Informed Consent for Fixed Prosthodontics

Informed consent for Fixed Prosthodontics

“Fixed Prosthodontics” refers to any dental prosthesis that fabricated out of the mouth and then permanently affixed to the teeth. This can include, but is not limited to:
• veneers;
• bridges;
• crowns;
• inlays/onlays.

Potential Complications
As with all dental and medical procedures, “Fixed Prosthodontics” is not without risk. Some of the potential complications of this treatment include, but are not limited to:
• Bonding failure of the prosthesis – If the tooth surface where the prosthesis will be attached becomes contaminated with saliva or water during the procedure, there is increased case of bonding failure. This may create a hair-like gap between them that can allow the external stimuli to reach the pulp and cause a toothache. This could also increases the risk of new decay.
• Prosthesis not shaped/smoothed properly – If the edges of the prosthesis are not shaped or smoothed properly, the adjacent teeth or gums may become irritated and cause a tooth pain after filling. This can also result in increased plaque retention and increase the risk of secondary decay.
• Incorrect bite – When the prosthesis is made higher than the original tooth, the increased contact pressure in this higher area causes a tooth pain when chewing.
• Galvanism effect – Oral galvanism is a condition when two different metals in the mouth come in contact, such as a metallic alloy from a prosthesis and an amalgam filling. This creates an electrical charge that causes tooth pain similar to that of sensitive teeth. Usually the condition resolves in its own after some time.
• Damaged pulp during the filling procedure – While some irritation of the pulp tissues can be expected after a prosthesis procedure, sometimes the pulp can be severely damaged. This may result in the need for Root Canal Treatment.
• Infected pulp tissue – A common cause of persistent toothache after a prosthesis is that tooth decay bacteria may have reached the pulp chamber and infected it. This can occur even if the decay hasn’t blatantly entered the pulp, as bacteria can still travel through the porous inner tooth surface. The toothache is usually constant, especially when eating.
• Chipping/fracture – Over repeated cycles of chewing, the prosthesis may develop chipping or even fracture. An incorrect bite can increase pressure on the prosthesis and increase the risk of fracture.
• Weakening of tooth – The removal of tooth structure, regardless of whether it may be decayed, weakens the integrity of the tooth. The remaining tooth structure is thinner after the prosthesis is placed, and repeated cycles of chewing may result in fatigue in the tooth and ultimately a fracture.
• Tooth decay – The junction between the prosthesis and the tooth is subject to a higher risk of tooth decay due to the microscopic irregularities present at this junction. Good oral hygiene and maintenance is required to prevent the development of tooth decay.
• Discolouration – Exposure to the oral environment may cause either the prosthesis itself, or the junction between the tooth and prosthesis, to become discoloured.
• Exposure of margins – Gums may recede over time and expose the junction between the prosthesis and the tooth that were not initially visible. This can result in an unaesthetic appearance.
• Allergic reaction – A rare complication of a prosthesis procedure is the development of an allergic reaction to the filling materials, which is more common with the amalgam or metallic alloy. Common allergy symptoms as itching or rash may also be present along with the toothache after filling the tooth.

The Dahl Concept
Crowns and bridges may be used to “open the bite” by increasing the length of certain teeth, either in a two-stage approach with the provisional composite material later replaced by fixed prosthodontics, or in a one-stage approach directly with fixed prosthodontics. This may result in other teeth in the mouth not touching. Teeth with their length increased will feel high in the bite and usually takes 1-2 weeks to get used to this new bite. These teeth may exhibit a small degree of tenderness and mobility, but this should be short-lived.

The teeth not touching are left to slowly erupt and meet again with the opposing tooth to re-establish the bite. This is known as the “Dahl concept”. Teeth will re-establish the bite in 96-98% of cases, typically within 4-6 months but can take up to 1 year. There is a chance (2-4%) that some teeth may never re-establish their position in the bite again.

Alternative Treatments
Depending on the reason for treatment with Fixed Prosthodontics, several alternative treatments are possible. If Fixed Prosthodontics is:
• due to the need to reconstruct a heavily broken down tooth, it may be possible to use a large direct filling instead, or extract the tooth and replace it with a denture or an implant;
• to replace a missing tooth, it may be possible to use denture or implant instead;
• to provide protection for a tooth that has Root Canal Treatment, it may be possible to use a large direct filling instead;
• If the Fixed Prosthodontics is for cosmetic improvement, it may be possible to consider placement of composite resin veneers instead.

The cost of Fixed Prosthodontics is as outlined in the attached treatment plan. A deposit of 20% is required prior to commencement of treatment. Full payment is required on the day of insertion of the fixed prosthesis.

Teeth requiring Fixed Prosthodontics:

• I have read and understand the conditions and information in this Consent Form.
• I have discussed the information contained in the Consent Form concerning Fixed Prosthodontic Treatment with my dentist, and am satisfied with the answers that I have received.
• 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 prosthodontics, but is not a prosthodontist.
• I authorise my dentist to provide me with Fixed Prosthesis/Prostheses.