ࡱ> *,)7 bjbjUU "7|7| l         $C c2 24  G444   4 4 46 :,    0m'.(l  ]0Rj 4    Moon Road Cosmetic & Family Dentistry Dr. Dayo Obebe Informed Consent Prosthodontic treatment- fixed Dental crowns are restorations that cover or cap teeth, restoring them to there natural size, shape, and color. A crown not only helps with the appearance, but can strengthen a tooth as well. A fixed, or stationary bridge is designed to replace teeth that have been lost. Missing teeth may be replaced for appearance, or to prevent, or correct bite and gum problems related to shifting or stressed teeth. Sometimes a crown covering the entire tooth is not necessary and an on lay, inlay, or porcelain laminate is required. An inlay restores the chewing part of the tooth without covering the cusps; an on lay restores the chewing part including the cusp; and a porcelain laminate covers the front part of a tooth. Dental crowns and bridges are made of porcelain or acrylic and usually an inner layer of metal. Some made be made of metal alone. Dental inlay and on lays can be made of porcelain or metal; porcelain laminates are made without metal. As with all procedures, there are certain potential problems associated with crowns and bridges. These include, but are not limited to: The potential need for root canal therapy. The cumulative effects of cavities, fillings and crack in the teeth may necessitate a root canal. The need for a root canal may become apparent during a crown preparation, or after a crown is made. Periodontal (gum) disease can occur at any age, with or without crowns and bridges. Generally speaking crowns and bridges do not create or prevent gum disease. Fractures to the porcelain may occur after placement. Small fractures may be repaired; large fractures may require a new crown or bridge. Dark lines at the gum line may appear on crowns or fixed bridges. This is the metal edge of the crown. If the gum recedes after placement, this metal will show. Sometimes this can be corrected, other times a new crown or bridge might be needed. Recurrent tooth decay can accrue after placement. A filling or a new crown may correct this or bridge may be needed. Food impaction may occure under a bridge. This may be an unavoidable condition. Meticulous home care is required. Temporomandibular Joint Dysfunction may occur due to change in the bite following crowns and bridges. This can usually be corrected, but in rare occasions, may cause symptoms requiring extensive treatment. I understand the recommended treatment, the risks of such treatment, any alternatives that may be available as well as risk of these alternatives, the consequences of doing nothing about my condition, and the fee(s) involved. Patient Signature____________________________________________Date_______________ Tooth#(s)____________________________________________________________________ Shade: _____________________________ Patient Signature________________________ Witness_______________________________________________________________________ 5i 8 B , ;  5CJ\CJ&56Hhi34 8 , l NOPDE$ & Fa$$a$E$a$ 1h/ =!"#$% i8@8 NormalCJ_HaJmH sH tH <A@< Default Paragraph Font*>@* Title$a$5\4J@4 Subtitle$a$ 5CJ\ &56Hhi348,l N O P D E 00000000000 0 0 0 0 0 0 00000000000 E   +RSstccklq  Dayo Obebe_C:\Documents and Settings\Owner\My Documents\Informed consent Prosthodontic treatment-fixed.doc Dayo Obebe_C:\Documents and Settings\Owner\My Documents\Informed consent Prosthodontic treatment-fixed.doc Dayo Obebe_C:\Documents and Settings\Owner\My Documents\Informed consent Prosthodontic treatment-fixed.doc Dayo ObebeC:\Documents and Settings\Owner\Application Data\Microsoft\Word\AutoRecovery save of Informed consent Prosthodontic treatment-fixed.asd Dayo Obebe_C:\Documents and Settings\Owner\My Documents\Informed consent Prosthodontic treatment-fixed.doc Dayo Obebe_C:\Documents and Settings\Owner\My Documents\Informed consent Prosthodontic treatment-fixed.doc Dayo Obebe_C:\Documents and Settings\Owner\My Documents\Informed consent Prosthodontic treatment-fixed.doc Dayo Obebe_C:\Documents and Settings\Owner\My Documents\Informed consent Prosthodontic treatment-fixed.doc Dayo ObebeC:\Documents and Settings\Owner\Application Data\Microsoft\Word\AutoRecovery save of Informed consent Prosthodontic treatment-fixed.asd Dayo Obebe_C:\Documents and Settings\Owner\My Documents\Informed consent Prosthodontic treatment-fixed.doc:6pRfcG&"D0h  ^ `.h^`.hL^`L.h| | ^| `.hLL^L`.hL^`L.h^`.h^`.hL^`L.h^`.h^`.hpLp^p`L.h@ @ ^@ `.h^`.hL^`L.h^`.h^`.hPLP^P`L.fcG:6                  @   @UnknownG: Times New Roman5Symbol3& : Arial"hǒf X !r0 l  2Q%Moon Road Cosmetic & Family Dentistry Dayo Obebe Dayo ObebeOh+'0 (4 P \ ht|&Moon Road Cosmetic & Family Dentistryt oon Dayo Obebeoayoayo Normal.doto Dayo Obebeo9yoMicrosoft Word 9.0&@ K @W[@ZM.( ՜.+,0 hp  Dayo Obebe DMD  &Moon Road Cosmetic & Family Dentistry Title  "#$%&'(+Root Entry FT3.(-1TableWordDocument"SummaryInformation(DocumentSummaryInformation8!CompObjjObjectPoolT3.(T3.(  FMicrosoft Word Document MSWordDocWord.Document.89q