Consentfor Composite Veneers

Consent for Composite Veneers
Composite Veneers are thin layers of composite resin that are placed on the front surfaces of teeth in order to
change the appearance of your smile. Teeth that are discolored, chipped, rotated, or spaced can be
transformed with veneers.
Composite veneers are placed directly on the teeth in the surgery. Porcelain veneers, an alternative choice,
tend to resist staining more readily than composite veneers. The goal of composite veneers is the same ds
porcelain veneers but the materials, technique’s, and timeline are a bit different.
The teeth are prepared and tooth colored filling material is placed on the front of the teeth and shaped to the
desired form and then finished and polished to a life—like shine. A second polishing appointment is usually
necessary.
In preparing the teeth for the reception of Composite Veneers, it is almost always necessary to reduce or
rougher the surface of the tooth to which the veneer(s) may be bonded. This preparation will be done as
conservatively as possible, but once this is done, the patient is committed to veneers or crowns for the
duration of life. If the veneer covering breaks or comes off, the uncovered tooth may become susceptible to
decay if the veneer is not replaced in a timely manner.
It is impossible to place any specific time criteria on the length of time that Composite Veneers should last. Should
the veneers become damaged, leaky, or stained, they will need to be replaced and charges will apply.
An acrylic lab fabricated night guard may be indicated to help protect your Composite Veneers from damage
due to night time clenching and grinding (additional charges will apply).
Patients must understand that a perfect result cannot be guaranteed.
Maintenance: The patient must be aware that there is a lifelong maintenance problem. This will involve
regular attendance for examinations and Dental Hygiene Treatment. It will mean have a good standard of oral
hygiene and also consuming a healthy diet, especially not consuming excessive sugar. Composite veneers can be
polished and glazed on a periodic basis and charges will apply for this.
The general maintenance can normally be done as part of the Dental Hygienist Visits but if the staining is large
(and eventually it will be), the dentist may need to polish or adjust the composite. The amount of staining
normally depends on consumption of colorants in the diet and drink, as well as smoking and plaque control
We strongly suggest that the patient has a maintenance visit with the dentist at least once a year which
will include a polish and deglazing of the composite Veneers. This maintenance visit is chargeable per
visit.
Informed Consent Declaration

No Warranty or Guarantee: Patients must understand that no guarantee has been made that the
procedure will improve the condition, and may even make my condition worse.
I certify that the dentist who examined me that the success of all treatment is determined in a big way by
following post treatment instructions, especially those that relate to anesthetic’s and prescription
medications and that these are always given to patients after treatment, both verbally and in writing, and it
is essential that patients read and keep them. Make sure you have them and do not be afraid to ask for
them! ! !
I certify that the dentist who examined me has fully explained to me, verbally and with leaflets, the purpose of
the procedure(s) and has also informed me of the expected benefits and complications (from known and
unknown causes), attendant discomforts and risks that may arise, as well as possible alternatives to the
purposed treatment, including no treatment.
I certify that the dentist has told me that composite veneers do eventually stain (as compared to
ceramic veneers that do not). This means that the appearance will deteriorate with time and therefore
there is a medium to long term commitment to repolishing/replacement (charges will apply) and
replacement (additional charges will apply).
I certify that the dentist who examined me has discussed my treatment plan verbally as well as consent forms
and other printed literature related to the treatment that is proposed as well as the alternative options.
I certify that I have been given an opportunity to ask questions and all my questions have been answered fully
and satisfactorily.
I acknowledge that no guarantees or assurances have been made to me concerning the results intended from
the procedure(s) which the dentist may consider necessary.
I also understand the financial obligation attached to this procedure and agree to comply as listed on the
treatment plan.
I understand that I am responsible for all fees. I also understand that as treatment progresses the above fees
may have to be adjusted, but that I will be informed of these adjustments and how this will affect my payment
plan.
I realize that signing does not mean that I am under an obligation to have any treatment and that I
may decide not to proceed with all or any part of the treatment. Similarly signing this means that I
pay for the treatment that I actually have done. I hereby consent to the proposed dental treatment
and acknowledge that it is being provided as a private patient.

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Consent for Composite Veneers

Patients must understand that a perfect result cannot be guaranteed.

Informed Consent Declaration

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