Crown and bridge prosthetics informed consent

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Patient name:

I UNDERSTAND that treatment of dental conditions requiring CROWNS and/or FIXED BRIDGEWORK includes certain risks and possible unsuccessful results, including the possibility of failure. Even though care and diligence is exercised in the treatment of conditions requiring crowns and bridgework and fabrication of the same, there are no promises or guarantees of anticipated results or the longevity of the treatment.

Nevertheless, I agree to assume the risks, possible unsuccessful results and/or failure associated with, but not limited to the following:

1. Reduction of tooth structure: In order to replace decayed or otherwise traumatized teeth it is necessary to modify the existing tooth or teeth so that crowns (caps) and/or bridges may be placed upon them. Tooth preparation will be done as conservatively as possible.

2. Injury : During the reduction of tooth structure or adjustments done to temporary restorations, it is possible for the tongue, cheek or other oral tissues to be inadvertently abraded or lacerated (cut). In some cases, sutures or additional treatment may be required.

3. Local Anaesthesia: In order to reduce tooth structure without causing undue pain during the procedure, it will be necessary to administer local anaesthetic. Such administration may cause reactions or side effects which include, but are not limited to, bruising, hematoma, cardiac stimulation, temporary or, rarely permanent numbness of the tongue, lips, teeth, jaws and/or facial tissues, and muscle soreness.

4. Sensitivity of teeth : Often, after the preparation of teeth for the reception of either crowns or bridges, the teeth may exhibit sensitivity, which can range from mild to severe. This sensitivity may last only for a short period of time or may last for much longer periods. If sensitivity is persistent, this office should be notified immediately such that all possible causes of the sensitivity may be ascertained.

5. Risk of Further Treatment: Following crown preparation and placement for either individual teeth or bridge abutments, the involved tooth or teeth may require root canal treatment. Teeth, after being crowned, may develop a condition known as pulpitis or pulpal degeneration. Usually this cannot be predetermined. The tooth or teeth may have been traumatized from an accident, deep decay, extensive preparation, or other causes. It is often necessary to do root canal treatments in these teeth, particularly if teeth remain appreciably sensitive for a long period of time following crowning. Infrequently, the tooth (teeth) may abscess or otherwise not heal completely. In this event, periapical surgery or even extraction may be necessary.

6. Breakage: Crowns and bridges may possibly chip or break. Many factors can contribute to this situation such as chewing excessively hard materials, changes in biting forces exerted, traumatic blows to the mouth, etc. Unobservable cracks may develop in crowns from these causes, but crowns/bridges may not actually break until chewing soft foods, or for no apparent reason. Breakage or chipping seldom occurs due to defective materials or construction unless it occurs soon after placement.

7. Uncomfortable or strange feeling: This may occur because of the differences between natural teeth and artificial replacements. Most patients usually become accustomed to this feeling in time. In limited situations, muscle soreness or tenderness of the jaw joints (TMJ) may persist for indeterminable periods of time following placement of the crown or bridgework.

8. Aesthetics or appearance: Patients will be given the opportunity to observe the appearance of crowns or bridges in their mouths prior to final cementation. If satisfactory, this fact will be acknowledged by the patient's signature (or signature of legal guardian) on the back of this form where indicated.

9. Longevity of crowns and bridges : There are many variables that determine "how long" crowns and bridges can be expected to last. Among these are some of the factors mentioned in preceding paragraphs. In addition, general health, good oral hygiene, regular dental checkups, diet, etc., can affect longevity. Because of this, no guarantees can be made or assumed to be made concerning how long crown and bridgework will last.

10. Opening the Bite: In some cases, years of wear on the teeth will create a situation where the patient over closes or loses length of the face. A full mouth reconstruction where all existing teeth are crowned will enable the dentist to reopen the bite to the proper length. As a result the patient may experience some temporary discomfort and the crowns will be more subject to wear and breakage. If a night-guard is recommended or made but not worn by the patient, there will be an increased risk of breakage or fracture of the porcelain.

11. Damage or trauma to teeth during the Replacement of old crowns or bridges: If you have an existing crown or bridge already and the Dentist recommended that it is in your best interest to change the current crown or bridge, please note the following if this is applies to you: There are three primary reasons to remove an individual crown or bridge that has been previously cemented into place:

  • To attempt to fix or redo crowns and/or bridges that have broke or fractured while in the mouth
  • To render some type of necessary treatment to a tooth that is difficult or impossible to perform or render treatment without removing the existing crown or bridge.
  • To confirm the presence of dental decay or other pathology that may be difficult to detect or may be obscured while the crown/bridgework is in place.

I UNDERSTAND that REMOVAL OF CROWNS AND OR BRIDGES include possible inherent risks such as, but not limited to the following; and also understand that no promises or guarantees have been made or implied that the results of such treatment will be successful: RISKS

a. Fracture or breakage of the existing crown or bridge: Many crowns and bridges are fabricated either entirely in porcelain or with porcelain fused to an underlying metal structure. In the attempt to remove these types of crowns there is a distinct possibility that they may fracture (break) even though the attempt to remove them is done as carefully as possible.

b. Fracture or breakage of the actual tooth from which the crown or bridge is removed: Because of the leverage of torque pressures necessary in removing a crown from a tooth, there is a possibility of fracturing or chipping the tooth. At times these fractures are extensive enough to necessitate extracting the tooth.

c. Trauma to the tooth: Because of the pressure and/or torque necessary in some cases to remove a crown, these pressures or torque may result in the tooth being traumatized and the nerve (pulp) injured which may necessitate a root canal treatment in order to preserve the tooth. Instruments used to remove crowns and bridges may inadvertently lacerate the gums, other tissues within the mouth, and tongue.

d. Failure of conventional methods in removing crowns: There are certain methods and instruments which are utilized in conventional attempts to remove crowns from teeth. In some instances, none of these methods or instruments will effectively remove the crown from a tooth and may result in the tooth being inadvertently extracted. This may necessitate a new bridge or an addition and extension of the existing bridge if the tooth is an abutment tooth for a bridge; or construction of a bridge if this is an individual tooth within an existing arch or teeth.

e. Inadvertent extraction of the crowned tooth: In extremely rare cases, the amount of pressure or torque necessary to remove the crown from a tooth may result in the tooth being inadvertently extracted. This may necessitate a new bridge or an addition and extension of the existing bridge if the tooth is an abutment tooth for a bridge; or construction of a bridge if this is an individual tooth within an existing arch of teeth.

***It is the patient's responsibility to seek attention from the dentist should any undue or unexpected problems occur. The patient must diligently follow any and all instructions, including the scheduling and attending 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 any questions regarding the nature and purpose of crown and/or bridge treatment and have received answers to my satisfaction. I voluntarily assume any and all possible risks, including 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. No guarantees or promises have been made to me concerning the results. The fee(s) for this service have been explained to me and are satisfactory. The nature and type of material used in my crown(s) or bridgework, for example porcelain-fused-to- metal, all porcelain, etc. has been explained to me.

By signing this form, I am freely giving my consent to allow and authorize Dr._______________(please write the name of the doctor below) to render treatment pertaining to crown and bridge prosthetics considered necessary and/or advisable to my dental conditions, including the prescribing and administering of any medications and/or anaesthetics deemed necessary for my treatment.

Authorize Doctor's Name

Once fully read and reviewed, please make sure that the above document is filled out appropriately. By signing below and submitting this document, we are assuming that it has been read in its entirety. All patient signatures will be verified for authenticity in the office.

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