Welcome to GC Implants Dental Care

It is important to understand exactly what you are getting into when deciding to undergo dental implant tooth replacements. Consent forms are needed to help the patient completely understand what it involved, what the other options are and what the risks of the procedure are. Below is a copy of the consent form you will receive from me which would need to be signed before going ahead with treatment. Of course every case is individual and so you can expect your consent form to differ depending on what you are having done.

Treatment options

There are three options available for replacing teeth:

Dentures - removable teeth which need to be taken in and out routinely. 

Dentures can be made of different materials and can be made to rest on your gum or on your remaining teeth if possible. Although every effort is made to make a denture as stable and retentive as possible, due to their inherent design of not being fixed into position, you will always experience some movement to a greater or lesser degree. Often you will require the denture material and metal clasps to wrap around your remaining teeth to help hold the denture in position, which can take its toll on your mouth over time. Being able to cope with dentures is a personal preference, while some get along very well with dentures, others just cannot, and this is very hard to predict.

Benefits: often the cheaper option, often the quickest option.

Drawbacks: not fixed into position, can move, or drop down when eating/talking, need to be removed multiple times a day for cleaning, can cause deterioration of remaining teeth the denture wraps around, may not be tolerable for some people, covers a lot of your mouth

Bridges – replacement teeth which are attached to neighboring teeth and are fixed in position.

Bridges are fixed into position via different methods: either “bonded” using dental adhesives or cemented in the form of crowns. This often involves a degree of preparation (drilling) to the adjacent tooth or teeth which may negatively affect their lifespan; future treatments such as root canal treatment or further tooth removal may be required. The overall result is that you will have a replacement tooth fixed in position, with the tradeoff that the neighboring tooth/teeth will uptake the extra biting forces of the false tooth attached to it.

Benefits:intermediate cost, fixed into position

Drawbacks: can involve a lot of dental drilling, risks of future treatment such as root canal treatment, can still get tooth decay around the bridge, not always a possible option

Implants - replacement teeth which are placed into the space where your natural tooth once was.

Implants are a fixed option which, unlike the above two options, do not affect the health of the adjacent teeth. The implant itself is precisely placed within your jaw, and a specific implant dental crown is screwed on top. This tooth is therefore fixed in position with no attachment to neighboring teeth. If needed, implants can be used to replace single teeth as crowns, multiple teeth as bridges or fixation posts for dentures.

Benefits: closest option available to a replacement natural tooth, does not negatively affect your remaining teeth, minimal drilling, best long-term tooth replacement

Drawbacks: initial investment, minor surgical procedure.

Leaving a gap - you of course do not have to undergo any tooth replacement option if you decide you are happy with the gap. 

After discussions, you expressed your desire to explore the implant treatment option for tooth replacement. From here on, I will only be discussing your implant treatment plan. Should you want to revisit your other options, please do not hesitate to ask.

Implant Treatment plan

This is where I will explain the findings of the assessment and discuss your specific plan including what procedures are necessary

Treatment Summary

This is where I will list the appointments required including what is to be done at each appointment

Treatment Costs

This is where I will outline the individual treatment costs.

The fees outlined above are our current fees and apply if treatment is undertaken within six months of the date of this letter.

Should your treatment need change then the costs may alter. If this occurs, you will be informed and asked how you wish to proceed.

The fees assume all surgical treatment will be carried out under local anaesthetic.

We will request a £500 deposit on booking of your implant placement appointment. This will only be refundable if you provide 3 days (72 hours) for cancellation.

Photographs

Clinical photographs often form part of the records that I need to maintain to carry out treatment effectively and so you can expect multiple photos to be taken during the procedures. Rarely photographs may be required for publication or teaching purposes. If this were the case, I would seek your permission prior to this.

Risks and Benefits of Implant tooth replacement

The obvious benefit for you to have an implant tooth replacement is improved function by allowing you to chew on both sides of your mouth again. This will have the secondary benefit of spreading out the forces of chewing to a larger number of teeth, reducing the force concentration on the fewer teeth you currently use. Replacing teeth will of course improve the aesthetics of a gap. An implant tooth is also a fixed immovable tooth and importantly to note, it cannot deteriorate with tooth decay.

Like any dental or medical surgery, there comes with it certain risks. It is important that you are aware of these risks to be able to make an informed decision on whether to go ahead with implant placement.

Discomfort or infections after implant placement

It is best to think about implant placement as a surgical procedure and not a dental procedure. Like any other surgical procedure, you can expect to experience some bruising and swelling during the first couple of days after surgery. In rare cases infections can arise, the risk of which I will minimize by providing you with an appropriate antibiotic. The experience of this can range from no discomfort at all, to some discomfort lasting a week or two. Discomfort after a procedure like this is usually easily managed with over-the-counter pain medication such as paracetamol and/or ibuprofen and infections can be managed with antibiotics. Often you can expect the discomfort to be akin to having a tooth removed. You will be provided with written instructions to help reduce the post-operative discomfort.

Guided Bone Regeneration (GBR)

This procedure is required to help bulk out and supplement your available bone in the region of implant placement. GBR requires the use of bone substitute products, which typically are animal derived and are either derived from bovine bone (cow bone) or derived from porcine collagen (pig collagen). Occasionally I will also use a synthetic animal free product.

Although considered a predictable procedure, GBR does of course add one more element of complexity to your procedure. Firstly, of course it will mean the implant placement will take a little bit longer to complete due to the added stages, and secondly there is an increased risk of infection after the procedure which is mitigated by providing antibiotics at the time of surgery, as well as expected swelling.

Uncommon events after this procedure include graft rejection, infections, and wound breakdown. Should these occur then this will compromise the end result.

IF YOU WOULD PREFER NOT TO USE ANIMAL PRODUCTS, PLEASE BRING THIS TO MY

ATTENTION BEFORE YOUR APPOITMENT DAY

Failure of implant integration

The delicate placement of the implant into your jawbone starts the body’s healing process immediately. Over the period of about 8-12 weeks, the jawbone fuses with the implant – this is called integration. The scientific literature shows that modern implants experience a very high integration rate. However, like with any surgical procedure, there is an element of success and failure. Should the implant fail to integrate with your jawbone (termed early implant failure), and there be sufficient bone quality and quantity, I can attempt a second placement. This will be at a reduced cost of £500, and there will be an increased treatment duration while more healing occurs. Should the bone quality and quantity diminish after the failure, then possible bone grafting may be indicated at extra costs. If you do not wish to proceed with a second attempt, then you will have no obligation to continue any payments for any later stages.

Achieving good aesthetics 

Following on with the medical analogies, dental implant crowns are considered “prosthetics”. In the same way you may not notice a person at a social distance has a prosthesis, so too the aim is to make your implant crown blend in from a social distance. This is done by attempting to match the shape, contours, size and shade of the neighboring teeth. On very close inspection looking under your lips in a mirror, it is likely that you will notice the implant crown between your natural teeth.

Achieving optimal gum contours

The gum line around natural teeth is the shape it is due to having a natural tooth root connecting to the gum and jawbone with collagen fibers (periodontal ligament or PDL). Unfortunately, this PDL is not present between the titanium implant and the jawbone making the gum contours more difficult to recreate. There are certain gum manipulation methods that can be implemented during the surgical implant treatment, as well as occasional use of temporary crowns/bridges, which will aid in the recreation and molding of the gum. Again, whilst the outcome is favorable for the most part, it may be that the gum contour around the implant crown is not as perfect as around your natural teeth. This may result in small spaces between your teeth which look like small black triangles - often these are not visible as they are high up under the lip. It may also be that small food accumulation around the implant crown can be noticed, which reinforces the need to maintain your good level of oral hygiene.

It is occasionally necessary to improve the soft tissue contour around an implant to give the most natural appearance. This is a minor surgical procedure carried out under local anaesthetic and should the need arise this option and fees will be discussed with you.

Implant crown maintenance

Implant crowns, like any other type of dental crown, can be made from a range of materials. Often, ceramic/porcelain is involved to make the crown look more tooth like. These materials can chip if not being used as designed…chewing food only! Getting the implant crown in the correct position for comfortable chewing is paramount so as not to overload the crown materials. Overloading can cause breakages, crown loosening, and potentially a reduction in the lifespan of the implant itself. It is important therefore to ensure that should you ever feel the bite on the implant is incorrect, that you notify me immediately. The bite can change over time, through several ways, most commonly having fillings placed in other teeth, or developing a tooth grinding/clenching habit. It is important therefore, that any treatment carried out on your other teeth at any time in the future is checked with the bite of your implant crown so as not to overload it.

Of course, like everything else in this world, implant crowns do have a finite lifetime, and wear and tear over the years can, and should, be expected.

Much like a car should be serviced routinely, it is strongly advised that your implants are reviewed at least on an annual basis, and it is your responsibility to arrange and maintain these appointments. You can request these to be done at your own dental examination appointments if your dentist accepts this, or you can arrange the reviews with me. My current fee for implant review is £100.

Gum disease around the implant and late implant failure

As mentioned above, implant crowns cannot experience tooth decay. However, they can experience gum disease. Around an implant, gum disease is called peri-implantitis. Like around natural teeth, the result is that bone is lost around the implant, reducing the support of the prosthesis, and resulting in the loss of the implant tooth (late implant failure). Unlike gum disease around a natural tooth, peri-implantitis is often much more rapid in its progression to implant loss. Peri-implantitis, like gum disease, is linked to bacterial accumulation around the teeth so it is therefore important that you maintain your high standard of oral hygiene to minimize the chance of peri-implantitis. 

Some important factors that can put you at a higher risk to developing peri-implantitis are poor oral hygiene, personal susceptibility, experience of gum disease, smoking including vaping, excessive alcohol consumption and uncontrolled diabetes, amongst others.

Scientific evidence shows that up to 50% of patients who suffer from gum disease may lose implants as well as their natural teeth, outlining the importance of continued, supportive gum care.

Rare Risk - altered nerve sensations.

One of the rarer risks of implant treatment is the possibility of altered nerve sensations due to close proximity of placing an implant near a nerve.

In the vast majority of cases the experience of temporary sensations in the form of tingling along the nerve pathways is observed - most often this is caused indirectly by mild swelling around the implant putting pressure on your nerves. In extremely rare cases you may experience permanent altered sensations (including pain) or complete numbness. Evidence suggests these injuries to are estimated to occur between 0-0.5%.

Whilst I do not expect you to experience any of the above sensations in any way, you must understand this rare complication can occur. Should you notice any altered sensations after the anaesthetic wears off, you must bring this to my attention the same day as it may necessitate the immediate removal of the implant.

These nerve risks are most important with lower jaw implants where the nerve provides sensations to the lower lip, gums, teeth and tongue on the same side of implant treatment.

There is a very small risk of altered nerve sensations to a very small part of the roof of your mouth when implants are used to replace your top front teeth, and often the sensations return in this region.

Whilst I do not expect you to experience any of the above sensations in any way, you must understand this rare complication can occur. Should you notice any altered sensations after the anesthetic wears off, you must bring this to my attention the same day as it may necessitate the immediate removal of the implant. 

Smoking

There is a very strong link to implant failure and smoking status. Whilst there is no clear rule, it is likely that the risk of implant failure is dose dependant, i.e. the more you smoke, the higher the chance of failure. We certainly would advise not smoking a minimum of 1 month before implant placement, and 2 months after implant placement. Doing this MAY improve your chances of implant success. Should there be evidence of smoking (including vaping) during these times and your implant fails, you will not be entitled to second attempt at the discounted cost as stated above. Should you decide to re-start smoking after your implant treatment, you must be aware that you are at a greatly increased risk of bone loss and gum recession around the implant in the future.

Attending appointments 

It is imperative that you attend all your appointments. If you fail to attend (or cancel without providing 24 hours’ notice – short notice cancellations, SNC) any of your appointments, you will be charged. All appointments will be charged on a time basis except for the implant placement appointment. The fee for failed and SNC appointments will be £25 per 10 mins. If you fail to attend (or cancel without providing 72 hours’ notice) your implant placement appointment, there will be a fee of £500.

Should you miss any of your follow up appointments after your implant placement and you experience failure of your implant and wish to re attempt the treatment, you will not be entitled to the discounted price as stated above. 

Follow up care

It is important that you understand the ongoing costs of dental implant treatment and adhere to the follow up care that is recommended. Routine dental visits and routine hygiene visits are paramount to:

· help maintain your teeth and implants in a healthy state.

· to identify any potential changes at an early stage to help minimize the negative consequences. 

You will be provided with tailored oral hygiene instruction to clean around your implant which will be familiar to you as it very similar to how you clean around your own natural teeth. Finally, I of course strongly advise you to remain a non-smoker/non-vaper for your general health as well as for the health of your teeth and implant.

I appreciate this letter may be a lot to take in and may need to be read more than once, but it is important that you understand the implant process from start to finish and their long-term maintenance. Should you have any questions about any of the above information, please do not hesitate to contact me.

Once you have understood all the above and are happy to proceed with implant treatment, please return a signed copy of this letter which will confirm your understanding and consent to treatment.

Yours sincerely,

Greg Coffey (BDS Hons Cardiff, MSc Primary Dental Care, DipImpDent RCS)

Diploma in implant dentistry awarded by the Royal College of Surgeons.

I have read and understand all the information in this letter including costs (including costs of missed appointments), risks and benefits and long-term maintenance of implant treatment. I fully understand that the long-term lifespan of my implant is improved through good quality home-care cleaning regimes of my implant, natural teeth, and gums. 

I therefore consent to have my missing teeth replaced with dental implants.

Name:

Signed:

Dated: