Treatment Plan Change During Surgery Authorization

A scan shows bone volume and shape. It cannot show how dense that bone will feel under a drill, whether a socket wall will hold, or what is found once a tooth is out. Sometimes the plan agreed beforehand turns out not to be the right plan once surgery is under way — and by then you may be sedated and unable to discuss it.

This form records what you agree to in advance, so your surgeon knows where your consent ends.

• Placing fewer or more implants than planned, or placing them in different positions or at different angles.
• Adding bone graft material or a membrane that was not planned, or increasing the amount used.
• Deciding not to place an implant at the time of surgery and allowing the site to heal first — a staged approach.
• Deciding not to attach teeth on the day of surgery if the implants are not stable enough to carry them safely.
• Smoothing or recontouring bone, or removing a small amount of additional bone or soft tissue, to allow the work to be completed.
• Closing an unexpected opening into the sinus, or managing bleeding, at the time it is found.

Anything outside what you have authorized here will be stopped, the site closed safely, and the situation discussed with you once you are awake and able to decide.

• Removing any tooth not listed on your treatment plan, unless leaving it would be unsafe.
• Any procedure in a part of the mouth not covered by your plan.
• Any change that increases your fee, other than the cost of additional graft material used, without your agreement afterward.

Any change made under this authorization is written into your chart with the reason for it, and explained to you at your first visit after surgery.