Informed Consent

Dental Members Australia (DMA) Clear Aligner Therapy

The following information is provided to you to ensure you are aware of our DMA Clear Aligner Therapy policies.

How Does the DMA Clear Aligner System Work?

DMA Clear Aligner system is a series of invisible, BPA*-free plastic aligners that apply subtle pressure to gradually shift your teeth. The invisible aligners are made to be worn in a specific sequence. Each new aligner will gradually shift teeth. While every case is unique to each patient, the process typically takes approximately 9 to 12 months to complete. You should be aware of the benefits, inconveniences and risks related to using aligners. Feel free to contact the DMA Help Desk team to discuss any concerns you may have.

DMA Clear Aligner Treatment plan

Treatment Plan

Your treatment plan will be discussed at the time of the fitting of the first set of Clear Aligners, which is approximately 4 weeks after the initial consultation. The ideal treatment option is to align teeth and correct any functional issues if possible.  You have chosen to have DMA Clear Aligner therapy, which is often referred to as a limited or compromised treatment.   Limited or compromised treatment means that tooth movements are targeted to a specific problem or region of your mouth. There may be other problems in your mouth that could benefit from comprehensive orthodontic treatment, but these may not be addressed as part of your treatment. With your treatment you will need to accept that you will receive a functional and aesthetically adequate result, but not 100% perfection.  If you wish to have all orthodontic problems corrected, you need to undertake comprehensive orthodontic treatment comprising of full upper and lower fixed braces.

Length of Treatment

The length of treatment depends on a number of issues. The actual treatment time is usually close to the estimated treatment time, but may be longer. Changes in the original treatment plan may become necessary. DURATION AND RESULT – The length of time you wear the aligners and the results depend on many factors, including, but not limited to: your own individual biology, the level of cooperation/compliance, periodontal or other dental problems occurring, the severity of your case, and/or the shape of your teeth. The average person generally wears the aligners for 9 – 12 months, but your particular rate of tooth movement is impossible to predict and could take longer or shorter. If the duration is extended beyond the original estimate, additional fees may be assessed. Difficult cases may require IPR (Interproximal reduction) and/or extractions with Smilefast* braces for ideal results.

Clear Aligner Treatment Plan 

Your Clear Aligner treatment plan is purely to align your front teeth.  This treatment will not address any bite or functional issue you may have.  If your expectations differ from our original discussion and treatment needs to extend further than 12 months, extra monthly fees will apply. Clear Aligner therapy is a compromised orthodontic treatment, purely to improve the alignment of your front teeth and you cannot expect the same clinical result with aligner therapy as you would with a 2 year comprehensive orthodontic treatment option.  This treatment is not a replacement for conventional orthodontic treatment. Infact Clear Aligner therapy can have very unpredictable movements and in some cases it is impossible to effectively rotate some teeth, extrude some teeth, and even tip or torque some teeth to an ideal position.   It will not correct overjets, position of your back teeth, midline discrepancies, TMJ problems, position of tooth roots. Aligners need to be worn for 22 hours per day. 

Results of Treatment

No guarantees are made concerning final treatment results as there are too many variables affecting treatment, which are not in the control of DMA, but we do everything to ensure the closest to clinical perfection result is achieved. The success of treatment also depends on your cooperation/compliance in maintaining good oral hygiene, and wearing your aligners as instructed by DMA.  DMA Aligners are required to be worn 22 hours per day.

If any additional refinement scanning is required a $295 fee is payable directly to Dental Members Australia. 

Non-Ideal Results

Due to the wide variation in the size and shape of the teeth, missing teeth, Etc, achievement of an ideal result, eg, complete closure of a space, may not be possible.  Restorative dental treatment such as aesthetic bonding, crowns or bridges and/or periodontal therapy may be required.  Treatment outside of the scope of DMA Clear Aligner therapy may be necessary and extra fees will apply.

Aligner Benefits

DISCREET – The aligners are made of clear, BPA-free plastic. The trays are thin, light weight and nearly invisible when worn; many people won't know you're wearing them.

HYGIENE – Aligners allow you to eat, brush and floss normally, and the process of using aligners may improve your oral hygiene habits.

Aligner Risks

DISCOMFORT – Your mouth is sensitive so you can expect an adjustment period and some minor discomfort from moving your teeth. You may also experience gum, cheek or lip irritation when you initially use an aligner while these tissues adjust to contact with the aligner trays.

ALLERGIC REACTION – It is possible for some patients to become allergic to the materials used to create your aligners. If you experience a reaction, please discontinue use and inform your primary care provider and us immediately.

TEMPORARY SIDE EFFECTS – You may experience temporary changes in your speech or salivary flow while using aligners because of the presence of the aligner tray in your mouth.

CAVITIES, GUM OR PERIODONTAL DISEASE – Cavities, tooth decay, periodontal disease, inflammation of the gums or permanent markings (e.g. decalcification) may occur or accelerate during use of aligners. These reactions are more likely to occur if you eat or drink lots of sugary foods or beverages, or do not brush and floss your teeth before inserting the aligners, or do not see a dentist for preventative check – ups at least every six months. In addition, in some circumstances discoloration or white spots may occur; small cavities may increase in size, causing sensitivity and in some cases pain or tooth breakage; gingival inflammation may increase causing soreness and or bleeding. If underlying periodontal conditions persists unchecked, they may become more prevalent leading to tooth loss. You may have to discontinue aligner treatment. All of these symptoms will require you to seek care from a dental professional.

SHORTENING OR THE ROOTS/RESORPTION – The roots of some patients' teeth become shorter (resorption) during use of aligners. It is not possible to predict which patients will experience it, but patients who have had braces in the past are at higher risk. Resorption can impact the long – term health of teeth. If resorption is detected during DMA orthodontic treatment, treatment may need to be discontinued or eventful tooth loss could occur. If a primary (or "baby") tooth is present, any orthodontic movement would accelerate the resorption process leading to its loss.

DAMAGE NERVES IN TEETH – Tooth movement may accelerate nerve damage or nerve death resulting in a root canal, other dental treatment, or loss of the tooth. It is not possible to predict which patients may experience nerve damage, but patients who have experienced tooth injury or had restoration work on a tooth are at higher risk. If your family dentist detects nerve damage prior or during your aligner treatment, treatment may need to be discontinued or eventual tooth loss could occur.

TEMPOROMANDIBULAR JOINT DYSFUNCTION (TMJ) – Problems may occur in the jaw joints during aligner therapy causing pain, headaches or ear problems. The following factors can contribute to this outcome: past trauma or injury, arthritis, hereditary history, tooth grinding or clenching and some medical conditions.

IMPACTED AND SUPERNUMERARY TEETH – Teeth may become impacted or trapped below the bone or gums. Sometimes some patients are born with "extra" or supplementary teeth. If you have impacted, un – erupted or supplementary teeth, aligners are not an ideal option.

SUPRAERUPTION – if an aligner does not properly cover a tooth, it may migrate outwards (supraeruption) leading to difficulty cleaning, gum disease, tooth decay and loss of tooth.

PREVIOUS DENTAL TREATMENT – Aligners will not move implants and may not be effective on some dental restorations, such as bridges. Additionally, dental restorations, such as crowns, veneers, or bridges, may require replacement due to tooth movement.

ORAL PIERCINGS – Piercings are contraindicated during aligner therapy and therefore should be removed during treatment. In some circumstances, failure to do so could result in fractures aligners or broken teeth leading to termination of aligner treatment.

OTHER RISKS – Orthodontic treatment and the movement of teeth bring inherit and potential risks and side effects. In the case of aligner therapy such risks include, but are not limited to, discomfort, swelling, sensitivity, numbness, sore jaw muscles, allergic reaction to dental materials, and unforeseen conditions that may be revealed during treatment which may necessitate extension of the original procedures or the recommendation of other patient – specific procedures. Additionally, the tissue attachment between the front teeth may become inflamed which is a common result of aligner therapy. The procedure required to treat this, known as a frenectomy, is not a part of my DMA treatment, but is a recommended adjunctive treatment for the best outcome and long-term stability of my smile.

SAFETY – Aligners may break, be swallowed or inhaled. You may also have an allergic reaction to the materials used in the aligners.

