Consent for Dental Implant Surgery

Stateline Oral and Maxillofacial Surgery, PC  


Note to patients:  this is a synopsis of the consent form used in our office.  The actual form may differ in small details from this text.  The doctor will review the risks and benefits associated with this surgery before you are given the opportunity to sign the actual consent form.    If you have any questions, please ask the doctor before signing.


You have the right to be given information about your proposed implant placement so that you are able to make the decision as to whether to proceed with surgery.  What you are being asked to sign is your acknowledgment that you fully understand the nature of the proposed treatment, the known risks associated with it, and the possible alternative treatments.

The purpose (goal) of today’s surgery is to place the following implants:


I understand that dental implants may be placed by either a one-stage technique or two-stage technique.  One stage means the implant will be surgically positioned with a portion of the implant protruding through your gum tissue at the completion of surgery. Two-stage surgery requires one surgery to place the implant, followed by a healing time, then a second surgery to uncover the implant and place a healing cap that protrudes through the gum tissue.  Both the one-stage and two-stage implant placement techniques usually require a healing period before your restorative dentist will be able to place a dental restoration.  Your surgeon and restorative dentist will utilize the technique that is best suited for your condition.

In certain unusual circumstances, and with very specific criteria, your surgeon and restoring dentist may elect to restore some or all of the implants immediately or shortly after the placement procedure.  This technique is called “Immediate Load” and it carries some increased concerns about bone and implant healing.

In certain cases, the surgery may involve additional materials and procedures (grafting with bone or artificial bone substitutes, use of healing membranes and associated fixation devices, impressions or indexing the implants, etc.).   The need for those procedures may not be apparent until after the surgery has begun.

The pros and cons of possible alternative methods (if any) of replacing my missing teeth have been explained to me, including: