications I am taking, including over the counter medications such as aspirin, nutritional supplements and herbs. I have told Dr. Bohra/ Dr. Siu about any present or prior head and neck radiation therapy. I have told Dr. Bohra/ Dr. Siu about any present or prior use of bisphosphonate medications.Some common brand names are Zometa®, Aredia®, Boniva®, Fosamax®, and Actonel®. I need to come back in for several post-operative check-ups so that healing may be monitored and so Dr. Bohra/ Dr. Siu can evaluate and report on the outcome of surgery to my dentist. It may be necessary to remove both non-resorbable sutures and non-resorbable membranes used in the bone regeneration surgery. I know that it is important to:

  1. Abide by the specific prescriptions and instructions given.
  2. See Dr. Bohra/ Dr. Siu for post-operative check-ups as needed.
  3. Not smoke or use smokeless tobacco for 1 month as noted above.
  4. Avoid water-piks for at least 3 months.
  5. Have any non-dissolvable sutures (stitches) and membranes removed.
  6. Get the tooth/teeth replaced as recommended.

No Warranty or Guarantee: While in most cases bone regenerative surgery heals quickly and without any problems, complications such as those listed previously, can happen despite the best of care.

Females Only: Antibiotics may interfere with the effectiveness of oral contraceptives (birth control pills). Therefore, I understand that I will need to use some additional form of birth control for one complete cycle besides just birth control pills after a course of antibiotics is completed.

Patient Consent I have been informed of the nature of the ridge augmentation oral surgery, the procedure to be utilized, the risks and benefits of this surgery, the alternative treatments available, and the necessity for follow-up and self-care. I have had an opportunity to ask any questions I may have in connection with the treatment and to discuss my concerns with Dr.Bohra/ Dr. Siu and his staff members. After thorough deliberation, I hereby consent to the performance of the oral surgery as presented to me during consultation as described above. I also consent to the performance of such additional or alternative procedures as may be deemed necessary in the best judgment of Dr.Bohra/ Dr. Siu.

Patient's Signature:

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