Download Golpa All-on-4® Extended Warranty and Maintenance Progran

Golpa All-on-4® Extended Warranty and Maintenance Program
Patient Name:__________________________________________________________
Nobel Biocare and Dr. Golpa guarantee to replace any Nobel Biocare implant that fails to remain
in the bone in which it is implanted. Nobel Biocare will replace free of charge the implant and
Nobel Biocare restorative components placed on the implant at the time of failure with the same
Nobel Biocare implant and restorative components as installed on the implant at the time of
failure (the only possible changes are related to diameter and/or length).
Your PMMA/Titanium bridge(s) are warrantied for a period of 5 years. Within the warranty
period we will repair or replace bridges that fail due to workmanship at no charge. This period
can be extended indefinitely through our Maintenance and Extended Warranty Program.
Your Prettau Zirconia bridge(s) are warrantied for 15 years. Within the warranty period we will
repair or replace bridges that fail due to breakage at no charge. This period can be extended
indefinitely through our Maintenance and Extended Warranty Program.
*Smoking, Diabetes, improper home care, and failure to maintain professional cleaning
appointments voids all warranties.
Your All-on-4® bridge/s and implants should receive special care and maintenance every 6
months. If you choose to participate in our voluntary Level A extended maintenance and
warranty program a complete assessment of your dental implants and bridge(s) will be
conducted at each re-care appointment which will include:
Visual assessment of the patient; including examining the patient for signs of inflammation,
bleeding, changes in probing depths, mobility, or exudate around the implant(s), and
debridement of the your dental prosthesis. In addition, we will radio-graphically examine your
Implant(s) to determine whether changes have occurred in bone levels. We will also conduct a
careful review of your current medications, as well as a review of your health status.
Golpa All-on-4® Extended Warranty and Maintenance Program
The Golpa Extended Warranty and Maintenance program is designed to ensure the long-term
success of your All-on-4® restoration.
Due to the nature of the tissue attachment surrounding the implant(s), Dental Implants may be
more susceptible to inflammation and bone loss when plaque accumulates. Proper maintenance
of the your tissues will ensure longevity of the Implant(s). Your home-care routine can
significantly influence Implant success. After your re-care appointment, a patient-specific homecare routine is developed for you.
The purpose of your re-care maintenance appointment is to identify if there is a problem or
potential problem that needs attention, and to reline your bridge(s) to insure proper fit.
6420 Medical Street Suite 101
Las Vegas, NV 89148
1-800-797-0406
1
Your initial re-care maintenance appointment is included in your treatment, and should be set
for no later than 4-6 months following surgery.
Participants in our extended warranty and maintenance program also have the option of
replacing the bridge(s) every 5 years (PMMA/Titanium) or 15 years (Prettau Zirconia), at no
charge.
Level A: return to our office bi-annually for maintenance, bridge(s) replacement, and hotel is
included.
Level B: have your cleaning and maintenance locally, bridge(s) replacement and hotel is
included.
With proper care and maintenance you All-on-4® bridges can last a lifetime. Our goal is to
provide you the most durable and aesthetic restorations possible. If there is ever anything we
can do to ensure your oral health we will be here for you.
_____ I would like to sign up for the Level A extended warranty and maintenance program to
ensure the long-term success of my All-on-4® Restoration and protect the investment I have
made in my Oral Health. I understand that this program has a one-time cost of $2,500.00 and
will protect my restoration for life.
_____ I would like to sign up for the Level B extended warranty and maintenance program to
ensure the long-term success of my All-on-4® Restoration and protect the investment I have
made in my Oral Health. I understand that this program has a one-time cost of $1,500.00 and
will protect my restoration for life.
Golpa All-on-4® Extended Warranty and Maintenance Program
There are two levels of participation in the program
____ I do not wish to participate in Extended Warranty and Maintenance Program at this time. I
understand the risk of complications that may arise from the improper maintenance of my
restorations, and I am willing to accept these risks.
Patient Name: _______________________________
Date:__________________________
6420 Medical Street Suite 101
Las Vegas, NV 89148
1-800-797-0406
2
Office Use Only
Plan Start Date:_______________________
First Maintenance Appointment Date: ____________________
Golpa All-on-4® Extended Warranty and Maintenance Program
Chart # __________________________
3
6420 Medical Street Suite 101
Las Vegas, NV 89148
1-800-797-0406