Informed Consent for Orthodontic Treatment (Plastic Aligners)

Precautions
General medical conditions and use of medications can affect orthodontic treatment. Make sure your medical history is completed to the best of your knowledge.
Potential Complications
Like other orthodontic treatments, the use of sequential clear plastic aligners may involve some of the risks outlined below:
• Affected treatment time/results - Failure to wear the appliances for the required number of hours per day, not using the product as directed by your doctor, missing appointments, and erupting or atypically shaped teeth can lengthen the treatment time and affect the ability to achieve the desired results. Aligners are not effective in the movement of dental implants;
• Soreness/discomfort - Dental tenderness may be experienced after switching to the next aligner in the series. Gums, cheeks and lips may be scratched or irritated;
• Relapse - Teeth may shift position after treatment. Consistent wearing of retainers at the end of treatment should reduce this tendency;
• Damage to teeth and soft tissue - Tooth decay, periodontal disease, inflammation of the gums or permanent markings (e.g. decalcification) may occur if patients consume foods or beverages containing sugar, do not brush and floss their teeth properly before wearing the sequential clear plastic aligner products, or do not use proper oral hygiene and preventative maintenance. Health of the bone and gums which support the teeth may be impaired or aggravated. A tooth that has been previously traumatised, or significantly restored may be aggravated. In rare instances the useful life of the tooth may be reduced, the tooth may require additional dental treatment such as endodontic and/or additional restorative work and the tooth may be lost;
• Effect on speech - The aligners may temporarily affect speech and may result in a lisp, although any speech impediment caused by the aligners should disappear within one or two weeks;
• Excess salivation or oral dryness - Aligners may cause a temporary increase in salivation or mouth dryness and certain medications can heighten this effect;
• Change of bite - The bite may change throughout the course of treatment and may result in temporary patient discomfort. At the end of orthodontic treatment, the bite may require adjustment (“occlusal adjustment”);
• Aligner wear - In rare instances, slight superficial surface wear of the aligner may occur where patients may be grinding their teeth or where the teeth may be rubbing and is generally not a problem as overall aligner integrity and strength remains intact;
• Loss of dental restorations - Existing dental restorations (e.g. crowns) may become dislodged and require re-cementation or in some instances, replacement;
• Root resorption - The length of the roots of the teeth may be shortened during orthodontic treatment and may become a threat to the useful life of teeth;
• Product breakage is more likely in patients with severe crowding and/or multiple missing teeth;
• Swallowing/aspiration of appliances - Orthodontic appliances or parts thereof may be accidentally swallowed or aspirated;
• Jaw joint problems - In rare instances, problems may also occur in the jaw joint, causing joint pain, headaches or ear problems;
• Allergic reactions – are rare but may occur to the aligner plastic;
• Supraeruption - Teeth that are not at least partially covered by the aligner may undergo supraeruption;
• Black trianges - Teeth which have been overlapped for long periods of time may be missing the gingival tissue below the interproximal contact once the teeth are aligned, leading to the appearance of a “black triangle” space;
• Use of attachments - Attachments may be bonded to one or more teeth during the course of treatment to facilitate tooth movement and/or appliance retention. These will be removed after treatment is completed. These attachments may fall off and require replacement;
• Need for shaping of teeth - Teeth may require interproximal recontouring or slenderising in order to create space needed for dental alignment to occur;
• Need for supplemental treatment - Treatment of severe open bite, severe overjet, mixed dentition, and/or skeletally narrow jaw may require supplemental treatment in addition to aligner treatment. Supplemental orthodontic treatment, including the use of bonded buttons, orthodontic elastics, auxiliary appliances/dental devices (e.g. temporary anchorage devices, sectional fixed appliances), and/or restorative dental procedures may be needed for more complicated treatment plans where aligners alone may not be adequate to achieve the desired outcome;
• Surgery - Oral surgery may be necessary to correct crowding or severe jaw imbalances that are present prior to wearing the sequential clear plastic aligner product. If oral surgery is required, risks associated with anesthesia and proper healing must be taken into account prior to treatment;

Alternative Treatment Options
Alternative methods of aligning teeth include:
• Conventional orthodontics using braces and wires;
• Removable orthodontic appliances.

Cost
The total cost of orthodontic treatment is as outlined in the treatment plan. Please take note of the timing of payment for various parts of the treatment, and also take into account the number of included retainers.

This quoted cost does not include:
• Extractions required to complete the orthodontic treatment;
• Scaling and cleaning throughout the course of orthodontic treatment;
• Restorative work (crowns, bridges, implants, fillings, veneers, etc.) which may be required after orthodontic treatment to achieve a more aesthetic outcome;
• Replacement retainers, should the ones provided fracture;
• Repair or replacement orthodontic apparatus used during treatment, in the event of breakage or loss.

• I have read and understand the conditions and information in this Consent Form.
• I have discussed the information contained in the Consent Form concerning the orthodontic treatment with my dentist.
• 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 orthodontics, but is not a orthodontist.
• I authorise my dentist to provide orthodontic treatment with Plastic Aligners.

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