Consent for Veneers / Crowns
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.
Even though this subject treatment will be exercised with care and diligence, there are no guarantees of anticipated or desired results nor the longevity of the treatment.
I agree to assume those risks, possible unsuccessful results and/or failure associated with but not limited to the following:
- Reduction or roughening of tooth structure: In preparing 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.
- 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, 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 resulting in the need for a root canal procedure. Your dentist will advise you of the most appropriate treatment based on the clinical findings.
- Aesthetics and appearance: Every possible effort will be made to match and coordinate the form and shade of veneers/crowns, which will be placed to be cosmetically pleasing to the patient. However, some differences may exist between natural dentition and artificial materials, making it impossible to have the shade and/or form perfectly match your natural dentition.
- Longevity: It is impossible to predict how long veneers/crowns should last. These periods may vary from very short to very long depending upon many conditions from patient to patient and/or upon each patient’s habits or circumstances, which may be either internal, external or both.
- 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 have been allowed to ask all questions regarding the nature and purpose of porcelain veneer treatment, and I 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 the administration and/or prescribing of any anaesthetics and/or medications.