Consent for Final Cementation in Denver, CO

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The most natural way to replace a missing tooth.

Consent for Final Cementation

The nature and type of material used in my crowns, bridges and/or veneers has been explained to me. By signing below I acknowledge and authorize the material discussed to be used in my mouth. I have been given the opportunity to view my crowns, bridges and/or veneers as processed, either on models or placed in my mouth prior to final cementation.

I approve the color, shape, feel and overall appearance of the porcelain. I understand that once the porcelain is cemented in my mouth, the factors of color, shape, feel and overall appearance cannot be changed without additional and possibly significant time being taken and fees assessed. I further understand that removing cemented porcelain may create the risk of injury or breakage to the underlying teeth and will destroy the porcelain, requiring a remake. I further understand that if I authorize cementation and later decide I do not like the restorations, any replacement(s) of the cemented restorations will be at full cost.

By signing this Consent for Final Cementation I give DENTAL ELEMENTS, PLLC my consent for final cementation, acknowledge my approval of the appearance and authorize use of the discussed material.


I had a long overdue deep cleaning, root canal/crown, AND fillings within a month. Dr. Thurman, Morgan, Kathy and staff were very attentive and kind with not ONLY the procedures and explanations but with checking up on me after the root canal. Also great at helping me figure out my insurance coverage and payments. Dental Elements is GREAT.

- Steve

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