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Informed Consent for Soft Tissue Grafts

Informed Consent for Soft Tissue Grafts

Precautions must be taken for soft tissue 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 soft tissue grafts is considered minor oral surgery and has some inherent risks. Potential complications that can occur during the placement of a soft tissue graft include:
• Damage to blood vessels – Preparation of the graft site or harvesting soft tissue from the donor site may damage nearby blood vessels, particularly if the graft is harvestedfrom the palate.
• Nerve damage – Preparation of the graft site or obtaining soft tissue 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 soft tissue graft 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 soft tissue is taken from your palate, 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 and/or clear stent 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.
• Increased gum recession/spacing between teeth – Problems with the graft may cause further damage to the surrounding healthy tissue and result in increased recession and/or spacing between the teeth.
• Inability to obtain full coverage of tooth/implant site – Although soft tissue grafting has been shown in clinical studies to be a predictable procedure, sometimes there full coverage of the tooth or implant site cannot be achieved.
• Need for regrafting – Healing of gums and bone around a soft 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 human or animal tissue, which may cause allergic reactions in susceptible patients.
• Scarring/colour change of tissue – Scarring or colour change of the soft tissue can occur where the graft is being placed or even from the donor site.
• Transient or permanent sensitivity of surrounding teeth – The surgical procedure can, in rare circumstances, cause surrounding teeth to become sensitive to hot/cold/sweet/acidic foods.

Necessary Follow-up Care and Self Care
• Appointments are required after a soft tissue 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 soft tissue 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 soft tissue 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 soft tissue, which may be from the immediate vicinity or from the palate. This is the most effective, but obtaining soft tissue from the donor site is more painful and expensive.
• Allograft – Human acellular collagen matrix. This is very effective and reasonable cost. Integrates will with your own soft tissue.
• Xenograft – Porcine collagen matrix. This is very effective and reasonable cost. Integrates with your own soft tissue.

The total cost of soft tissue grafting is as outlined in the treatment plan. The full amount of soft tissue grafting is due on the day of the service.

Soft tissue 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 soft tissue grafts with my dentist, and am satisfied with the answers that I have received.
• I understand the dentist has a special interest in periodontics, but is not a periodontist.
• 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 authorise my dentist to provide me with soft tissue grafts.