Dental Veneer Consent

Dental Veneer Consent

Dental Veneers Consent

I have been informed and understand that dental veneers are available to certain dental patients.
These veneers are made of a ceramic/resin material and are bonded to the enamel of my teeth using resin cement.

I wish to undergo this procedure as a patient of 

and they have given me the option of a specialist referral for this procedure.My dentist has shown me a mock up of the contour of my veneers . I have opted to go ahead with the shade:

I realize that this shade is lighter than my other natural teeth. I am happy with the appearance of the mock up and therefore consent to my teeth being trimmed back to allow for placement of the veneers.
I understand that my dentist will keep the preparations on my teeth to a minimum to achieve best aesthetics. I have been informed that veneers bond to the tooth enamel and if the quality and quantity of enamel on my teeth is poor, we might need to consider crowns for the teeth. My dentist has advised me about the following post-operative issues with veneers.

Veneers can de-bond from the natural teeth occasionally. In such instance, if intact the same veneer can be re-cemented onto the tooth at an additional cost. However, if this happens a number of times, we then need to consider a remake or a crown for the tooth.The will incur an additional cost.

Hard food substances can cause veneers to fracture.

My habit of night grinding can cause damage to my veneers and I will therefore have to wear the provided night guard.

I will need to maintain regular recall hygiene maintenance to ensure that the veneers and the supporting teeth are healthy.

The veneering process will need removal of the tooth structure.

Resin veneers can change colour with time and will need replacement every 3-5 yrs.

My treating dentist is solely responsible from any claims that might arise from this procedure. Having been fully informed of the above, I hereby knowingly consent to the recommended dental veneer and crown treatment outlined to me by my dentist and request him/her to place veneers and crowns on my teeth for aesthetic enhancement.

I further state that I have carefully read this consent form and understand the contents

Sign Here