Generally,
excellent orthodontic results can be achieved with informed and cooperative
patients.You should be aware that
orthodontic treatment, like treatment of any part of the body, has some
inherent risks and limitations.These are
seldom severe enough to affect the advantages of treatment, but they should be
considered in making the decision to undergo orthodontic treatment.
Tooth decay, gum
disease and permanent markings (decalcification) on the teeth can occur. Excellent oral hygiene and reduction of sugar
intake will help minimize these problems.
A tooth that has
been traumatized by an injury or a tooth that has a large filling can die over
a long period of time with or without orthodontic treatment. A nonvital tooth may flare up during
orthodontic treatment and require root canal (endodontic) treatment.
In some
patients, the length of the roots of some teeth may be shortened during
orthodontic treatment. This can occur
with or without treatment. Under healthy
circumstances, the shortened roots usually do not present a problem.
Sometimes
insufficient or undesirable growth of the jaws may limit our ability to achieve
the desired result. Additional
treatment, including jaw surgery, may be required in these cases.
In some cases,
possible problems may exist or occur in the temporomandibular joint. Orthodontic treatment may help remove dental
causes of TMJ problems, but not in all cases. If problems exist before, during or following treatment which we cannot
resolve, we will refer you for additional treatment.
Headgear
instructions must be followed carefully. A headgear that is pulled outward while the elastic force is attached
can snap back and cause injury.
Teeth have a
tendency to change position following treatment. Some of these changes may be desirable, but
some will undoubtedly be undesirable. Faithful wearing of retainers reduces this tendency. The swallowing of an appliance, chipping of a
tooth, and/or dislodging of dental work may occur.
Excessive or
insufficient bone growth, poor cooperation, broken appliances and missed
appointments are all important factors which can lengthen treatment time and/or
adversely affect the quality of the treatment results.If there is excessive breakage of appliances,
missed appointments, or poor cooperation, additional charges may be
incurred. Any incident of a broken
appliance or noncompliance at any visit can extend treatment by four to six
weeks each time.
The above list
of risks and limitations is neither exclusive nor all-inclusive.
Moreover, I hereby
provide Heim Orthodontics the right and permission to use and/or publish
photographs of the Patient for any marketing or promotional purposes including,
but not limited to advertising, publicity, commercial or display of use.Additionally, I also authorize photos and
names to be used for social media purposes on platforms such as the Heim
Orthodontics' Website, Facebook, Twitter, Instagram, etc.Such images may include photographs or
radiographs, before, during or after treatment to be used for marketing or
scientific purposes. Moreover, I hereby
release and discharge Heim Orthodontics from any damages or claims associated
with the use of said likeness.
I certify that I
have read or have had explained to me the contents of this form and realize the
risks and limitations involved, and do consent to orthodontic treatment, as
well as the releases outlined above.