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I acknowledge that certain patients do not heal in a favourable manner and in these cases the implant can be lost. Since each patient’s condition is unique, long-term success could not occur.


Additionally, the surgery’s success might be dependent on my general medical condition, nutritional health issues, tobacco use, alcohol consumption, teeth grinding or clenching, inadequate oral hygiene, and certain medications.


Even though they are rare, I understand that certain complications could result from my surgery, the medications, and the anaesthetics. These include, but are not limited to:


- Jaw joint pain or muscle spasms

- Post-surgical infection, bleeding, swelling, bruising

- Temporary, and sometimes permanent, altered sensory touch perception of the lips, tongue, teeth, chin, and gums

- Loss of the implant

- Loss of sensation in the lip and chin area


The exact duration of any complication cannot be determined.


I understand that the drawing and the structure of the prosthetic (crown/bridge/prosthetic) can be an important factor in the success or failure of an implant. I also understand that alterations made on this prosthetic or on the implant could result in the loss of the implant. I have been made aware of the possible failure of the connection between the implant and the bone and that it would be deemed necessary, in this case, to remove the implant. This could happen during the preliminary phase, during the initial integration of the implant to the bone, or anytime afterwards.


I understand that maintaining an oral hygiene routine as recommended by my dentist as well as taking the prescribed medications are important to the success of the treatment. Bi-annual oral care appointments with my dentist will also be necessary once the treatment is complete.  


I have been fully informed of the nature of my case, the treatment plan being proposed to me, of its length, its limitations or risks associated with my condition, of the prognosis, of the nature of the surgery, of available alternative treatment options including non-treatment, of the benefits, of the necessity of follow-ups and personal hygiene and care. I have had the opportunity to ask all the questions I had pertaining to this treatment and have obtained satisfactory responses from my surgeon.


I understand that the scope of work will be lead collaboratively with my dentist, that the surgical phase will be done by Doctor Chouinard, and that the prosthetic portion will be done by my dentist. I also understand that the follow-ups will be jointly lead. Bi-annual oral hygiene appointments will have to be made by my dentist. 


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