Bone Grafting: Dental Consent Form Template (2025)

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CONSENT FOR BONE GRAFTING

Patient Information:

Name: __________________________________________

Date of Birth: _____________________________________

Consent for Dental Treatment

I, the undersigned, hereby give consent to Dr. ___________________________ to perform bone grafting on: ______________________________________ (“Treatment”) on me or my dependent. I understand that during the course of the procedure, unforeseen conditions may arise that could necessitate additional or alternative procedures, and I authorize the performance of such procedures as deemed necessary by my dentist.

I acknowledge that the nature, purpose, and expected outcomes of the recommended Treatment have been explained to me. I understand that no guarantees or promises have been made regarding the final results.

Alternatives to Treatment

I have been informed about alternatives to the recommended Treatment, including the option of receiving no treatment, and I understand the potential consequences of choosing not to proceed.

Potential Risks and Complications Related to Bone Grafting

I understand that dental bone grafting and related oral surgical procedures carry certain risks and complications, which may include, but are not limited to:

Graft Non-Integration or Failure: The bone graft material may fail to bond with the existing jawbone.
Graft Resorption or Insufficient Bone Growth: The new bone may not form as expected or may resorb over time.
Infection at the Graft Site: The grafted area may become infected, requiring additional treatment or graft removal.
Rejection or Allergic Reactions to Graft Material: The body may reject the graft or react adversely to materials used.
Sinus Involvement (for Upper Jaw Grafts): Creation or enlargement of an opening into the sinus cavity, potentially requiring further procedures.
Nerve Disturbance: Temporary or permanent numbness, tingling, or altered sensation in the lips, chin, tongue, gums, or facial skin due to nerve irritation or damage.
Swelling, Pain, or Bruising: Common post-operative discomfort, which may require pain management.
Delayed Healing or Prolonged Discomfort: The graft site may heal more slowly than anticipated or remain tender for an extended period.
Damage to Adjacent Teeth or Restorations: Existing teeth, crowns, fillings, or other restorations near the graft site may be affected.
Aesthetic Outcomes May Vary: The final appearance may not meet personal expectations.

Acknowledgment and Consent

I confirm that:

I have had the opportunity to ask questions and have received satisfactory answers.
I have been provided sufficient information to make an informed decision about my dental care.
I understand the risks, benefits, and alternatives related to the recommended Treatment.

By signing below, I consent to the performance of the Treatment as described above.

Signature:

Patient/Parent/Guardian: _____________________________________

Date: ________________________________

Relationship (if signing for a minor): ___________________________________

What To Include In A Bone Grafting Consent Form

When preparing a bone grafting consent form, it's essential to include all the necessary legal and medical components to ensure the patient is fully informed and protected. This form should serve both as a communication tool and a record of consent. Here's what to make sure is included:

Patient Identification: Start with the patient’s full name and date of birth to clearly identify who the treatment is for.
Clear Treatment Description: Clearly state the procedure being performed — in this case, bone grafting — and specify the area where the graft will be placed.
Permission for Additional Procedures: Allow for flexibility during the procedure by including consent for any necessary changes or additional treatment based on unforeseen conditions.
Explanation of Risks and Complications: List all potential risks, even the rare ones, such as infection, nerve disturbance, or graft rejection. This shows transparency and helps manage expectations.
Alternatives to Treatment: Include information about all possible alternatives, including doing nothing, and outline what the consequences might be.
Acknowledgment of Understanding: Patients must confirm they’ve received all the information, had their questions answered, and understand the procedure and its risks.
Signature and Date Lines: This formalizes the consent, confirming the patient’s agreement to proceed with treatment.

This level of detail not only protects your practice legally but also ensures your patient is truly informed.

How To Use This Bone Grafting Consent Form Template

Ready to use this consent form in your practice? Just follow these quick steps:

Scroll to the top of this page.
Highlight the full template under "CONSENT FOR BONE GRAFTING".
Click ‘Copy’.
Paste the template into your favorite text editor—Microsoft Word, Google Docs, or your practice’s documentation software.
Customize the fields (like your name, practice details, and patient info) before printing or uploading to your system.

That’s it! You’re good to go. This simple form will help standardize how you collect consent for all your bone grafting procedures.

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*Disclaimer: This document is a sample form provided by Denota and should not be considered medical or legal advice. Because the details of your situation may vary, and the laws in your jurisdiction may differ, you are advised to consult your attorney or other qualified professionals if you have any questions related to legal or medical responsibilities, state or federal laws, contract interpretation, or any other legal matters.

Bone Grafting: Dental Consent Form Template (2025)

What To Include In A Bone Grafting Consent Form

How To Use This Bone Grafting Consent Form Template

Need To Automate Your Dental Clinical Notes For This, Too?

Detailed dental patient notes, without the stress.