Socket Preservation / Bone Grafting Consent Form

I, the undersigned, consent to undergo the socket preservation procedure as recommended by my dentist/oral surgeon. This procedure involves the placement of bone graft material into the tooth socket following an extraction to preserve the bone structure for future dental restoration.

The purpose of this procedure is to maintain the bone contour and volume in the area of the extracted tooth, which may be necessary for future dental implants or other restorative treatments.

I understand that, as with any surgical procedure, there are potential risks and complications, including but not limited to:
- Pain, swelling, or discomfort.
- Infection requiring additional treatment.
- Bleeding or bruising.
- Allergic reactions to medications or materials used.
- Failure of the graft material to integrate with the bone.
- Numbness or tingling in the affected area, which may be temporary or permanent.

I have been informed of alternative options, including:
- Extraction without socket preservation.
- No treatment.

I understand that local anesthesia will be used during the procedure. The risks associated with anesthesia, including allergic reactions or discomfort, have been explained to me.

I agree to follow all post-operative care instructions provided by my dentist/oral surgeon. I understand that smoking or failure to follow instructions may increase the risk of complications.

I have had the opportunity to ask questions about the procedure, risks, benefits, and alternatives. All my questions have been answered to my satisfaction. I understand that no guarantees can be made regarding the outcome of the procedure.

By signing below, I acknowledge that I have read and understood this consent form. I voluntarily consent to the socket preservation procedure.

At any stage of treatment, the provider may refer the patient to an endodontist for further evaluation or treatment.