This information is to help you make an informed decision about having implant treatment. You should take as much time as you wish to make the decision in relation to signing the following consent form. You are encouraged to ask any questions, and have the answers to your satisfaction before you give permission for the treatment to be carried out.
Below is described your proposed dental implant treatment and the formal terms and conditions of my engagement. I apologise for the large amount of information contained in this letter but it is important that you should understand and read it carefully. Please keep this letter in a safe place as the treatment described is long-term and it can often be difficult to remember the exact details several months later. Also you have received a patient leaflet containing further information regarding your implant treatment. If you are unclear as to any of the areas discussed please contact me.
During the course of the implant treatment it is important that you keep the dentist informed of any changes to your general medical condition and of any other additional treatment you may be receiving from a doctor or dentist. Failure to keep the dentist informed may adversely affect or delay your treatment.
It is also important that you keep your appointments and do not miss any stages, as this could adversely affect treatment and delay placement of the new teeth.
WHY ARE IMPLANTS NEEDED?
Once teeth are lost, the bone in which they are embedded gradually disappears because it is no longer required to support the teeth. The teeth and lost bone are usually replaced by removable dentures or fixed bridges to restore appearance, speech and chewing. As with all man made substitutes for nature’s living tissues, there are drawbacks to artificial appliances. Dentures can reduce masticatory efficiency and in certain situations can suffer from poor retention. On the other hand, bridges if conventional may involve cutting away healthy teeth in order to provide support.
An alternative method of tooth replacement is to insert implants into the jawbone to support the false tooth or teeth. Such implants may become firmly attached or integrated with the bone. If an implant is placed soon after a tooth is extracted the jawbone is more likely to be preserved and its further loss prevented. For this reason it is best not to delay the decision to place implants, as bone will be lost with time which can make the placement of implants more difficult. However, even after considerable bone loss has occurred, it may still be possible to place an implant although additional bone grafting techniques may be required.
The condition of the jaws will be assessed for suitability and the treatment planned using X-ray films, photographs and models of the teeth. It may be necessary to take a Jaw Scan (CT) type X-ray to check the amount and position of the available bone. The final decision whether or not to proceed with implant placement will be made at the time of surgery and will be determined by the quality and quantity of the jaw bone. An important nerve runs in the lower jaw that supplies sensation to the lower lip and skin of the chin.
The X-ray is important in determining the position of this nerve avoiding the slight possibility of injury which could result in altered sensation. In the upper jaw it is important to ascertain the size and position of the air sinuses and nasal cavities prior to implant insertion. Occasionally the implants may have to be placed slightly into the sinus or nasal cavity. Usually this is not noticeable but there may be a slight nasal discharge with a small amount of temporary bleeding. The implants may be placed under the gum and so will not be visible in the mouth.
IF YOU HAVE INSUFFICIENT BONE:
At implant placement it sometimes necessary to use materials to build up the bone (bone augmentation). If this is necessary the materials that are used are mainly from animal origin. If required this will be discussed with you during the procedure and your consent gained prior to placement.
TYPE OF ANAESTHETIC
The procedure is usually performed under a local anaesthetic. If sedation is required this is to be discussed with your dentist.
AFTER IMPLANT PLACEMENT
After the procedure there will be some discomfort and swelling. The degree of swelling will depend upon the number of implants placed and whether or not additional surgical procedures were carried out. Occasionally along with the swelling there may also be slight bruising of the skin overlying the area which will fade over a week. If you are a smoker or have a pre-existing medical condition which affects soft tissue healing, the amount of swelling may be greater. The gum tissue in the region where the implants have been placed may change appearance or colour and take on a white appearance for a short time (normally two weeks) after surgery.
After 6/10 days once the soft tissue has healed sufficiently the stitches are removed if dissolving stitches have been used this may not be necessary. During this period it may not be possible to wear dentures. After this stage the implants will be left undisturbed for at least three months to attach to the jawbone. During this period the top of the implant may show through the gum slightly and metal may become visible. Although this is normally no cause for concern, should it occur please contact the practice to have the area checked.
FOR CURRENT DENTURE WEARERS:
If you wear a removable denture, this will be altered at the time of implant placement so that it does not damage the implant site(s). You should wear your denture minimally, mainly to smile, and must not wear your denture to eat, for approximately 2-3 weeks following implant placement as this will increase pressure on the implants and may damage their integration with the bone. The dentist will provide you with further guidance on this. If possible it is best practice to leave the denture out for the initial healing period of 2-3 weeks.
MAKING THE NEW TEETH
After a 3/6-month period a second surgical procedure may be necessary to expose the implants and check for firm bony attachment. In the event that an implant has failed to take it can simply be removed, as it will not be attached to bone. Once the implants have been uncovered and are firm a post or abutment will be connected which will be used to support either a provisional denture or bridge. This intermediate stage will last approximately two months allowing time for the gums to settle and form a tight attachment to the implant abutment. During this time the abutment may become visible as the gum shrinks slightly exposing the underlying metal. The final teeth will be made to cover as much of the exposed metallic areas possible improving the final appearance. Impressions will be necessary prior to construction of the final restoration.
The total treatment time required will vary with the degree of difficulty and the amount of work needed. It is important to bear in mind that the teeth have to be made individually to suit your specific requirements and mouth. This type of precision work is very time consuming and cannot be rushed, as it must be of the highest quality. Prior to fitting the finished teeth a variable number of visits may be necessary to make fine adjustments to the teeth. Therefore, it is important to keep your dentist informed of any travel arrangements or important engagements you may be planning and to give as much notice as possible.
WHAT HAPPENS IF THE IMPLANTS DO NOT TAKE
Fortunately this occurs rarely as potential problems should have been anticipated and discussed with you before treatment starts. Should an implant fail to take then it is often possible to replace it with a second implant at the same time as the first implant is removed. It will of course be necessary to wait a further six months while the second new implant attaches to the bone. It is not difficult to replace the failed implant at this time, as it will be very loose and is easily removed. It has been shown that alcohol and tobacco consumption can reduce the rate of success. These habits also have an effect on the rate of healing and may increase the chances of post-operative infection.
**Smoking Risks: In particular, research shows an elevated risk of failure associated with smoking due to the higher risk of infection and reduced healing capabilities caused. This risk is heightened in relation to bone grafted sites. If you are a smoker, we would advise that you attempt to stop. We can advise and assist you in smoking cessation. As stated above, the long term care of your dental implants will involve regular examinations, hygiene visits and daily oral care.
** Gum disease: Those patients with a history of gum disease undergoing implant therapy do need to accept and be aware of their increased risk of potential problems around their implants in time. The risks are that of implant / gum infections and inflammation which may lead to the ultimate loss of the implant. It is imperative that your oral hygiene is maintained with hygienist visits which will be recommended to you. Failure to do so can result in recession of gums around the implants exposing the metal implant which if in an area visible in your smile will show. Costs for rectifying this if possible will apply.
**Occlusion: Those patients who have a history of grinding or clenching are more likely to require long term maintenance to the crown overlying the implant which can loosen and fracture over the years. This will then require a replacement crown to be made which will incur further costs. If you have been recommended a splint (guard to wear over your teeth at night) it is imperative that you wear this as directed.
AFTER CARE AND MAINTAINENCE REQUIREMENTS FOR IMPLANTS
Implants are not “Fit and Forget” they need the same care and attention as natural teeth. On completion of treatment it will be necessary for you to attend a number of recall appointments to check the condition of the implants and to adjust the bite if required.
After this, regular six monthly dental check-ups are required to monitor the condition of the implants and any remaining natural teeth. Also regular hygiene maintenance appointments, as a build of plaque will cause gum problems and possible bone loss from around your implants, resulting in their eventual loss.
If you have teeth and implants mixed together it is also very important to maintain the health of the natural teeth. Should the natural teeth become infected or are lost for any reason the remaining implants may be damaged by the extra pressure caused by the addition work load.
IMPLANT SUPPORTED REMOVABLE DENTURES ONLY
If a removable denture has been made to fit over your implants it is important to understand that in addition to the above it will require replacing approximately every three years, depending on the amount of bone loss, which has occurred from your mouth. Failure to compensate for this loss, by adjusting or remaking the denture, will place extra strain on the implants, which could result in their eventual loss or breakage. If the over denture is held onto the implants by mechanical clips, then these too will need to be periodically replaced as a result of wear during to normal function.
COST OF YOUR TREATMENT AND TERMS OF FEE PAYMENT
The fee for your treatment will be outlined following your implant consultation appointment.
If bone augmentation is required there will be an additional fee of £350 per site.
If an appointment is missed or cancelled with less than 48 hours notice an additional fee will be charged.
IF THE IMPLANT CANNOT BE PLACED:
The full charge for the implant will not be charged. There will be a cost for the time taken and the disposables which will be advised prior to commencing the treatment.
ACCEPTANCE FOR TREATMENT
Patients will only be accepted for this treatment if they can demonstrate that they can maintain a high level of plaque control and oral hygiene. There should be no medical conditions that would contraindicate the procedure. It is important to inform the dentist of any changes to your general health or medical condition.
It would be inappropriate for a physician or dental surgeon to guarantee the results of any treatment or operation. While the results cannot therefore be guaranteed our undertaking is to make every effort to meet the criteria of the proposed treatment and to provide a comfortable and pleasing result. Please do not hesitate to ask if you still have further questions.