CONSENT FOR PERIODONTAL/IMPLANT EXPLORATORY FLAP SURGERY

As per the conversation with my surgeon regarding the unknown entity that cannot be diagnosed radiographically or clinically, I consent to the proposed treatment of exploratory flap for better assessment to help resolve my ongoing issues and/or have a biopsy of the site for diagnostic purposes. I understand that during these procedures, my gums will be opened to permit better access to the structure. Inflamed and infected gum tissue will be removed, and the root/implant surfaces will be thoroughly cleaned. Bone irregularities may be reshaped, and bone regenerative material may be placed. My gum will then be sutured back into position, and a periodontal bandage or dressing may be placed.

Expected Benefits. The surgery is intended for a diagnostic purpose to help investigate or resolve my ongoing issue as indicated by the clinical and radiographic examination.

Assessment of Dental Implants Already Present. I understand that for any implants present in the surgical area, my surgeon will assess their condition and the health of the surrounding gum and bone. This will involve identifying any implant abnormalities (e.g. fracture, loose components) and evaluating the degree of bone loss, tissue inflammation, or presence of infection around the implant(s). If necessary, treatment such as debridement, removal of diseased tissue, reshaping of bone, or placement of regenerative material may be performed to improve the condition of the implant site. I acknowledge that although these procedures may help preserve or improve implant health, there is no guarantee of long-term success, and in some cases, the implant(s) may fail or require removal.

Principal Risks and Complications. I understand that a small number of patients do not respond successfully to periodontal surgery. I understand that complications may result from the periodontal surgery, drugs, or anesthetics. These complications include, but are not limited to post-surgical infection, bleeding, swelling and pain, facial discoloration, transient but on occasion permanent tingling/numbness of the jaw, lip, tongue, teeth, chin or gum; jaw joint injuries or associated muscle spasm, transient but on occasion permanent increased tooth looseness, tooth sensitivity to hot, cold, sweet or acidic foods, shrinkages of the gum upon healing resulting in elongation of some teeth and greater spaces between some teeth, cracking or bruising of the corners of the mouth, restricted ability to open the mouth for several days or weeks, impact on speech, allergic reactions, and accidental swallowing of foreign matter. The exact duration of any complications cannot be determined, and they may be irreversible.

Necessary Follow-Up Care And Self-Care. I understand that I will need to come for follow-up appointments so that my healing can be assessed and managed. I understand that it is important to closely follow the post operative care as explained to me. I understand that smoking will adversely affect gum and bone healing and will limit the successful outcome of my surgery. DO NOT SMOKE for a minimum of 2 weeks before surgery and 4 weeks after surgery. I know that it is important to abide by the specific prescriptions given to me. I agree to cooperate with the recommendations of my surgeon while I am under their care, realizing that any lack of cooperation may result in a less-than-optimal result.

I have had the opportunity to discuss my medical and health history, including any serious problems and/or past surgeries. I have been fully informed of the nature of exploratory surgery and possible risk and alternative options and the necessity for follow-up and self-care. I have had an opportunity to ask any questions I may have in connection with the treatment and to discuss my concerns with my surgeon. I hereby consent to the performance of exploratory surgery as presented to me during consultation and as described in the treatment plan.

By signing below, I verify that I have read and understand the exploratory flap surgery.