Invisalign Consent Form
Patient Consent Form
Orthodontic treatment, like any medical or dental treatment, has some risks. The more common risks of orthodontic treatment include
1 – Inflammation
If you do not keep your teeth and gums clean you will develop gum disease.
Gum disease causes inflamed and bleeding gums
Gum disease is preventable if you take good care of your teeth and gums.
I understand that I need to remove my Invisalign aligner to clean my teeth yesno
I understand there is a risk of gum inflammation during orthodontic treatment if I do not clean my teeth yesno
I understand that I need to brush and floss at least twice a day and ideally after meals yesno
2 – Recession
A less common gum problem that can occur during any type of orthodontic treatment is gum recession.
Receding gums causes an exposure of the root of the tooth by loss of gum tissue (see photo).
This can happen on any tooth and can be very difficult to predict.
Your dentist will inform you if you are at an increased risk of this happening during your treatment.
I understand there is a risk of gum recession during orthodontic treatment yesno
3 – Black triangles
Sometimes when overlapping or very crowded teeth are straightened there is a lack of supporting gum tissue surrounding the teeth.
This may cause the appearance of a “black triangle”.
I understand there is a risk of black triangles occurring during orthodontic treatment yesno
This is shortening of the roots of the teeth.
Mild resorption is common with all types of braces.
Severe resorption is uncommon but can occur if teeth have previously been traumatised (damaged by accident) or had previous braces.
However It can happen without any known cause.
Even with severe resorption, prognosis can be good in the medium to long term.
I understand there is a risk of root resorption during orthodontic treatment yesno
Relapse after orthodontic treatment
Teeth will want to move back to their original position after orthodontic treatment. This is called relapse.
Relapse can be prevented by wearing a retainer.
It is important to follow the instructions given to you by your dentist when treatment is complete in order to reduce the risk of relapse.
You must wear your removable retainer for a minimum of 6 months following treatment and every night thereafter.
If you lose or break this retainer you must have a replacement made immediately or there is a risk your teeth could move. You will incur the cost of the replacement retainer.
I understand there is a risk of relapse after orthodontic treatment if I do not wear my retainer as advised by my dentist yesno
A Non-Vital Tooth
A non vital tooth means the nerve in the tooth has died.
Certain teeth are at a higher risk of becoming non vital during orthodontic treatment. For example, teeth which have already had a root canal treatment or teeth which have had accidents.
An undetected non vital tooth may flare up during orthodontic treatment, requiring root canal treatment to maintain it.
I understand that during orthodontic treatment a tooth may become non vital and require root canal treatment yesno
Length of Treatment
I have seen the 3D movement of my teeth on the computer called ‘Clincheck’ and I am happy that my concerns are being addressed yesno
I have been given adequate time to read the above consent document.
I understand the benefits and risks associated with this treatment.
I have had the opportunity to ask questions and discuss any concerns I have regarding the treatment.
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Signed by Nina Bal
Signed On: 8th January 2020
If you have questions about the contents of this document, you can email the document owner.
Document Name: Invisalign Consent Form
Agree & Sign