Patient Agreement and Informed Consent for Cosmetically Focused Adult Orthodontics SmileTRU – Clear Sequential Aligners Patient Name: _____________________________________________________________________ Please read this form carefully and discuss with your dentist any points which require further clarification: The Cfast system has been designed to straighten your teeth in a reasonable time - usually 4-9 months and generally speaking we will not make significant changes to your biting position. There are several situations which are out with the scope of this type of treatment. These include but are not limited to: • overjets/underjets - the horizontal relationship between the upper and lower teeth • overbites – the vertical relationship between the upper and lower teeth • the position of your back teeth • midline discrepancies • facial profiles • temporomandibular joint problems, • Position of tooth roots The goal of cosmetically focused orthodontic treatment is to provide a significant improvement in the appearance of primarily the front six teeth within a time frame of no more than nine months. Full correction of issues such as those listed above will require you to attend an orthodontist and may require years of treatment to correct. As such this treatment is not a replacement for conventional orthodontic treatment. If you decide to proceed with treatment there are obligations you must agree to. If these obligations are not met to our satisfaction we reserve the right to terminate or postpone treatment. This will lead to an increase in the time taken to complete treatment as well as a possible increase in cost to you. These obligations include: Good mouth hygiene: It is important that your mouth and gums are cared for to a high standard. We recommend a hygienist appointment before, during and after Cfast to ensure you are aware of the oral care required for proper hygiene and are able to perform these easily for yourself. We can supply you with additional tools to carry this out. An interproximal brush is one of the best devices to help keep your teeth and braces clean and our hygienist can show you the best way to use this and similar aids. Food types: Ideally remove the appliance when you are eating. Initially you may find eating difficult because your back teeth may not be in full contact when you bite. Certain drinks such as tea, coffee, and red wine can stain the positioners. Also heavily coloured foods such as currys and certain tomato based sauces may also stain the appliances. Remember to keep the appliance safe while it is out of your mouth and clean your teeth thoroughly before replacing the appliance after your meal.
Transcript
Patien t Agreement an d I nformed Consen t for Cosmetical ly Focused Adult Orthodontics
Patient Nam e:
Please read this form carefully and discuss with your dentist any points which require fu rther c lar ification:
The Cfast system has been designed to strai ghten your teeth in a reasonable time - usually 4-9 months and
general ly speaking we will not make significant changes to your biting position . There are several situat ions
which are out with the scope of this type of trea tment. These include but are not limited to:
- Overjets/und erjets - the hori zontal rel ationship between the upper and lower teeth
- Overbites – the verti cal rel ationship between the upper and lower teeth
- The position of your back teeth
- M idli ne discrepa ncies
- Facial profi les
- Temporomandibular joint problems
- Position of tooth roots
The goal of cosmetically focused orthodontic treatment is to provide a significant improvement in the appearance of primarily the front six teeth within a time frame of no more than nine months. Full correction of issues such as those listed above will require you to see an orthodontist and may require years of treatment to correct. As such this treat-ment is not a replacement for conventional orthodontic treatment.
If you decide to proceed with treatment there are obligations you must agree to. If these obligations are not met to our satisfaction we reserve the right to terminate or postpone treatment. This will lead to an increase in the time taken to complete treatment as well as a possible increase in cost to you. These obligations include:
GOOD MOUTH HYGIENE | It is important that your mouth and gums are cared for to a high standard. We recom-mend a hygiene appointment before, during and after Cfast to ensure you are aware of the oral care required for proper hygiene and are able to perform these easily for yourself. The brackets and wires require thorough cleaning, especially after meal times and before going to bed. We can supply you with additional tools to carry this out. An interproximal brush is one of the best devices to help keep your teeth and braces clean and our hygienist can show you the best way to use this and similar aids. You need to brush effectively but not too hard – brushing too hard may remove the tooth-colored coating on the wires.
PROFESSIONAL CLEANINGS | We recommend at least one professional cleaning with our hygienist during your treatment. Oral hygiene during treatment must be kept to a very high standard. Poor oral hygiene will delay treatment and compromise the health of your teeth. Our hygienist will show you how best to keep your mouth healthy during Cfast treatment.
Patient Agreement and Informed Consent for Cosmetically Focused Adult Orthodontics SmileTRU – Clear Sequential Aligners
Please read this form carefully and discuss with your dentist any points which require further clarification: The Cfast system has been designed to straighten your teeth in a reasonable time - usually 4-9 months and generally speaking we will not make significant changes to your biting position. There are several situations which are out with the scope of this type of treatment. These include but are not limited to:
• overjets/underjets - the horizontal relationship between the upper and lower teeth • overbites – the vertical relationship between the upper and lower teeth • the position of your back teeth • midline discrepancies • facial profiles • temporomandibular joint problems, • Position of tooth roots
The goal of cosmetically focused orthodontic treatment is to provide a significant improvement in the appearance of primarily the front six teeth within a time frame of no more than nine months. Full correction of issues such as those listed above will require you to attend an orthodontist and may require years of treatment to correct. As such this treatment is not a replacement for conventional orthodontic treatment.
If you decide to proceed with treatment there are obligations you must agree to. If these obligations are not met to our satisfaction we reserve the right to terminate or postpone treatment. This will lead to an increase in the time taken to complete treatment as well as a possible increase in cost to you. These obligations include:
Good mouth hygiene: It is important that your mouth and gums are cared for to a high standard. We recommend a hygienist appointment before, during and after Cfast to ensure you are aware of the oral care required for proper hygiene and are able to perform these easily for yourself. We can supply you with additional tools to carry this out. An interproximal brush is one of the best devices to help keep your teeth and braces clean and our hygienist can show you the best way to use this and similar aids.
Food types: Ideally remove the appliance when you are eating. Initially you may find eating difficult because your back teeth may not be in full contact when you bite. Certain drinks such as tea, coffee, and red wine can stain the positioners. Also heavily coloured foods such as currys and certain tomato based sauces may also stain the appliances.
Remember to keep the appliance safe while it is out of your mouth and clean your teeth thoroughly before replacing the appliance after your meal.
Patien t Agreement an d I nformed Consen t for Cosmetical ly Focused Adult Orthodontics
Patient Nam e:
Please read this form carefully and discuss with your dentist any points which require fu rther c lar ification:
The Cfast system has been designed to strai ghten your teeth in a reasonable time - usually 4-9 months and
general ly speaking we will not make significant changes to your biting position . There are several situat ions
which are out with the scope of this type of trea tment. These include but are not limited to:
- Overjets/und erjets - the hori zontal rel ationship between the upper and lower teeth
- Overbites – the verti cal rel ationship between the upper and lower teeth
- The position of your back teeth
- M idli ne discrepa ncies
- Facial profi les
- Temporomandibular joint problems
- Position of tooth roots
The goal of cosmetically focused orthodontic treatment is to provide a significant improvement in the appearance of primarily the front six teeth within a time frame of no more than nine months. Full correction of issues such as those listed above will require you to see an orthodontist and may require years of treatment to correct. As such this treat-ment is not a replacement for conventional orthodontic treatment.
If you decide to proceed with treatment there are obligations you must agree to. If these obligations are not met to our satisfaction we reserve the right to terminate or postpone treatment. This will lead to an increase in the time taken to complete treatment as well as a possible increase in cost to you. These obligations include:
GOOD MOUTH HYGIENE | It is important that your mouth and gums are cared for to a high standard. We recom-mend a hygiene appointment before, during and after Cfast to ensure you are aware of the oral care required for proper hygiene and are able to perform these easily for yourself. The brackets and wires require thorough cleaning, especially after meal times and before going to bed. We can supply you with additional tools to carry this out. An interproximal brush is one of the best devices to help keep your teeth and braces clean and our hygienist can show you the best way to use this and similar aids. You need to brush effectively but not too hard – brushing too hard may remove the tooth-colored coating on the wires.
PROFESSIONAL CLEANINGS | We recommend at least one professional cleaning with our hygienist during your treatment. Oral hygiene during treatment must be kept to a very high standard. Poor oral hygiene will delay treatment and compromise the health of your teeth. Our hygienist will show you how best to keep your mouth healthy during Cfast treatment.
Decalcification and Dental Caries: Excellent oral hygiene is essential during orthodontic treatment as are regular visits to your family dentist. Inadequate or improper hygiene could result in cavities, discoloured teeth, periodontal disease and/or decalcification. These same problems can occur without orthodontic treatment, but the risk is greater to an individual wearing braces or other such appliances. These problems may be aggravated if you consume sweetened beverages or foods.
Nerve Damage: A tooth that has been traumatised by an accident or deep decay may have experienced damage to the nerve of the tooth. This may not be obvious at the start of the treatment as quite often there are no obvious symptoms or signs. In some cases orthodontic tooth movement may aggravate this condition and in some rare cases, root canal treatment may be necessary.
Professional Cleanings: We recommend at least one professional cleaning with our hygienist during your treatment. Oral hygiene during treatment must be kept to a very high standard. Poor oral hygiene will delay treatment and compromise the health of your teeth. Our hygienist will show you how best to keep your mouth healthy during Cfast treatment.
Appointments: It is very important that you attend regularly for your review appointments as advised by your dentist. Failure to do so will result in delay to your treatment and may require us to take other measures or terminate treatment which will incur additional costs. Broken, missed or late cancellation of appointments will incur a charge.
Retention: We aim to move your teeth into a straightened position in a relatively short period of time. As such if they are not held in this position indefinitely, there is a strong possibility that they will start to return to their original position. This relapse can happen very quickly - sometimes within a few days.
Your dentist will discuss with you the importance of long term retention using fixed and removable retainers. It is advisable that you have both types of retainers as one will act as a back-up should the other one fail. We need your full compliance in wearing retainers as instructed as we cannot take responsibility for movement of teeth after appropriate retainers have been provided. If retainers are lost or broken, we rely fully on you to take the initiative to have them replaced or repaired. In this instance call the practice immediately for an appointment.
Please initial here __________
Patien t Agreement an d I nformed Consen t for Cosmetical ly Focused Adult Orthodontics
Patient Nam e:
Please read this form carefully and discuss with your dentist any points which require fu rther c lar ification:
The Cfast system has been designed to strai ghten your teeth in a reasonable time - usually 4-9 months and
general ly speaking we will not make significant changes to your biting position . There are several situat ions
which are out with the scope of this type of trea tment. These include but are not limited to:
- Overjets/und erjets - the hori zontal rel ationship between the upper and lower teeth
- Overbites – the verti cal rel ationship between the upper and lower teeth
- The position of your back teeth
- M idli ne discrepa ncies
- Facial profi les
- Temporomandibular joint problems
- Position of tooth roots
The goal of cosmetically focused orthodontic treatment is to provide a significant improvement in the appearance of primarily the front six teeth within a time frame of no more than nine months. Full correction of issues such as those listed above will require you to see an orthodontist and may require years of treatment to correct. As such this treat-ment is not a replacement for conventional orthodontic treatment.
If you decide to proceed with treatment there are obligations you must agree to. If these obligations are not met to our satisfaction we reserve the right to terminate or postpone treatment. This will lead to an increase in the time taken to complete treatment as well as a possible increase in cost to you. These obligations include:
GOOD MOUTH HYGIENE | It is important that your mouth and gums are cared for to a high standard. We recom-mend a hygiene appointment before, during and after Cfast to ensure you are aware of the oral care required for proper hygiene and are able to perform these easily for yourself. The brackets and wires require thorough cleaning, especially after meal times and before going to bed. We can supply you with additional tools to carry this out. An interproximal brush is one of the best devices to help keep your teeth and braces clean and our hygienist can show you the best way to use this and similar aids. You need to brush effectively but not too hard – brushing too hard may remove the tooth-colored coating on the wires.
PROFESSIONAL CLEANINGS | We recommend at least one professional cleaning with our hygienist during your treatment. Oral hygiene during treatment must be kept to a very high standard. Poor oral hygiene will delay treatment and compromise the health of your teeth. Our hygienist will show you how best to keep your mouth healthy during Cfast treatment.
Things You Should Know About SmileTRU – Clear Positioners
In rare circumstances, clear positioners can be inhaled or swallowed. Therefore you should exhibit extreme care when placing and removing the positioners.
The tooth positioners should always be placed in the provided retainer box when not in use.
If you have been given multiple clear positioners it is the dentists responsibility to explain their use and your responsibility to ensure that the aligners are fitted as shown, used in the correct sequence and changed at the appropriate times.
If you lose or damage a positioner, go back to the previous one if possible and arrange to see the dentist as soon as possible.
Keep the retainer box with your SmileTRU clear positioners in out of the reach of children and away from the dog.
The clear positioners should not be exposed to extreme heat as they will distort.
Use denture cleaner to clean the positioners. Do not use toothpaste or chemicals such as bleach as these can damage the positioners.
Positioners should be removed when eating and drinking with the exception of drinking water
Drinking tea, coffee, and red wine can stain or distort the positioners.
Some patients experience an excess of saliva when starting treatment. One or more teeth may become temporarily sensitive when placing new positioners.
The positioners may have a mild effect on speech. Talking with the positioners in place will speed the adaptation process.
You must maintain proper oral hygiene. Failure to do so can cause caries and periodontal disease.
If you have any questions regarding your diagnosis or your treatment plan with SmileTRU it is your responsibility to ask your dental provider these questions.
Please initial here __________
Patien t Agreement an d I nformed Consen t for Cosmetical ly Focused Adult Orthodontics
Patient Nam e:
Please read this form carefully and discuss with your dentist any points which require fu rther c lar ification:
The Cfast system has been designed to strai ghten your teeth in a reasonable time - usually 4-9 months and
general ly speaking we will not make significant changes to your biting position . There are several situat ions
which are out with the scope of this type of trea tment. These include but are not limited to:
- Overjets/und erjets - the hori zontal rel ationship between the upper and lower teeth
- Overbites – the verti cal rel ationship between the upper and lower teeth
- The position of your back teeth
- M idli ne discrepa ncies
- Facial profi les
- Temporomandibular joint problems
- Position of tooth roots
The goal of cosmetically focused orthodontic treatment is to provide a significant improvement in the appearance of primarily the front six teeth within a time frame of no more than nine months. Full correction of issues such as those listed above will require you to see an orthodontist and may require years of treatment to correct. As such this treat-ment is not a replacement for conventional orthodontic treatment.
If you decide to proceed with treatment there are obligations you must agree to. If these obligations are not met to our satisfaction we reserve the right to terminate or postpone treatment. This will lead to an increase in the time taken to complete treatment as well as a possible increase in cost to you. These obligations include:
GOOD MOUTH HYGIENE | It is important that your mouth and gums are cared for to a high standard. We recom-mend a hygiene appointment before, during and after Cfast to ensure you are aware of the oral care required for proper hygiene and are able to perform these easily for yourself. The brackets and wires require thorough cleaning, especially after meal times and before going to bed. We can supply you with additional tools to carry this out. An interproximal brush is one of the best devices to help keep your teeth and braces clean and our hygienist can show you the best way to use this and similar aids. You need to brush effectively but not too hard – brushing too hard may remove the tooth-colored coating on the wires.
PROFESSIONAL CLEANINGS | We recommend at least one professional cleaning with our hygienist during your treatment. Oral hygiene during treatment must be kept to a very high standard. Poor oral hygiene will delay treatment and compromise the health of your teeth. Our hygienist will show you how best to keep your mouth healthy during Cfast treatment.
Main objectives – I understand the following:
The main objective of my treatment is to reposition primarily my front upper and/or lower six teeth for cosmetic reasons. There will be little or no change in my biting position and any changes to my bite will most likely settle completely within a few months of treatment ending. I understand that this treatment is not a replacement for conventional orthodontics.
Procedures: Where there a shortage of space in teeth that are crowded, space will sometimes be made by care-fully removing a small amount of enamel from the sides of the teeth. This has been shown to be a perfectly safe and acceptable clinical procedure. Although rare, it is possible to have some sensitivity following this procedure, but this is transient.
