Informed Consent - Direct & Indirect Restorations
  • I have been advised of and understand that treatment of dental conditions requiring crowns, fixed bridgework and/or fillings includes certain risks and possible unsuccessful results, including the possibility of failure. Even when care and diligence is exercised in the treatment of conditions requiring crowns, bridgework, fillings and fabrication of same, there are no promises or guarantees of anticipated results of the length of time that the restoration will last.
Potential Benefits:
While there are risks to all dental treatment, including direct and indirect restorations, I agree to assume the risks associated with the restoration, as the benefits outweigh the risks. These benefits may include:
  • Strengthening of tooth structure
  • Replacing a damaged or broken tooth
  • Protecting a worn tooth
  • Removing tooth decay
  • Reducing or eliminating discomfort
  • Anchorage for a dental appliance
Risks include but are not limited to the following:
  • Reduction of tooth structure: To replace decayed or otherwise traumatized teeth, it is necessary to modify the existing tooth or teeth so that restoration can be placed on/in them. Tooth preparation will be done as conservatively as practical.
  • Numbness following use of anesthesia: In preparation of teeth, anesthetics are usually needed. As a result of the injection, there may be swelling, jaw muscle tenderness or even resultant numbness of the tongue, lips, teeth, jaws and/or facial tissues that is usually temporary; in rare instances, such numbness may be permanent.
  • Sensitivity of teeth: Often, after the preparation of teeth for the reception of either crowns, bridges and composite resin fillings the teeth may exhibit sensitivity. It may be mild to severe. This sensitivity may last only for a short period of time or for much longer periods. If it is persistent, notify us so that we can determine the cause of sensitivity and seek to treat the condition.
  • Necessity for root canal therapy: The preparation of the teeth often requires the removal of adequate tooth structures to ensure that the diseased or otherwise compromised tooth structure provides sound tooth structure for placement of the restoration. At times, this may lead to exposure or trauma to underlying pulp tissues. Infrequently, the tooth or teeth may abscess or otherwise not heal, which may require root canal treatment, root surgery or possibly extraction.
  • Breakage: Crowns, bridges and composite resin fillings may chip or break. Many factors could contribute to this situation such as chewing excessively hard materials, change in biting forces, traumatic blows to the mouth, etc. Undetectable cracks may develop in dental materials from these causes, but the restoration themselves may not break until sometime later. Breakage or chipping because of defective materials or construction is somewhat uncommon, and if it occurs, it's usually soon after placement.
  • Uncomfortable or Strange Feeling: Crowns, bridges and composite resin materials are artificial and therefore feel different from natural teeth. Most patients usually become accustomed to this feeling of their new restoration over time. In limited situations, muscle soreness or tenderness of the jaw joints - temporomandibular joint (TMJ) syndrome - may persist for indeterminable periods of time following placement of the prosthesis.
  • Esthetics or Appearance: Patients will be given the opportunity to observe the appearance of crowns or bridges in place prior to final cementation. Composite resin fillings are matched to the shade of surrounding teeth to the best of your providers ability.
  • Longevity of Restoration: Many variables determine how long restorations can be expected to last. Among these are some of the factors mentioned in the preceding paragraphs, including the general health of the patient, oral hygiene, regular dental checkups and diet. As a result, no guarantees can be made or assumed to be made regarding the longevity.
  • Risk of Fracture Inherent in the placement or replacement of any restoration is the possibility of the creation of fracture lines in the tooth structure. Sometimes these fractures are not apparent at the time of removal of the tooth structure and/or the previous filling and placement or replacement, but they can appear at a later time.
  • Risk of Future Treatment:  The patient must diligently follow any and all instructions, including the scheduling of and attendance at all appointments. Failure to keep the cementation appointment can result in ultimate failure of the crown/bridge to fit properly and an additional fee may be assessed.
I have been given the opportunity to ask questions regarding the nature and purpose of my treatment and have received answers to my satisfaction. I voluntarily assume any and all possible risks including those listed about and including the risk of substantial harm, if any, which may be associated with any phase of this treatment in hopes of obtaining the desired results, which may or may not be achieved. By signing this document, I am freely giving my consent to allow and authorize my dentist and/or his/her associates to render any treatment necessary and/or advisable to my dental conditions including the prescribing and administering of any medications and/or anesthetics deemed necessary to my treatment.