The most natural way to replace a missing tooth.
An explanation of your need for sinus augmentation surgery, the procedure care, its purpose, benefits, possible complications as well as alternatives to this proposed treatment were discussed with you at your consultation, and we obtained your verbal consent to undergo the treatment planned for you. Please read this document which repeats issues we discussed and provide the appropriate signature on the last page. Please ask us to clarify anything that you do not understand and answer any of your questions at any time.
After a careful oral examination and study of my dental condition, my dentist has advised me that my missing upper tooth or teeth may be replaced with an artificial tooth or teeth supported by a dental implant. However, there is insufficient bone between the oral cavity and the maxillary sinus to allow placement of dental implants and a sinus augmentation procedure with bone replacement graft is necessary prior to, or during implant placement.
In order to treat this condition, my dentist has recommended that my treatment include a sinus augmentation procedure with bone replacement graft. I understand that sedation may be utilized and that a local anesthetic will be administered to me as part of the treatment. My gum tissue will be opened to expose the bone above my missing upper tooth or teeth and a small portion of bone will be removed to access the floor of the sinus. I understand that surgery will be performed to place a bone graft material onto the floor of the maxillary sinus to build up adequate bone height and volume for the placement of implants. Various types of graft materials may be used. These material may include my own bone, synthetic bone substitutes, or bone obtained from tissue banks (allografts). Membranes may also be used. The soft tissue will be stitched closed and healing will be allowed to proceed for four to eight months. I understand that a denture usually cannot be worn during the first one or two weeks of the healing phase.
Dental implants may or may not be placed at the same time as the sinus augmentation procedure. Whether dental implants will be placed at the same time can not be determined with certainty before the procedure, and I understand that implant placement may have to be delayed for as long a time as my dentist deems advisable.
I further understand that unforeseen conditions may call for modification or change from the anticipated treatment plan. These may include, but are not limited to: (1) placing the bone replacement graft or dental implants at a later date (2) termination of the procedure prior to completion of all of the surgery originally outlined. Any of these unforeseen changes may lead to a change in my dental treatment plan. I understand that I consent to any such changes as deemed indicated in the opinion of my dentist. This may include, but is not limited to: (1) the need for additional dental work, or (2) the modification of the planned dental work. Some complications could include the need for a referral to other dental or medical specialists.
The purpose of the sinus augmentation procedure is to add bone height and volume to the floor of the maxillary sinus to allow the placement of dental implants.
I understand that some patients do not respond successfully to the sinus augmentation procedure, and in such cases, the bone graft material may need to be removed. The sinus augmentation procedure may not be successful in providing adequate bone for dental implants. Because each patient’s condition is unique, long-term success may not occur.
I understand that complications may result from the sinus augmentation procedure, drugs, and anesthetics. These complications include, but are not limited to, post-surgical infection or bleeding that might require further treatment including hospitalization and surgery, swelling and pain, discoloration of the face, neck and mouth, transient but on occasion permanent numbness or tingling of the upper lip, gums, teeth, cheek or palate, which may be temporary, or rarely, permanent, injuries or associated muscle spasm, 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, altered sense of smell, injury to teeth, bone fracture, sinus perforations, bloody nose, congestion or post-nasal drip, delayed healing and accidental swallowing of foreign matter. The exact duration of any complications cannot be determined, and they may be irreversible.
My dentist has discussed with me that any form of smoking is particularly harmful to the success of this operation. I have been requested to stop smoking.
My dentist has explained to me that if new bone does not incorporate into the bone graft material, alternative tooth replacement measures will have to be considered.
Alternative treatments for the sinus augmentation procedure include no treatment, new removable or fixed appliances, and other procedures – depending on the circumstances.
I understand that it is important for me to see my dentist for follow-up care, to follow home care instructions and to abide by the specific pre- and post-operative prescriptions and instructions given by my dentist and his staff. I understand that the failure to follow such recommendations could lead to ill effects, which would become my sole responsibility. I also need to inform my dentist as soon as possible of any complications or symptoms that may relate to the sinus elevation procedure for placement of the graft. These symptoms include but are not limited to, nose bleeds, pain, unusual feeling of sinus pressure, fever, swelling, pus formation and reactions to the medications prescribed.
I hereby acknowledge that no guarantee, warranty or assurance has been given to me that the proposed treatment will be successful. Due to individual patient differences, my dentist cannot predict certainty of success. There exists the risk of failure, relapse, additional treatment or worsening of my present condition, including the possible loss of bone replacement grafts, certain teeth or implants despite the best care.
I consent to photography, filming and x-rays of my oral structures as related to these procedures and for their educational use in lectures or publications provided my face, my name or other identifying information or characteristics are not revealed or disclosed.
I have been fully informed of the nature of the sinus augmentation surgery, the procedure to be utilized, the risks and benefits of my treatment, the alternative treatments available and the necessity for pre-, 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 the dentist. After thorough deliberation, I hereby consent to the performance of the sinus augmentation procedure as presented to me during consultation and in the treatment plan presentation as described in the document. I also consent to the performance of such additional or alternative procedures as may be deemed necessary in the best judgement of the dentist.
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