Dr. Sambhav (Sam) Jain, DMD, MS
Dr. Arpana Gupta, DDS

bayareaimplantdentistry.com
info@bayareaimplantdentistry.com

Fremont3381 Walnut AveFremont, CA 94538Tel.(510) 574-0496Fax(510) 574-0499

San Francisco4318 Geary Blvd, Suite 201San Francisco, CA 94118Tel.(415) 696-2922Fax(510) 574-0499

Oral surgery

Alveoloplasty and Ridge Recontouring Consent

Consent for smoothing and reshaping the jaw ridge so a denture or implant bridge can seat properly.

About 6 minutesRead, sign and download from your own device

Completion

0 of 15 required items

Patient details
Patient-specific fields
Acknowledgments
Electronic signature

Before you sign

Review this document before your appointment when possible. Your treating dentist must still explain the patient-specific treatment, benefits, material risks, alternatives—including no treatment—and answer your questions. Do not sign after receiving sedating medication.

1. Who this form is for

Fields marked * are required for a signed PDF.

Patient full legal name *Date of birth *Email *Phone *

Treating dentist

Dr. Jain & Dr. Gupta

Treating office *Signer full legal name *Enter the patient’s name when the patient is signing. An authorized representative must enter their own name.Relationship or authorityRequired when someone other than the patient signs.

2. What you are agreeing to

Proposed treatment

After teeth are removed the bony ridge is often sharp, uneven, or undercut. Alveoloplasty lifts the gum and smooths or reshapes that bone so a denture or a fixed implant bridge can seat comfortably and be made the right thickness. It is frequently done at the same visit as extractions or full-arch implant surgery.

Material risks and limitations

Bone is permanently removed. It does not grow back, and removing too much would reduce what is available for implants later — which is why only what is necessary is taken.
Pain, swelling, bruising, bleeding, and stitches that may need removing.
Infection, delayed healing, or a small area of exposed bone.
Numbness or altered feeling of the lip, chin, gum, or tongue — usually temporary.
The ridge continues to change shape as it heals, so a denture made now will need adjustment, relining, or remaking.
Sharp bone edges can reappear during healing and occasionally need a second smoothing.
Opening into the sinus when the upper back jaw is reshaped.

Reasonable alternatives

Leaving the ridge as it is and adjusting the denture instead, waiting for natural remodeling before making a denture, grafting to build the ridge up rather than reducing it, or no treatment.

3. Your case, in your words

Treatment, tooth number(s), or area discussed with your dentistUse the wording from your treatment plan when available.Questions you asked or information you want your dentist to addressEnter “None” only if you have no remaining questions.Patient-specific risks or special considerations discussedFor example: medications, allergies, smoking, bone quality, nerve or sinus proximity.

4. Confirm, then sign

I have reviewed this form and understand the proposed treatment, its expected benefits, its material risks, reasonable alternatives, and the likely consequences of no treatment.I have had an opportunity to ask my treating dentist questions, and my questions have been answered in language I understand.I understand that this form supports—but does not replace—the informed-consent discussion with my treating dentist, and that I may withdraw consent before treatment.I agree to sign this form and receive it electronically. I understand this agreement applies only to this form, and that I can complete this and any other form on paper instead — completing forms on paper does not affect my treatment, my fees, or my care in any way.I understand that I may withdraw my agreement to sign electronically at any time before I sign by simply not signing and asking the office for a paper copy, and that after signing I may ask the office for a paper copy at no charge.I understand that I need a current web browser and a device able to open and save a PDF file, that I should download and keep the PDF this form produces, and that I can ask the office to print or re-send my signed form at any time.I intend my drawn or typed signature to be my electronic signature on this form, and I am signing it myself.

Patient or authorized representative signature *

Sign inside the box using a mouse, stylus, or finger.

Where this form goes

Nothing you type here is uploaded — the signed PDF is built in your browser. Download the signed PDF saves it to your device and sends nothing. Bring it to your appointment or hand it to the front desk, and staff will place it in your dental record.

Completion

0 of 15 required items

Patient details
Patient-specific fields
Acknowledgments
Electronic signature

Need help? Call the office before signing. A patient form should document a conversation, not replace one.

Who is responsible for this document

Responsible clinicians

Dr. Sambhav (Sam) Jain, DMD, MS
Implant Surgeon, Implantologist & Founder · CA Dental License #50472
Dr. Arpana Gupta, DDS, MDS
Implant Surgeon & Implantologist · CA Dental License #50467

Arpana Gupta, DDS and Sambhav Jain, DDS, Inc., practicing as Center for Implant Dentistry.

Where to reach us

Fremont
3381 Walnut Ave, Fremont, CA 94538
Phone (510) 574-0496 · Fax (510) 574-0499
San Francisco
4318 Geary Blvd, Suite 201, San Francisco, CA 94118
Phone (415) 696-2922 · Fax (510) 574-0499

Questions about a form? info@bayareaimplantdentistry.com — that address is for questions about a form, not for sending one. A completed form holds health details that should never travel through ordinary email: download the signed PDF and bring it to your appointment, or hand it to the front desk.