Consent for Veneers / Crowns

I consent the dentist, and assistants/associates of their choice, to provide such additional services as he may deem reasonable and necessary, including, but not limited to, the administration of anaesthetic agents, the performance of necessary laboratory, radiological (x-ray), photographic and other diagnostic procedures and administration of medications.

There are some unlikely risks that you should be aware of, such as:

  1. Reduction or roughening of tooth structure: To prepare teeth for the reception of porcelain veneers/crowns, it is necessary to slightly reduce or roughen the surface of the tooth to which the veneer(s)/crown(s) may be bonded. This preparation will be done as conservatively as possible. If the veneer/ crown covering breaks or comes off, the uncovered tooth may become more decay susceptible. The tooth may require replacement with another veneer or crown.
  2. Sensitivity of teeth: Even though there is usually no appreciable sensitivity, this treatment may cause teeth to become sensitive. Should sensitivity occur and persist for any length of time, please contact this office for an examination. In a small number of cases, the preparation of a tooth for a crown or veneer may result in the nerve of the tooth becoming affected and the consequent need for a root canal procedure. Based on the clinical findings, your dentist will advise you of the most appropriate treatment.
  3. Chipping, breaking or loosening of the veneer/crown: This could occur no matter how well performed the treatment goes. Many factors may contribute to this happening, such as: chewing of hard materials; changes in occlusal (biting) forces; traumatic blows to the mouth; breakdown of the bonding agents; and other such conditions over which the dentist has no control.
  4. Aesthetics and appearance: Every effort possible will be made to match and coordinate both the form and shade of veneers/crowns, which will be placed to be cosmetically pleasing to the patient. However, some differences may exist between the natural dentition and the artificial materials, making it impossible to have the shade and/or form perfectly match your natural dentition.
  5. Longevity: it is impossible to place any specific time criteria on the time that veneers/crowns should last. The duration may vary from a very short to a very long time depending upon many conditions in each patient and/or their habits or circumstances, which may be internal, external or both.
  6. Unforeseen conditions can arise during treatment, which may alter the treatment plan. I consent that the doctor and assistants/associates of their choice do what they deem necessary under the circumstances, including the decision not to proceed with the restorative treatment. If unforeseen conditions arise, the doctor will inform you as quickly as possible of these conditions, treatment changes, and the costs involved.
  7. Alternative treatmentshave been explained to me, including their risks and benefits.
  8. I am responsible for immediately informing the dentist and seeking attention from him/her should any unexpected problems occur or if the patient is dissatisfied. Also, all instructions must be diligently followed, including scheduling and attending all appointments.

I UNDERSTAND that I will require ongoing maintenance care, and longevity is related to what I eat and drink and my home care habits.

I UNDERSTAND that porcelain, veneer/crowns treatment may entail certain risks and possible unsuccessful results, with even the possibility of failure to achieve the results which may be desired or expected. I agree to assume those risks, possible unsuccessful results and/or failure associated with, but not limited to the following: (Even though care and diligence is exercised in this subject treatment, there are neither guarantees of anticipated or desired results nor the longevity of the treatment)

Informed Consent

I have been allowed to ask any and all questions regarding the nature and purpose of porcelain veneer treatment and have received all answers to my satisfaction.

I voluntarily assume all possible risks, including the risk of substantial harm, if any, which may be associated with any phase of this treatment in hopes of obtaining the desired results, which may or may not be achieved.

No guarantees or promises have been made to me concerning the results.

The fee(s) for these services have been explained to me and are satisfactory.

By signing this form, I am freely giving my consent to allow and authorise my Doctor to render any treatment deemed necessary, desirable, and/or advisable to me, including administering and/or prescribing any anaesthetics and/or medications.


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