There are many advantages to Resin Onlays.  Resin onlays are bonded to the tooth this creates a tight superior fit and restores the tooth to nearly it’s original strength.  They can be used in cases where a crown would have been needed in the past.  This keeps your tooth stronger because less tooth structure is removed.  Resin onlays wear like natural teeth.  since resin onlays are almost invisible they do not need to be placed under the gum line.  This is kinder and gentler on the gums.  They look great!






Patient’s Name__________________________________ Date________________________

I am being provided this information and consent form so I may better understand the treatment recommended for me. Before beginning, I want to be provided with enough information, in a way I can understand, to make a well-informed and confident decision regarding my proposed treatment.

Nature of Crown Restorations

A crown restoration has been recommended for me on the following tooth (teeth): #____

Crown restoration cover and protect teeth that have been weakened by decay, prior restoration, or root canal treatment. Crown can also be placed to change the bite or for cosmetic purposes. Crowns require at least two visits to complete treatment. At the first visit, the dentist uses the drill to reduce the size of the tooth. This makes room for the crown itself to fit on the remaining stump of the tooth, called the preparation. After drilling is complete, an impression, or mold, of the preparation is made using a rubbery material. A plastic temporary crown is held on the tooth with the temporary cement while a dental laboratory is making the crown restoration. It is important to return for the cementation of the new crown as soon as it is ready in order to reduce the chance of redecay or other problems.

This recommendation is based on visual examination(s), on and x-rays, models, photos, and other diagnostic tests taken, and on my doctor’s knowledge of my medical and dental history. My needs and wants have also been taken into consideration.

The crown restoration is necessary because of:

( ) Extensive Decay ( ) Broken Tooth ( ) Decay around large prior filling

( ) Changing my Bite ( ) Cosmetic Purposes ( ) Other___________

The intended benefit of a crown restoration is to replace natural tooth structure and restore the tooth to normal function. The

crown restoration may also relieve current symptoms of discomfort I may be having.

Alternatives to Crown Restorations

Depending on my diagnosis, there may or may not be alternatives to a crown restoration that involve other types of dental care. I understand that possible alternatives to crown restorations may be:

Other restorative alternatives, such as onlay, inlay, veneer, or tooth colored filling material.

Extraction. may choose to have tooth #____ removed. The extraction tooth usually requires replacement by an artificial

tooth by means of a fixed bridge, dental implant, or removable partial denture.

No treatment. I may choose to not have any treatment preformed at all. If I choose no treatment, my condition may

worsen and I may risk serious personal injury, including severe pain, localized infection, loss of this tooth, and possibly

other teeth, severe swelling, and/or/severe infection.

Risk of Crown Restorations:

I have been informed and fully understand that there are certain inherent and potential risks associated with crown restorations.

I understand that the nerve inside my tooth may be irritated by treatment and I may experience pain or discomfort during and/or after treatment.

I understand that once prior fillings and decay are removed, it may reveal a more severe condition of my tooth. This

Condition may require root canal treatment in addition to a crown restoration, or may instead require the extraction of the tooth.

Patient Signature________________________________________ Date______________________________

Witness Signature_______________________________________ Date______________________________

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