Alternative Treatment

• Retaining tooth/teeth as is and monitoring with your dentist long term.
• Leaving a portion of the tooth roots or teeth (coronectomy) to try to decrease risk of damage to adjacent structures (sinus or nerve).

Surgical Procedures may involve some, or all, of the following:

• Use of local anesthetic, oral or intravenous sedation, antibiotics, analgesics and sutures (stitches).
• Use of a bone graft to preserve the bone on neighboring teeth or to fill deficits. The bone may be my own bone, human donor bone or cow bone and a membrane (which may require an additional procedure to remove the membrane) may be utilized.

Risks and Complications of Extraction and Bone Graft (if applicable):

• Allergic reactions to dental materials/medications
• Bleeding, swelling, infection
• Pain and/or tooth sensitivity
• Bruising
• Perforation of upper jaw sinus or nasal cavity
• Bone fracture
• Scarring
• Damage to other teeth/roots which may need repair or removal
• Damage to dental appliances
• Cracking/stretching corners of mouth
• Cuts inside mouth or on lips
• Slow healing
• Temporary restriction of mouth opening
• Stress or damage to jaw joints (TMJ)
• Increased tooth/teeth mobility of neighboring teeth
• Possible altered or loss of sensation due to dental nerve damage (including loss of taste)
• Dry socket
• Bony ridges or splinters that may require further treatment
• Part of tooth and/or roots may be left to prevent damage to nerves or other structures
• Nerve injury in the place the graft was taken from (if applicable)
• Rare chance of disease spread from processed bone
• Failure/infection of the bone graft

Risks and Complications of Local Anesthetic Use:

Nerve injury, altered or loss of sensation, numbness, pain, or altered feeling in the face, cheek(s), lips, chin, teeth, gums, and/or tongue (including loss of taste). Such conditions may resolve, but in some cases may be permanent.

No Warranty or Guarantee:

I understand that the doctor cannot guarantee the results of the procedure.

Consent to Unforeseen Conditions:

Unknown conditions discovered during treatment may modify or change the original treatment plan. I authorize the treating dentist to perform additional or alternative procedures if it is in my best interest.

Compliance with Self-Care Instructions:

I have provided an accurate and complete medical history, including dental and medical conditions, medications, allergies, recreational drug use, and pregnancy (if applicable).

I understand that excessive smoking and/or alcohol intake may affect healing and may limit the successful outcome of my surgery.

I agree to follow all instructions before and after the procedure, take prescribed medications, practice good oral hygiene, keep all appointments, and inform my doctor of any post-operative problems.

Supplemental Records and Their Use:

I consent to photography, filming, recording, and x-rays of my oral structures related to these procedures for educational use in lectures or publications, provided my identity is not revealed.

Patient Endorsement:

I have read and fully understood this document and consent to the performance of any and all procedures related to third molar extraction and bone grafting as presented during consultation and treatment planning.