1. I understand that dental lasers marketed and sold in the United States have been cleared for marketing by the Food and Drug Administration (FDA) for use in dentistry.
2. I understand that Dr. Armin Abron has been trained extensively in the use of Dental Lasers by the best universities, academies and experts that teach this information.
3. I have been presented with the laser treatment plan and fees-for treatment. I have been informed of other methods of treatment and the alternatives. The expected results and risks of the proposed treatment (and/or no treatment) have been explained to me.
4. I understand there is no guarantee of success or permanence of the treatment.
5. I understand that dental conditions in my mouth can change and alter the proposed treatment plan.
6. I understand that any time teeth are manipulated, whether by a mechanical drill or laser, there is always the possibility and risk that Root Canal Therapy may be necessary. I realize that in spite of observing every reasonable precaution—prior nerve damage, infection, or tooth trauma may have pre-existed in the tooth.
7. I understand that anytime that soft tissue is manipulated, whether by traditional dental technology, or laser dentistry; there is always a possibility and risk of unexpected and undesirable side effects.
8. “Spaces” between your teeth can result from reduction of inflammation, swelling, and the removal of diseased tissue after the LANAP treatment. These spaces usually fill in over time, and again, bite adjustment is critical to making sure the teeth and the “papilla” is not traumatized and can regrow.
9. “Occlusal adjustment” and “occlusal equilibration” has been fully explained to me. I have had the opportunity to ask questions, and I fully understand that occlusal adjustments and equilibration require my 100% cooperation and compliance. It has been explained to me that failure to complete all phases of occlusal adjustments and equilibration may result in oral-facial pain, temporal mandibular joint dysfunction (TMJ) sore and painful teeth; and that it has been explained to me that until the teeth have been fully adjusted and/or equilibrated I may experience transitional TMJ pain, muscle soreness, headaches, tooth pain, tooth sensitivity, and cheek biting. I understand adjusting crowns can remove porcelain, expose metal and/or tooth structure, and requiring the replacement of any and all crowns.
10. I understand that “high technology” dentistry, including laser therapy, may be considered “investigational” or “experimental” and may not be reimbursed by some insurance companies, and I must anticipate paying 100% of any such treatment.
11. I understand that insurance reimbursement is only an estimate. I am ultimately responsible for any fees incurred during treatment. I understand this office does not operate on the assumption that insurance will reimburse me for the treatment rendered.
12. I understand that this office is performing this treatment in my own best interests.
13. I have read and agreed to the foregoing. I have had the opportunity to ask treatment related questions and have been advised of the risks and benefits of treatment, including the use of local anesthesia and dental lasers.
14. I understand that is necessary to complete all phases of recommended treatment, and agree to do so.