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INFORMATION
PROCEDURE involves local anaesthetic, creating suitable sized space for insertion of implant in the bone. If the
procedure involves bone graft it will be discussed separately. Leaflets regarding details of the procedure are
available. Surgery will cause some discomfort, swelling and bleeding. The symptoms are generally well controlled
with analgesics. Success rate with implants is about 95%. It is slightly lower in smokers. If an implant fails, it needs
to be removed. Implant restorations need good hygiene maintenance for their long term success. The crowns and
bridge or restorative work may need repair and maintenance on the long term and this may incur significant costs.
Treatment duration varies depending on healing. We will give you the best possible intermediate prosthesis
during the process of treatment. It may be inevitable in some circumstances that you may not be able to wear
temporary dentures for a short space of time.
There is no method to accurately predict the gum and bone healing abilities in each patient following implant
surgery. To this end no guarantees or assurances as to the outcome of results can be made. As the implant does
not replace missing soft tissue, often it may be necessary to compromise the gum margin appearance or replace
it with pink prosthetic material.
Medical knowledge changes continuously and new information becomes available all the time regarding various
aspects. New information and knowledge may change treatment philosophies in future.
CONSENT
I have read and understood the above information and discussed in detail the procedure, risks,
benefits, options and long term needs related to implant based dental restorations. I have considered
all alternatives carefully. All my questions related to implant treatment have been answered to
satisfaction.
I give consent to carry out
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Examination and investigations
Surgical placement of dental implants
Additional procedures as soft tissue surgery and grafts
Restoration using dental implants
Photography, filming and radiographs to be recorded and used for educational
purposes.
I agree to follow all home care instructions given to me by the dentist. To the best of my knowledge I
have given an accurate history about my health, medications and allergies. I understand the importance
of regular maintenance visits following implant treatment to ensure long and healthy life of implants. I
will seek regular implant check up appointments with my dental practitioner or dentist providing the
restorative treatment.
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I have asked all relevant questions related to my treatment.
I have received a definitive treatment plan and all other alternate options available in
writing and have considered the options carefully.
I have received in writing, the cost of my treatment, both for surgical and restorative
stages. I agree to pay the fees as per schedule.
I have understood the approximate time needed to complete this treatment process.
Patient Name
Date and Signature.
Mr K Shanbhag Dental Surgeon