Dental Implant Consent

I hereby give permission to Dr.McAllister to surgically place DENTAL IMPLANT (S) and such additional procedures as are considered necessary on the basis of findings during the course of said treatment.

I have been informed of alternative treatment options, benefits and possible risks and after the dentist’s explanation, I have chosen said treatment.

I understand there are various inherent or potential risks that can occur as a result of said procedure despite all efforts to the contrary which include but are not limited to:

  1. pain, swelling, bleeding, bruising and/or which may require further treatment
  2. changes in occlusion (biting) and/or damage to existing restoration which may require replacement
  3. stiffness of the muscles in the jaw muscles cramps or nearby
  4. It might be hard to open my mouth for several days. This might be from swelling and muscle soreness, or from stress on the jaw joint (TMJ)
  5. damage to nearby teeth during said procedure that may require additional treatment or even result in tooth loss
  6. an infection after said procedure which may require additional treatment or cause loss of the implant
  7. stretching of the corners of the mouth that might cause cracking and bruising and might heal slowly
  8. drug reactions and side effects to medications or any materials used in said procedure
  9. during the surgery, pieces of bone, synthetic bone or synthetic membranes may be placed which may become infected or devitalized and require antibiotics or additional surgery
  10. post-operative bleeding or infection that may require treatment
  11. involvement of the nerve within the lower jaw resulting in temporary (but possible permanent) loss of taste, tingling and/or numbness in the lips, chin, tongue, gums, cheeks, and teeth
  12. the jaw may break and require additional surgical treatment for repair
  13. the use of other materials such as synthetic membranes that might require removal at a later date
  14. bone loss around implants and/or adjacent teeth
  15. fracture of the implant or restorative parts
  16. loss of an implant or implants
  17. aspiration and/or swallowing of foreign objects
  18. involvement of the sinus of the upper jaw requiring possible surgery for repair at a future date

I understand that my gum tissue will be opened to expose the bone, and one or more implants will be threaded into holes made in the bone. The implants will be the support for one or more missing tooth replacements to hold a crown, bridge or denture or partial complete denture. The doctor has explained the procedure to me.

Sometimes dental implants remain covered by the gum tissue during the initial healing period. If the implant is covered by gum tissue, it will have to be surgically uncovered before it can be restored by the dentist. Sometimes dental implants are left exposed through the gum tissue when placed. Gum tissue grafting or trimming may be necessary before or after restoration by the dentist.


Not one how long implants will last the promised. I have been told that once the implant is placed, I need to follow through with the entire treatment plan and finish it within the time period that is set by my doctors. If this is not done, the implants may fail.

If my doctor finds a different condition than expected and feels that a different surgery or more surgery needs to be done, I agree to have it done.

I am aware the practice of dentistry is not an exact science and acknowledge that no promises or guarantees of results have been made nor are expected. I have read and understand the above and give my consent to surgery. I have given a complete and purehearted medical history, including all medicines drug use, pregnancy, etc. All of my questions have been answered before signing this form.



Signature of





Signature of Parent/Guardian if patient is at minor___


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