CONSENT FOR USE OF GRAFTING MATERIAL

CONSENT FOR USE OF GRAFTING MATERIAL FOR RIDGE PRESERVATION / AUGMENTATION

Bone loss is inevitable following extractions (performed in the past or present). Bone / Tissue grafting can lessen the extent of the bone loss and/or restore deficiencies.

GRAFTING MATERIALS:

• Hydroxyapatite Graft (Sterile) – Laboratory synthesized calcium apatite used as filler for the purpose of bone growth.
• Calcium Sulphate / Phosphate (Sterile) – Laboratory processed calcium material used as a filler for the purpose of bone growth
• Bovine Bone Graft (Sterile) – Composite anorganic bovine-derived bone material & synthetic peptide
• Allograft (Sterile) – Commercially prepared laboratory processed human donor bone 
• Autograft – Bone material harvested from another part of your own body
• Collagen Membrane / Barrier (Sterile) – Laboratory processed purified protein barrier derived from animal (bovine/porcine/human) source
• Titanium Mesh/Netting (Sterile) – Commercially prepared non-absorbing mesh to contain the graft material for a temporary period. After a short healing period, it will need to be removed.
• No Graft elected

ADJUNCTIVE PROCEDURES:

I also consent for use of Adjunctive Procedures which can facilitate a more successful outcome:

• Platelet Rich Fibrin – Concentrated natural fibrin clot isolated from your blood for facilitating tissue healing
• Botox Therapy – Purified proteins administered to temporarily relax/reduce the damaging forces of clenching/chewing muscles

I have had the above options explained to me and have had my questions answered to my satisfaction by Doctor. I elect/consent to have the above choice(s) performed by: