Schedule an Appointment (801) 298-1812

Sinus Lift Consent

  • Ask The Doctor

 Sinus Lift Consent

  • CONSENT FOR TWO-STAGE OSSEOUSINTEGRATED IMPLANT WITH SINUS-LIFT/BONE GRAFTING PROCEDURE

  • Date Format: MM slash DD slash YYYY
  • Please check each paragraph after reading. If you have any questions, please ask your doctor before initialing.

    You have the right to be given information about your proposed implant placement so that you are able to make the decision as to whether to proceed with surgery. What you are being asked to sign is confirmation that you have been given information on the nature of your proposed treatment, the known risks associated with it and the possible alternative treatments.

  • CONSENT FOR TWO-STAGE OSSEOUSINTEGRATED IMPLANT WITH SINUS- LIFT/BONE GRAFTING PROCEDURE

  • Risks of Implant Surgery

    A. Post-operative discomfort and swelling that may require several days of at-homerecuperation.

    B. Prolonged or heavy bleeding that may require additional treatment. Because the sinus isinvolved, some bleeding may be from the nose.

    C. Injury or damage to adjacent teeth or roots of adjacent teeth, possibly requiring further rootcanal therapy, and occasionally the loss of an injured tooth.

    D. Post-operative infection, including sinus infection, which may require additional treatment. Inrare instances an opening may develop between mouth and sinus, again requiring additional treatment.

    E. Stretching of the corners of the mouth that may cause cracking and bruising.

    F. Restricted mouth opening for several days; sometimes related to swelling and musclesoreness, and sometimes related to stress on the jaw joints (TMJ).

    G. Possible prolonged symptoms of sinusitis requiring certain medications and longer recoverytime, resulting from intentional entry into the sinus. H. Fracture of the jaw.

    I. Possible injury to nerve branches in the bone resulting in numbness, pain

    or tingling of the lips, cheek, gums or teeth. If implants are placed in the lower jaw, there may be numbness or pain of the chin or tongue also. These symptoms may persist for several weeks, months or, in rare instances, may be permanent.

    General Risks of Bone Grafting:

    A. Bleeding, swelling or infection at the donor site requiring further treatment.

    B. Allergic or other adverse reaction to drugs used during or after the procedure.

    C. The need for additional or more extensive procedures in order to obtain sufficient bone forgrafting.

  • CONSENT FOR TWO-STAGE OSSEOUSINTEGRATED IMPLANT WITH SINUS LIFT/BONE GRAFTING PROCEDURE
  • Risks and Complicatins of Grafting from Within a Mouth Area

    A. Damage to adjacent teeth, which may require future root canal procedures, or may cause lossof those teeth.

    B. Removal of adult teeth in order to obtain sufficient bone material.

    C. Numbness or pain in the area of the donor or recipient site, or moreextensive areas, which may be temporary or permanent.

    D. Penetration of the sinus or nasal cavity in the upper jaw which could result in infection or othercomplication requiring additional drug or surgical treatment.

    Risks of Freeze-Dried, Demineralized or Other Banked Bone

    On occasion, additional donated bone is used to supplement the patient’s bone, or to spare an extensive donor site surgical procedure. Use of such bone may involve separate risks including, but not limited to:
  • CONSENT FOR TWO-STAGE OSSEOUSINTEGRATED IMPLANT WITH SINUS LIFT/BONE GRAFTING PROCEDURE

  • Consent:

    I certify that I speak, read and write English and have read and fully understand this consent for surgery, and that all blanks were filled in prior to my initialing and signing this form and that all my questions were answered to my satisfaction.
  • Date Format: MM slash DD slash YYYY

After submitting, feel free to return to the Patient Forms page. Please note, there are multiple forms for each section.

 

Schedule Your Appointment with the Holistic Dentist

Every service we offer is aimed at improving your overall health. We offer several procedures that eliminate the need for surgical incisions, reducing your discomfort, downtime, and the need for multiple visits. Call our office to schedule your consultation today.