Oral surgery · CID-ORS-12 · v1.0

Sinus Opening (Oroantral) Closure Consent

Consent for surgically closing an opening between the mouth and the sinus.

About 7 minutesRead, sign and download from your own device

Completion

0 of 16 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

The roots of upper back teeth sit close to the maxillary sinus, and sometimes separated from it by little more than a thin sheet of bone. An opening between the mouth and the sinus can appear when such a tooth is removed, when an implant site is prepared, or when infection erodes the bone.

The opening is closed by moving nearby tissue over it — commonly a flap of gum advanced from the cheek side, a pad of fat from the cheek, or a graft material — and stitching it in place.

Why it needs closing

An opening left to itself lets mouth bacteria and food into the sinus. Sinus infection follows in a large proportion of cases, often within days, and an established opening tends to become a permanent tract that is harder to close later.

Material risks and limitations

The closure can fail and the opening can reopen — reported in up to about a third of cases across techniques — usually because of wound contraction or infection. A second procedure may then be needed.
Sinus infection, congestion, discharge, facial pressure, or a bad taste or smell; antibiotics, decongestants, or referral to an ear, nose and throat specialist may be needed.
Pain, swelling, bruising, bleeding, nosebleed, and stitches coming apart.
Reduced depth of the gum fold beside the cheek where tissue has been moved, which can affect how a denture sits.
Numbness or altered feeling of the cheek, lip, or gum — usually temporary.
Where a cheek fat pad is used, a change in cheek contour, usually slight.
Future implant treatment in the area may need to wait, and may need additional grafting.

You must follow the sinus precautions

Do not blow your nose. Sneeze with your mouth open. Do not use a straw, do not smoke or vape, and avoid heavy lifting and air travel as instructed until you are told the site has healed.
These precautions protect the repair. Breaking them is one of the commonest reasons a closure fails.

Reasonable alternatives

Observation with antibiotics for a very small opening that may close on its own, a different closure technique, referral to an oral and maxillofacial or ENT specialist, 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 understand that the closure can fail and may need to be repeated, and that following the sinus precautions I have been given materially affects whether it holds.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 16 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
Lead Implant Dentist & Founder · CA Dental License #50472
Dr. Arpana Gupta, DDS, MDS
Implant Dentist · 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.

What happens to what you type

While you type, nothing is sent and no draft, analytics, or advertising script records your answers. Download builds the PDF in your browser, saves it to your device, and sends nothing — this website never transmits your completed form. Hand it to our staff at your visit so they can place it in your record. Once accepted there, it becomes part of your dental record and is protected under California’s Confidentiality of Medical Information Act (Civil Code § 56) and, where it applies, HIPAA. You can read how we handle records in our health information privacy notice.

Controlled document CID-ORS-12 · v1.0 · Effective 06 Sep 2026 · Next clinical review 06 Sep 2028 · Owner Sambhav (Sam) Jain, DMD, MS & Arpana Gupta, DDS, MDS