Dental Implant Consent Form Pdf Examples - Dental Jobs Expert

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Dental Implant Consent Form Pdf Examples

What is dental implant consent form? This time we’ll give you some good examples (pdf available) of this form, and why every dental office in United States requires you to fill out the form before your dental implant surgery is performed.

Dental implant is one of the most amazing discoveries in dentistry. It has so many benefits, and perform much better than any other alternatives available on the market to date. We’ve explained about the dental implant pros and cons, but here they are again:

Dental implant benefits include: it acts as the perfect base a natural artificial teeth look, which is identical in color compared to your real teeth. Another huge advantage is the implant acts as the replacement for your teeth’s root. It may be surprising, but the tooth’s root is an anchor to your jawbone. It is often that people have bone loss after they lost their teeth. The dental implant can prevent this from happening. Moreover, aside of its beautiful and natural design, the dental implant can be as comfortable as regular teeth. Some reviewers even said that you can even eat steak and other chewy foods.

That said, there are still some risks present in the procedure, albeit the success rate is very high. For this reason, the dental implant consent form is needed. It’s basically a documentation that mention that you’re getting the implant under your own will, and you’re ready to take a risk if there’s unwanted things happen during the surgery.

Dental Implant Consent Form Examples

Below are some of the examples of the form. Please note that this is not an actual form used in a dental office, but we’ve arranged the words that are commonly used in the form. You can download the pdf version of this form in our reference section.



Patient Name: ____________               Date of Birth: ____________

Every person has the right to make decisions for their own health care. In this form you can find summarized information about the procedure, and you will need to acknowledge your consent to the treatment recommended by your dentist. Please read the form carefully and ask your dentist about anything that you want to know.

Implants functions like natural teeth. The implant is anchored to your jawbone, which is usually done through oral surgery. Usually the dentist or oral surgeon will put the patient under local anesthetic, open the gum tissue and then drill holes in the jawbone to plant the implant. Depending on the condition of the mouth, bone grafting or guided tissue regeneration also may be necessary to install the anchors and posts. After the implant is placed, typically you’ll have to wait for about four to eight months later to let the implant integrate with the jawbone. After that, the prosthetic is placed over the implant. The prosthetic fee is different from the surgical fee.

Consent Statements

I authorize Dr. ____________ and her associates to perform oral surgery to place the dental implant upon me. The doctor has recommended this procedure and explains the alternatives to replace my natural teeth, which include complete or partial dentures or bridges (fixed or removable).

I understand that and consent to the use of anesthesia or other medications before, during and after the procedure done by qualified person.

I understand that there are potential risks, side effects or complications related to any dental procedure. The dentist has informed me about the risk of dental implant surgery, which may include but not limited to bleeding, infection, swelling, discomfort, injury or damage to adjacent teeth or lower jaw nerves, lock jaw, allergic reaction, bone loss, or implant failure.

I understand that these risks are rare, yet it cannot be predicted or prevented by the dentist handling the procedure. I understand that there are no guarantee has been made about the result of this procedure.

Hereby I declare that I have been given the opportunity to ask questions about the procedure and the dentist has answered all of the questions asked. I certify that I have read the contents of this dental implant consent form. I understand the potential risks and have decided to continue the procedure after considering the possibilities.

______________               _______________

Signature of Patient                 Date

______________               _______________

Signature of Guardian             Date



You can download the dental implant consent form examples pdf version here

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