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Informed Consent for Bone Grafts

Informed Consent for Bone Grafts

Precautions must be taken for Bone Grafts in certain circumstances. You MUST inform the dentist prior to treatment if you:
1) have any of the following medical conditions:
• coagulopathy;
• heart condition;
• history of rheumatic heart disease;
• artificial heart valves;
• blood clotting disorders (Haemophilia, Von Willebrand’s disease, etc.);
2) are taking any of the following:
• blood thinning medication (Warfarin, Aspirin, etc.);
• medication affecting the bone (for osteoporosis, bone cancer, Paget’s disease).

Potential Complications
Placement of bone grafts is considered minor oral surgery and has some inherent risks. Potential complications that can occur during the placement of a bone graft include:
• Damage to adjacent teeth – Preparation of the graft site or harvesting bone from the donor site may inadvertently cause damage the crown and/or root of the adjacent tooth.
• Nerve damage – Preparation of the graft site or obtaining bone from the donor site can be in very close proximity to nerves that give feeling to your teeth, lips, and tongue. These nerves can potentially be damaged during the procedure, and can cause numbness to the areas they supply. Depending on the severity of the damage, the numbness can be temporary or permanent.
Potential complications that can occur shortly after preparation or placement of a dental implant include:
• Pain – Some discomfort is inherent in any oral surgery procedure. Grafting with materials that do not have to be harvested from your body are less painful because they do not require a donor site surgery. If bone is taken from your chin or wisdom tooth area in the back of the mouth, there will be more pain. This can be largely controlled with pain medications.
• Bleeding – This can occur especially if taking blood thinning drugs (such as Warfarin, Aspirin, Clopidogrel, or Dipyrdamole). A spare pack of gauze will be provided to aid in stopping the bleeding, but if bleeding does not stop, contact your dentist for further management.
• Delayed healing and wound infection – Any surgical procedure introduces bacteria into the operative site and can result in wound infection. This can delay both the healing and progression of the treatment plan.
• Swelling and bruising – The local area may become swollen and bruised, but this will typically resolve in 7 days with maximal swelling from the third to fourth day after the procedure.
• Failure of bone graft – Although bone grafting of localised areas to increase the width of existing bone has been shown in clinical studies to be a predictable procedure, some bone graft procedures may not be successful and may require removal.
• Need for regrafting – Healing of gums and bone around a graft cannot be accurately predicted. There may be a need for a second procedure if the results are not satisfactory.
• Allergic reactions – Allografts and Xenografts are composed of animal or synthetic bone particles. Some of these constituents may cause allergic reactions in susceptible patients.
• Scarring of tissue – This can occur where the incisions were made inside the mouth to gain access to the bone.

Necessary Follow-up Care and Self Care
• Appointments are required after a Bone Graft, which may be for follow-up procedures or post-operative evaluation. Patient attendence at these appointments are critical for appropriate healing and success of the procedure. After the procedure has been completed, it is importance to return for periodic examination and preventative treatment to facilitate continued success of the Bone Graft.
• The success of surgical grafting procedures can be affected by medical conditions, dietary and nutritional problems, smoking, alcohol consumption, clenching and grinding of teeth, inadequate oral hygiene, and certain medications. Accurate reporting of any prior drug reactions, allergies, diseases, symptoms, habits, or conditions is imperative. Also, diligence in maintaining personal daily oral care recommended after the procedure and taking all prescribed medications is important for the success of the procedure.

Alterative Treatment Options
There are several bone graft alternatives. This can include:
• No graft – This may compromise the outcome of a periodontal treatment or placement of a dental implant.
• Autogenous graft – Grafts your own harvested bone, either small particles or in block form, for jaw rebuilding. This is the most effective, but obtaining bone from the donor site is more painful and expensive.
• Allograft – Pre-packaged cadaver bone particles. This is very effective and reasonable cost. Resorbs away and eventually is replaced with your own bone.
• Xenograft – Pre-packaged cow or pig bone particles. This is very effective and reasonable cost. There exists a rare risk of disease (<1:2,000,000), and will preclude blood/tissue donations for 1 year or more at most blood banks. Does not resorb away and therefore does not get replaced with your own bone.
• Alloplast – Synthetic/chemically derived bone substitutes. There less effective but no risk of disease transmission.

The total cost of bone grafting is as outlined in the treatment plan. The full amount of bone grafting is due on the day of the service.
Bone grafting sites:

• I have read and understand the conditions and information in this Consent Form.
• I have discussed the information contained in the Consent Form concerning Dental Implants with my dentist, and am satisfied with the answers that I have received.
• To my knowledge, I have given an accurate report of my physical and medical history.
• I have had explained to me the cost of the treatment and I accept responsibility for that cost.
• I understand the dentist has a special interest in periodontics, but is not a periodontist.
• I authorise my dentist to provide me with bone grafts.