Informed Consent for Dental Implants: An Audit to help formulate a Gold Standard S.Stern, M.Suleiman BACKGROUND Implant placement involves a number of risks. The severity of these are variable and may be site-related. Informed consent requires the clinician to fully inform the patient of all the common risks for their own particular procedure. This means that should complications occur, the patient will have been aware of this possibility prior to agreeing to surgery. Currently, there is no Gold Standard regarding giving patients information about serious, unavoidable, or frequently-occurring risks prior to gaining informed consent for implant placement. Aim (300): To improve the quality and reliability of informed consent for dental implants. To audit the current levels of consent provided in order to create a Gold Standard for site-specific informed consent with regard to dental implant placement. Materials + Method A retrospective analysis of consent forms signed by patients undergoing implant placement in the Department of Implantology between the dates of 28.01.16-16.03.17. The consent forms were assessed a minimum of 3 months after implant placement to ensure any post-operative complications could be recorded. All consent forms and surgeries were performed by either post-graduate Specialist trainees or consultants. Comprehensive data regarding the patient, site of surgery, surgical procedure and if there were any post-operative complications were collected. The content of the consent forms was analysed to provide an assessment of the risks the patient was informed about prior to the procedure, as well as whether any post-operative complications had been reflected in the consent form. The audit allowed an assessment of the commonest risks mentioned, as well as those omitted, and the post-operative complications suffered. RESULTS 23 patient records were analysed. 57 implants were placed. All results are at the patient level. 22 subjects had the risks of implant surgery stated completed on their consent form. 1 had no risks stated at all. Of the 23 records, the risks that were stated and their frequency are presented in the table below: RISKS STATED: Pain 22 Swelling 21 Bleeding 21 Bruising 14 Inflammation 7 Damage to Adjacent Teeth 5 Numbness 6 Infection 21 Failure of implants 20 Graft Failure 2 OAC 3 Sensitivity 2 Recession 2 Mobility 1 10 of the subjects had signed consent forms at the initial consultation and then reconfirmed on the day of surgery. 3 subjects experienced serious post-operative complications related to the surgery. 2 of these 3 subjects had been warned of these risks in the consent form pre-operatively. This means that 33% of common post-operative complications that occurred were not in fact covered by the consent form. This suggests the current consent procedure is not therefore not be comprehensive. CONCLUSION This audit demonstrates variations in consistency of the risks stated regardless of the identical nature of implant sites. A suggested Gold Standard of informed consent for implant placement should include the following risks: “Pain, swelling, bleeding, bruising, infection, failure of implants.” Appropriate site-specific warnings should be stated for sites posterior to the 1st premolar in both jaws, and sites with adjacent teeth. This audit allows the creation of a comprehensive Gold Standard for informed consent, benefitting both the patient and clinician. A repeat audit should be carried out in 2 years.
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