PATIENT CONSENT FORM FOR SNAP-ON DENTURE (IMPLANT-RETAINED OVERDENTURE)

Patient Information:

Last Name:

Middle Name:

First Name:

Date of Birth:

Phone:

Email:

I. INTRODUCTION

You are being advised to undergo treatment involving the placement of 2 to 4 dental implants to support a removable snap-on denture (implant-retained overdenture). This treatment aims to improve stability, retention, and function compared to traditional dentures.

This form outlines the nature, benefits, risks, alternatives, and aftercare responsibilities associated with this treatment option.

II. ATTACHMENT OPTIONS

A. Locator Attachment System (Individual Stud Attachments)

Description:

Each implant has a separate attachment (Locator) with a nylon insert connecting directly to the denture.

Pros:

Simple and cost-effective.
Easier to clean and maintain.
Inserts are inexpensive and replaceable every 4–6 months.
Good option for limited vertical space.

Cons:

Inserts wear out more frequently, requiring regular maintenance.

Initials:
Potential for denture rocking with only 2 implants.

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May require frequent denture relines.

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Less ideal for patients with heavy biting forces.

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B. Hader Bar Attachment System (Splinted Bar Over Implants)

Description:

Implants are connected via a metal bar, and the denture clips onto the bar.

Pros:

Superior retention and stability.
Forces distributed more evenly across implants.
Reduces denture rocking significantly.
Better bone preservation over time.

Cons:

Higher cost due to fabrication of bar and surgical complexity.

Initials:
Cleaning under the bar is more challenging.

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Clips may wear and need replacement every 4–6 months.

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Requires more vertical space to accommodate the bar and denture design.

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III. BENEFITS (PROS)

Enhanced Stability: Reduces denture movement.
Improved Chewing Function: Better than conventional dentures.
Bone Preservation: Slows down bone loss where implants are placed.
Improved Speech and Comfort: Compared to traditional dentures.
Cost-Effective: Less expensive than full-arch fixed implant restorations.

IV. RISKS AND LIMITATIONS (CONS)

Implant Failure: 5–10% even under optimal conditions.

Initials:
Denture Still Removable: It will not be a "fixed" or permanent prosthesis.

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Wear and Tear:
- Nylon inserts in attachments wear out every 4–6 months and must be replaced.
  
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- Attachments themselves may loosen or wear over time and require maintenance or replacement.
  
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Denture Adjustments Needed: Relines, repairs, or remakes may be necessary periodically.

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Bone Loss Continues: In non-implant areas, bone loss may still occur, requiring future adjustments.

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Hygiene Commitment: Must maintain daily hygiene around implants and under denture.

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V. MAINTENANCE REQUIREMENTS

Attachment Maintenance:
- Nylon inserts must typically be replaced every 4–6 months to maintain secure fit.
  
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- Metal housings or abutments may need adjustment or replacement over time.
  
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Denture Maintenance:
- Periodic relines or remakes will be needed as oral tissues change.
  
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- If fit deteriorates or attachments become loose, schedule an appointment promptly.
  
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Oral Hygiene:
- Daily cleaning of implants, gums, and the underside of the denture is essential.
  
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- Use of water flosser and specialized brushes is highly recommended.
  
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Recall Visits:
- Every 4–6 months for examination, implant cleaning, and attachment maintenance.
  
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Failure to maintain implants or follow up for attachment changes may lead to:

Implant infection (peri-implantitis)
Bone loss
Loosening or failure of implants
Poor denture retention and dissatisfaction

VI. ALTERNATIVES DISCUSSED

Traditional (non-implant) removable dentures.

Initials:
Fixed implant-supported bridges (All-on-X).

Initials:
No treatment.

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VII. LEGAL DISCLAIMER

I understand that while the clinical team will exercise their best professional efforts and judgment, treatment outcomes cannot be guaranteed. I acknowledge the need for continuous maintenance and possible future costs associated with replacement parts, denture adjustments, or additional treatments.

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VII. PATIENT ACKNOWLEDGEMENT

I acknowledge:

Full understanding of the procedure, benefits, risks, and alternatives.

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Importance of hygiene maintenance and commitment to follow-up care.

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Acceptance that the prosthesis is removable, not fixed.

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Understanding that attachments and nylon inserts require regular maintenance and replacement every 4-6 months.

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Understanding of the difference between Locator attachments and Hader Bar attachments.

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Acceptance of potential future adjustments, relines, or remakes.

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Acceptance that treatment outcomes are not guaranteed.

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By signing below, I confirm that:

I have had the opportunity to ask questions.
All of my questions have been answered to my satisfaction.
I voluntarily consent to the Snap-On Denture treatment as explained.

Patient's Signature

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Date:

Witness's Name:

Witness' Signature:

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Date:

Emergency Contact

Keerthi Senthil DDS MS

Phone: 760-318-4400

Email: drsenthil@smileguru.dentist

Thank you for entrusting us with your care.