Informed consent for fixed prosthodontics treatment (crown/bridge/inlay, veneers) Informed Consent for Fixed Prosthodontics Treatment (Crown/Bridge/Inlay, Veneers)Patient's Name *Phone Number *Canada +1Date *Tooth NumberCostCADI hereby authorize and give consent to *Dr. Mohamad IssaDr. Mohamad IssaDr. Mrunali DesaiDr. Zaineb HamoudDr. Mohamad Issa1. Purpose of Treatment *I understand that the purpose of fixed prosthodontics treatment (crowns, bridges, inlays, veneers) is to restore function, improve aesthetics, and protect damaged teeth.2. Description of Procedure *The procedure involves: Preparing the affected tooth/teeth by removing a portion of the enamel. Taking impressions or a digital scan of the prepared tooth/teeth. Fabricating the prosthetic (crown, bridge, inlay, veneer) in a dental laboratory. Placing and adjusting the prosthetic to ensure proper fit and function. 3. Risks and Complications *I understand that there are potential risks and complications, including but not limited to: Tooth sensitivity to hot and cold. Temporary or permanent nerve damage, which may cause numbness. Infection at the treatment site. Failure or dislodgement of the prosthetic, requiring repair or replacement. Root canal therapy – Due to crown preparation or cementation, the dental pulp might become inflamed, and the tooth may require a root canal before or after receiving a crown to prevent infection or possible extraction. Breakage of artificial dental crowns due to multiple factors. Unpredictable longevity – Regular dental check-ups are required. Patients should avoid harmful habits and use protective devices such as night guards or mouthguards as needed. 4. Benefits *I understand the benefits of the treatment, which include: Improved ability to chew and speak. Enhanced appearance of the teeth and smile. Long-lasting restoration compared to other treatments. 5. Alternatives: *I have been informed of alternative treatments, including: Fillings Removable dentures No treatment 6. Post-Treatment Care *I understand the importance of maintaining good oral hygiene and attending regular dental check-ups to ensure the longevity of the prosthetic.7. Patient Responsibilities *I agree to follow the dentist's instructions for care and maintenance of the prosthetic and to report any issues or discomfort experienced after the procedure.8. Consent *I acknowledge that I have read and understood the information provided above. I have had the opportunity to ask questions and have received satisfactory answers. I consent to proceed with the fixed prosthodontics treatment as described.Signee Name *Signee Role: (Please check one) *PatientParent / Guardian (if minor)Signature *Sign hereYour browser does not support e-Signature field.Submit