BONE REGENERATIVE PROCEDURES INFORMATION AND CONSENT
After a careful oral examination and study of my dental condition, my DR. JONATHAN ABENAIM has advised me that I have periodontal disease. I understand that periodontal disease weakens support of my teeth by separating the gum from the teeth and possibly destroying some of the bone that supports the tooth roots. The pockets caused by this separation allow for greater accumulation of bacteria under the gum in hard to clean areas and can result in further erosion or loss of bone and gum which support the roots of my teeth. If untreated, periodontal disease can cause me to lose my teeth and can have other adverse consequences to my health.
Please ask for clarification of anything you do not understand.
In order to treat this condition, my DR. JONATHAN ABENAIM has recommended that my treatment include bone regenerative surgery. I understand that sedation may be utilized and that a local anesthetic will be administered to me as part of the treatment.
During this procedure, my gum will be opened to permit better access to the roots and to the eroded bone. Inflamed and infected gum tissue will be removed, and the root surfaces will be thoroughly cleaned. Bone irregularities may be shaped, and bone regenerative (graft) material may be placed around my teeth. Graft material will be placed in the areas of bone loss around the teeth. Various types of graft materials may be used. These materials include: my own bone, synthetic bone substitutes, bone obtained from animal sources, and/or bone obtained from a bone bank (allograft). Membranes may be used with or without graft, depending on the type of bone defect present. My gum will then be sutured into position, and a periodontal bandage or dressing may be placed.
I further understand that unforeseen conditions may call for a modification or change from the anticipated surgical plan. These may include, but are not limited to,
(1) extraction of hopeless teeth to enhance healing of adjacent teeth,
(2) the removal of a hopeless root of a multi-rooted tooth so as to preserve the tooth, or
(3) termination of the procedure prior to completion of all the surgery originally outlined.
DESCRIPTION OF THE GRAFT MATERIAL:
(1) Bone tissue harvested from other areas of your mouth.
(2) Processed Bone Allograft- this is human bone tissue donated by the next of kin of deceased persons. All donors are screened by physicians and other health care workers to prevent the transmission of disease to the person receiving the graft. They are tested for hepatitis, syphilis, blood and tissue infections, and the AIDS virus. Tissue is recovered and processed under sterile conditions. Processing includes preservation of the bone by the process of freeze-drying.
(3) Bone processed similar to the above descriptions after harvesting from bovine sources.
(4) Artificial bone-like ceramic or mineral substances.
The purpose of bone regenerative surgery is to reduce infection and inflammation and to restore my gum and bone to the extent possible. The surgery is intended to help keep my teeth in the operated areas and to make my oral hygiene more effective. It should also enable professionals to better clean my teeth. The use of bone, graft material, or membrane is intended to enhance bone and gum healing.
Principle risks and complications:
I understand that a small number of patients do not respond successfully to periodontal surgery, and in such cases, the involved teeth may eventually be lost. Periodontal surgery may not be successful in preserving function of appearance. Because each patient’s condition is unique, long-term success may not occur.
I understand that complications may result from periodontal surgery, drugs, or anesthetics. These complications include, but are not limited to, infection; bleeding; swelling; discomfort; temporary facial discoloration; transient but occasionally permanent numbness of the lip, jaw, tongue, teeth, chin, or gum, tooth sensitivity; shrinkage of the gum upon healing, resulting in a longer appearance of the operated teeth; cracking or bruising of the corners of the mouth; restricted ability to open the mouth for several days; impact on speech; allergic reaction; and accidental swallowing of foreign matter. The exact duration of any complications cannot be predetermined and may be irreversible.
There is no method that will accurately predict how my gum and bone will heal. I understand that no guarantee or warranty for success can be provided to me. I understand that occasionally there may be a need for a second procedure if the initial results are not satisfactory. The success of periodontal procedures can be affected by medical conditions, dietary and nutritional problems, smoking, alcohol consumption, clenching and grinding of teeth, inadequate oral hygiene, and medications that I may be taking. To my knowledge, I have reported to my DR. JONATHAN ABENAIM any prior drug reactions, allergies, diseases, symptoms, habits, or conditions, which might in any way relate to this surgical procedure. I understand that my diligence in providing the personal daily care recommended by my DR. JONATHAN ABENAIM-brushing and keeping the area clean, and taking all medications as prescribed are important to the ultimate success of the procedure.
PATIENTS WHO SMOKE DURING THE HEALING PERIOD WILL HAVE A DECREASE OF A SUCCESS RATE. IN TURN THE BONE REGENERATIVE PROCEDURE WILL NOT BE GUARANTEED AND THE PATIENT WILL BE RESPONSIBLE FOR COST OF A NEW REPLACEMENT BONE GRAFT PROCEDURE AT FULL PRICE.
Alternatives to suggested treatment:
I understand that alternatives to periodontal surgery include: No treatment – with the expectation of possible advancement of my condition which may result in premature loss of my teeth; Extraction of teeth involved with periodontal disease; and Non-surgical scaling and root planing of the tooth roots, with or without medication, in an attempt to further reduce bacteria and tartar under the gumlinewith the expectation that this may not fully eliminate deep bacteria and tartar, may not reduce gum pockets, will require more frequent professional care and time commitment, and may not stop the worsening of my condition and premature loss of teeth.
I understand that some types of bone graft material are obtained from a bone bank. The materials from the bone bank are put through a rigorous process of sterilization and processing to remove elements that may cause infection, allergy, or other reactions. understand that I should inform my DR. JONATHAN ABENAIM prior to bone regenerative surgery if I do not wish to receive bone allograft.
Necessary Follow-up Care and Self Care:
I understand that I will need to return to my DR. JONATHAN ABENAIM periodically following my surgery in order to monitor my healing. Proper healing after periodontal surgery depends greatly on following the postoperative instructions that have been given to me. Smoking, alcohol consumption, and inadequate oral hygiene can all affect both the initial healing as well as the overall result of periodontal surgery.
I have been fully informed of the nature of periodontal surgery, the procedure to be utilized, the risks and benefits of periodontal surgery, the alternative treatments available, and the necessity of 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 DR. JONATHAN ABENAIM. After thorough consideration, I hereby consent to the performance of periodontal surgery as presented to me. I also consent to the performance of such additional or alternative procedures as may be deemed necessary in the best judgment of my DR. JONATHAN ABENAIM.
I certify that I have read and fully understand this document.
(You May Refuse to Sign This Acknowledgement*)