I understand that due to infection or/and structural deficiencies, extraction of my dental implant(s) has been recommended by my surgeon. I have had alternative treatment (if any) explained to me, as well as the consequences of doing nothing about my dental conditions.
I understand that no treatment may result in, but not be limited to: localized infection, swelling, pain, bone loss, periodontal disease (bone loss) around adjacent teeth, malocclusion (damage to the way the teeth hit together) and possible systemic infection.
I understand that there are risks associated with any dental procedure, which include and are not limited to: post-operative pain, bruising, swelling, infection and excessive bleeding; damage to adjacent teeth, fillings and anatomical structures which may require additional treatment or surgical repair; fracture or dislocation of the jaw; damage to nerves resulting in temporary or permanent numbness or tingling of the lip, chin, tongue or other areas; and side effects and adverse reactions from any prescribed medications. In the case of delayed healing, additional and prolonged post-operative care may be necessary.
I understand the recommended treatment, the risks of treatment, any alternatives and risks of these alternatives, including the consequences of doing nothing. I have had all of my questions answered, and have not been offered any guarantees.