Following treatment the edges of my teeth may be uneven due to the fact that the teeth have not worn evenly. There may also be small spaces between the newly straightened teeth which the gum has failed to fill leading to a small “black triangle” appearance. As such there may be a requirement for further cosmetic work to even the edges of teeth, correct misshapen teeth or to close residual spaces. This will incur a separate fee which will be discussed with me by my dentist and is charged according to my individual needs.
The f inal result: My dentist aims to get as good a result as is possible within a 9 month period. It may not be possible to get the teeth into a perfect position using this treatment alone although for the vast majority the results are more than acceptable. I understand that should there be a demand for further treatment beyond what my dentist feels is acceptable, this may necessitate a referral to an orthodontist which will lead to an increase in costs over and above what has been paid to date.
Damages and replacements: There may be times when ART’s are damaged or lost. The repair or replacement of these will incur a charge. My dentist will discuss more significant charges with me before any additional work is carried out.
Soreness: Generalised pain from the teeth, gums, lips and cheeks are common after the ART’s are fitted. Usually these symptoms subside to a manageable level after two weeks or so. There is also likely to be some mobility of the teeth. If there is excessive pain or mobility, I will contact the practice as soon as possible so appropriate adjustments and/or measures can be taken to remedy the situation. In some rare cases there may be nerve irri-tation or damage which in very rare circumstances may require root canal therapy. Although x-rays will routinely be taken it may not always be possible to predict which teeth may be affected in this way.
Moving: If I move out the area it may not be easy to get another dentist to complete my treatment and there-fore I understand that I will most likely have to complete treatment with the dentist that started it. Retainers: I will wear retainers as prescribed and will contact the practice immediately should they become lost or damaged. I accept full responsibility for any relapse should I fail to comply with retention protocols.
Please initial here __________
Patien t Agreement an d I nformed Consen t for Cosmetical ly Focused Adult Orthodontics
Patient Nam e:
Please read this form carefully and discuss with your dentist any points which require fu rther c lar ification:
The Cfast system has been designed to strai ghten your teeth in a reasonable time - usually 4-9 months and
general ly speaking we will not make significant changes to your biting position . There are several situat ions
which are out with the scope of this type of trea tment. These include but are not limited to:
- Overjets/und erjets - the hori zontal rel ationship between the upper and lower teeth
- Overbites – the verti cal rel ationship between the upper and lower teeth
- The position of your back teeth
- M idli ne discrepa ncies
- Facial profi les
- Temporomandibular joint problems
- Position of tooth roots
The goal of cosmetically focused orthodontic treatment is to provide a significant improvement in the appearance of primarily the front six teeth within a time frame of no more than nine months. Full correction of issues such as those listed above will require you to see an orthodontist and may require years of treatment to correct. As such this treat-ment is not a replacement for conventional orthodontic treatment.
If you decide to proceed with treatment there are obligations you must agree to. If these obligations are not met to our satisfaction we reserve the right to terminate or postpone treatment. This will lead to an increase in the time taken to complete treatment as well as a possible increase in cost to you. These obligations include:
GOOD MOUTH HYGIENE | It is important that your mouth and gums are cared for to a high standard. We recom-mend a hygiene appointment before, during and after Cfast to ensure you are aware of the oral care required for proper hygiene and are able to perform these easily for yourself. The brackets and wires require thorough cleaning, especially after meal times and before going to bed. We can supply you with additional tools to carry this out. An interproximal brush is one of the best devices to help keep your teeth and braces clean and our hygienist can show you the best way to use this and similar aids. You need to brush effectively but not too hard – brushing too hard may remove the tooth-colored coating on the wires.
PROFESSIONAL CLEANINGS | We recommend at least one professional cleaning with our hygienist during your treatment. Oral hygiene during treatment must be kept to a very high standard. Poor oral hygiene will delay treatment and compromise the health of your teeth. Our hygienist will show you how best to keep your mouth healthy during Cfast treatment.
I understand that the dentist providing my treatment is a general dental practitioner and is not an orthodontic specialist. I give my dentist the right to change treatment at any time during the procedure after discussion with me. This may be due to unforeseen complications during the procedure or any other situations that might arise. This will be in consideration of what is best for my final result and the long–term success of the treatment.
