BONE GRAFTING INFORMATION AND CONSENT FORM Page 1/2
1. I have been informed and I understand the purpose and the nature of the Bone Grafting procedure that will be performed to place a bone graft material onto the deficient site of my jaw in order to retain or build up adequate bone width and/or height for the placement of implants or the reconstruction of my jaw for other purposes such as prosthetic requirements.
2. The bone graft that will be placed can either be of animal origin, human origin (other than my own), my own bone. I consent to the use of such materials with the exception of:
3. In approximately 4-9 months after the bone graft has partially healed and integrated, a second procedure will be done by Perio Specialty Group (Dr. Farzin Ghannad, Dr. Hannu Larjava, Dr. Nabil Nadji, Dr. Robert Straga, Dr. Farzan Ghannad) or my dentist to insert the implant(s) into my jaw should this be part of the original treatment plan. In some instances it is possible to insert the implant(s) at the same appointment of the bone grafting surgery.
4. Although the success rate of bone grafting in implant dentistry is high, Perio Specialty Group (Dr. Farzin Ghannad, Dr. Hannu Larjava, Dr. Nabil Nadji, Dr. Robert Straga, Dr. Farzan Ghannad) has explained to me that if the bone graft does not incorporate with my own bone, alternative prosthetic measures will have to be considered, including but not limited to, dentures and or bridges and or no treatment.
5. Bone grafting of the jaws has consistently been shown in the research literature to enjoy very high success with a low chance of rejection or infection. However, there is no guarantee that your graft will not become infected or rejected.
6. It is understood that although good results are expected, they cannot be and or not implied guaranteed or warrantable. There is also no guarantee against unsatisfactory or failed results.
7. I have been informed and I understand that occasionally there are complications of surgery, drugs and anesthesia including but not limited to: Pain, swelling, discoloration of the face, neck and mouth. Numbness and tingling of the upper lip, chin, gums, teeth, cheek, and palate, which may be temporary or, rarely permanent. Infection of the bone, that might require further treatment including hospitalization & surgery Mal-union, delayed union or non-union of the bone graft material to normal bone Lack of adequate bone growth into the bone graft replacement material Bleeding which may require extraordinary means to control hemorrhage Limitation of jaw function; stiffness of facial and jaw muscles Injury to teeth and or loss of teeth and bone segments Referred pain to the ear, neck and head Postoperative complications involving the sinuses, nose, nasal cavity. Postoperative unfavorable reactions to drugs, such as nausea, vomiting and allergy.