Consent for Fixed Bridge Restorations Form

Fixed bridges replace missing teeth. They also help to maintain the position of the teeth and the contours of the face.

Fixed bridges require at least two visits to complete. Natural teeth next to the area of the missing tooth are used to support a fixed bridge. At the first visit, the dentist will reduce the size of the support teeth, making room for the fixed bridge to fit. Next, an impression or digital scan of the teeth is made. A plastic temporary fixed bridge is placed while the fixed bridge is made by a dental laboratory. It is important to return for the cementation of the new fixed bridge as soon as it is ready in order to reduce the chance of a new cavity or other problems.

Alternatives

• A dental implant and implant-supported crown restoration.
• Replacement of the missing tooth or teeth by a removable partial denture. Partial dentures are removed from the mouth for cleaning. They are supported by the remaining teeth and the jawbone and retained by clasping selected remaining teeth.
• No treatment. I may decide not to replace the missing tooth or teeth. If I decide upon no treatment, my teeth may shift over time, causing chewing, periodontal (gum), or jaw joint (TMJ) problems.

Risks

• Nerve irritation, discomfort, sensitivity to hot and cold – root canal treatment may become necessary during or after treatment and may not be avoidable
• Once prior fillings and decay have been removed it may reveal a more serious condition of my tooth/teeth that may require periodontal (gum) surgery, root canal treatment, or extraction
• Changes in the bite, soreness or stiffness of the jaw joint (TMJ)
• Injury to gums near the tooth being prepared or receding gums

I understand that poor eating habits, oral habits (smoking, fingernail biting, ect.), and poor oral hygiene will negatively affect how long my fixed bridge lasts.

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.