Consent For Ridge Augmentation and/or Upper Jaw

Diagnosis

After a careful oral examination and study of my dental condition, my periodontist has advised me that I have insufficient bone in a horizontal and/or vertical dimension for implant placement. I understand that an appropriate volume of bone is necessary to stabilize a dental implant(s).

Recommended Treatment

In order to treat this condition, my periodontist has recommended ridge and/or sinus augmentation procedures be performed. I understand that sedation may be utilized and that a local anesthetic will be administered to me as part of the treatment.

Ridge Augmentation and/or Upper Jaw (Maxillary) Sinus Floor Elevation

The purpose of this treatment is to increase the volume of bone to successfully anchor a dental implant(s). Bone obtained either from my jaw, a bone bank allograft (human donor) or xenograft (animal donor), or a combination of any of the above will be used. The grafted material may be fastened with small screws, tacks, membranes or the combination of above. Biologic materials (growth factors) may also be added to increase the predictability of the procedure.

As in any oral surgical procedure there are some risks of post-operative complications. They include but are not limited to, the following:

• Swelling, bruising or discomfort in the surgical area.
• Bleeding – significant bleeding is not common, but persistent oozing can be expected for several hours or days.
• Nosebleeds (Sinus Elevation Surgery)
• Tearing of the sinus membrane (Sinus Elevation Surgery)
• Post-operative infection requiring additional treatment or medication.
• Tooth sensitivity, tooth mobility (looseness), or tooth pain.
• Numbness or altered sensations in the teeth, gums, lip, tongue or chin, around the surgical area following the procedure. Almost always the sensation returns to normal, but in rare cases, the loss may be permanent.
• Limited jaw opening due to the inflammation or swelling. Sometimes it is a result of jaw joint discomfort (TMJ), especially when TMJ disease already exists.
• Damage to adjacent teeth, especially those with large fillings, crowns or bridges.

Although success rates are quite high, there are occasions that the result will be less than adequate for implant placement. It has been explained to me that once grafted the entire treatment plan must be followed and completed on schedule. If this schedule is not carried out on schedule, additional procedures (ie bone grafts) may be required which will alter the proposed plan and treatment fees.

I hereby certify that I clearly comprehend the nature, purpose, benefits, risks and alternatives to (including no treatment), the proposed procedure(s). I have been given the opportunity to ask questions and they have been answered to my complete satisfaction.

I authorize photos, slides, x-rays or any other viewing of my care and treatment during or after its completion to be used for advancement of dentistry and for reimbursement purposes. However, my identity will not be revealed to the general public without my permission.

I have read and understand the above.