GUM CONTOURING INFORMED CONSENT

PURPOSE OF THE TREATMENT: Gum contouring improves appearance and function. Soft tissue is either removed, or repositioned. The surgical procedure may last from fifteen to sixty (15-60) minutes. Home care instructions and required prescriptions will be provided after the surgery. It may take 1 to 2 days for my gums to feel comfortable, and another two to four (2-4) weeks for the tissue around the site to heal completely. Final positioning of gums may take 4-6 months.

BENEFITS OF THE TREATMENT: Gingival appearance and function is improved. Tooth proportion is improved.

RISKS OF THE TREATMENT: Despite excellent skill and care, it is possible for complications to arise. The tissue in the surrounding area may be sensitive and healing may be delayed without proper care and oral hygiene. Infection may also result. The teeth may become sensitive, usually transient, if the root becomes exposed.

If the final appearance is not ideal, touch-up contouring may be necessary. Gums or tissues involved in the anesthetic injection may be sore for several days following treatment. Swelling of the tissues around the injection site is possible and can be treated by applying pressure and cold (ie. ice packs) the day of treatment to the area of swelling for a minimum of 1-2 minutes.

ALTERNATIVES TO THE TREATMENT: In order to treat mispositioned, or otherwise unsatisfactory gum tissue, there are no other alternatives. I have had the purpose, benefits, reasonable risks, and alternatives, if any, to the procedure(s) explained to me. I have carefully read and understood all available explanatory material. I have been given the opportunity to ask questions.

I hereby authorize the dentist to perform the aforementioned procedure(s) necessary for my dental treatment, and any additional treatment procedures as are considered immediately necessary on the basis of findings during the above-mentioned treatment. I consent to the administration of such local anaesthesia and/or medication as is required for the aforementioned dental treatment. I have been given the opportunity to ask any further questions and I am satisfied with the answers given.

I am a competent consenting adult of at least 18 years of age (or my parent or legal guardian is giving consent on my behalf), and further:

• Pre and post-treatment instructions have been explained to me.
• I have had the opportunity to ask questions, and all my questions have been answered to my satisfaction.
• I declare that while completing the medical questionnaire, I have answered the information related to my personal medical history questions completely and I have not withheld any information.
• Must notify the clinician if my medical history changes prior to subsequent treatments.
• I consent to clinical photographs being taken of my treated areas for my personal health record only.
• There are no refunds for services rendered and/or after a year from purchase and not used.
• The treatments I receive here are voluntary, and I release KAI LIFE CLINIC, my doctors, nurse, and/or my technician from liability and assume full responsibility thereof for this appointment and future appointments.

My signature below constitutes my acknowledgment and understanding of all this information.

I hereby authorize and direct the doctors to perform the treatment on me.