Diagnosis: After careful oral examination, my periodontist has confirmed I am a candidate for a canine exposure. The canine teeth can sometimes be buried in the palate or high up in the gum which impedes their eruption. Your orthodontist has suggested an exposure is required of the tooth/teeth to allow for continuation of orthodontic treatment.

Recommended treatment: A buccal/palatal canine exposure usually requires the removal of gum and/or bone to expose the buried crown. Sometimes a bracket/button may need to be bonded to the exposed tooth at the time of exposure.

Primary risks and complications: Whilst this could be considered a low risk procedure, risks related with a canine surgery can include post-surgical infection, bleeding, bruising, swelling, and/or pain and damage to dental appliances.

Based on the relation of the impacted canine tooth to adjacent teeth, there is the risk of damage to other teeth/roots, nerve injury, changes to appearance of the teeth, and in rare instances may result in loosening or loss of these teeth. The applied bracket may come off and need to be reattached. The position of the bracket + chain may cause irritation to the tongue, lip or cheek areas. Risks related to the anaesthetics might include but are not limited to allergic reactions, accidental swallowing of foreign matter, facial swelling or bruising, pain, soreness or discoloration at the site of injection of the anaesthesia.

Alternatives to suggested treatment: I understand that alternative to canine exposure surgery may include no treatment or the tooth upon uncovering is found to not move, it may be left in place or may need to be removed.

No warranty or guarantee: Although good results are generally expected, they cannot be and are not implied, guaranteed, or warrantable. There is also no guarantee against unsatisfactory or failed results. In a small percentage of cases, a further procedure may be required.

Sedation:  Please speak to your treatment coordinator if this is something you wish to discuss further as this requires to be arranged prior to your procedure date, with a minumum of 24 hours notice.

I understand that if I take oral sedation, I will need a driver to and from my appointment and that I should not operate any heavy equipment/machinery for 24 hours following the use of oral sedation.

PATIENT CONSENT:

I have been fully informed of the nature of t he canine exposure procedure, the risks and benefits, the alternative treatments available and the necessity for follow up care. I have had an opportunity to ask any questions I may have in connection with the treatment and discuss my concerns with my periodontist. I hereby consent to the canine exposure surgery as presented to me during consultation and in the treatment plan. I understand that during the procedure, conditions may become apparent which warrant additional or alternative treatment for my best interest, which I will be informed of. This may involve additional costs that may not have been outlined in the provided treatment plan.

By providing my signature, I certify that I have read and fully understand this document and that all my questions have been answered to my satisfaction.

The success of surgical procedures can be affected by medical conditions, dietary and nutritional problems, smoking, alcohol consumption, clenching and grinding of teeth, adequate oral hygiene, and medications that I may be taking. To my knowledge I have reported to my periodontist any prior drug reactions, allergies, diseases, symptoms, habits or conditions that in any way relate to this surgical procedure.

I have agreed to follow the post-operative instructions and to report to all follow up appointments.

Please note, due to the sterile environment, no family or friends are permitted chairside at the time of the procedure.