GENERAL HEALTH PROBLEMS – Overall medical conditions such as bone, blood or hormonal disorders, and many prescription and non – prescription drugs (including bisphosphonates) can affect the movement of the teeth and the outcome.

RETAINERS – Teeth may move again after you stop wearing the aligners. Retainers will be required to keep your teeth in their new positions for a lifetime. Your retainer should be worn full – time for 2 weeks and then nightly from then on. You can expect a retainer to last about one year, but this can vary greatly from patient to patient. 

BITE ADJUSTMENT – Your bite may change during treatment and may result in temporary discomfort. Your bite may require adjustment after use of the aligners.

AGREEMENT TO ARBITRATE – I hereby agree that any dispute regarding the products and services offered by DMA and/or affiliated dental professionals, including but not limited to medical malpractice disputes, will be determined by submission to arbitration and not by lawsuit filed in any court, except claims within the jurisdiction of Small Claims Court. 

BLACK TRIANGLES – Teeth, which have been overlapped for long periods of time, may be missing the gum tissue and when these teeth are aligned, a "black triangle" appears below the interproximal contact.

IPR, Attachments, Extractions 

IPR-Interproximal reduction is polishing between the teeth and is performed by hand using flexible diamond coated strips that are worked back and forth to gain minimal space allowing your teeth to move.  Your teeth will remain healthy and sound. DMA will discuss IPR with you prior to this procedure being performed but be assured this causes no damage to the teeth.

ATTACHMENTS - To obtain the desired results in the final positions of the teeth, strategically placed tooth coloured attachments are necessary.  Without certain types of attachments, the results from the aligners would not be ideal.

EXTRACTIONS - Some cases will require the removal of deciduous (baby) teeth or permanent teeth. There are additional risks associated with the removal of teeth, which you should discuss with your DMA dentist prior to the procedure.

Healthy Teeth & Gums

DM Clear aligners are most effective if your teeth and gums are healthy. It is your responsibility to see a dentist to verify that your teeth and gums are healthy prior to using DMA aligners.

My dentist cleaned my teeth. My dentist took x-rays of my teeth. My dentist checked for and repaired cavities, loose or defective fillings, crowns or bridges. My dentist checked my x-rays and I have no shortened or resorbed roots. My dentist checked my x-rays I have no impacted teeth. My dentist has probed or measured my gum pockets and says I do not have periodontal or gum disease. My dentist preformed a full oral-cancer screening in the last 6 months and I do not have oral cancer. I have no pain in any of my teeth. I have no pain in my jaws. I have no loose teeth. I have no “baby teeth” and all of my permanent teeth are present. (Dentist signature & Name__________________________________________________________________) (Patient Initial_________________________________)

Informed Consent

I consent to DMA and DMA provider sharing my personal and medical/dental information, both orally and visually with third parties, business associates, or affiliates for the purposes of diagnosis, treatment planning and/or manufacturing purposes.

 

I certify that I can read and understand English. I acknowledge that DMA has not made any guarantees or assurances to me. I have read this form and fully understand the benefits and risks listed in this form related to my use of DMA aligners. I have had an opportunity to discuss and ask any questions to a DMA provider about the use of DMA aligners. I understand that DMA cannot guarantee any specific results or outcomes. I further understand that my DMA invisible aligner treatment will only address the alignment of my teeth and will not correct my existing bite condition. In order to correct the current condition of my bite, I will need to seek more comprehensive treatment via an orthodontic or dental professional with experience in more comprehensive orthodontic treatments. Because I am choosing not to engage in comprehensive orthodontic, I understand and accept that my bite or occlusion will be improved and that my teeth will be straighter than they currently are but will still be compromised.

I hereby grant DMA the right to use photographs taken of my dental treatment and my first name for educational and/or marketing purposes. I acknowledge that since my participation is voluntary, I will receive no financial compensation and agree that my participation is voluntary, I will receive no financial compensation and agree that my participation confers upon me no right of ownership. I release DMA from liability for any claims by me or any third party in connection with my participation or use of the invisible aligner treatment.

In the event that DMA determines that I am not an appropriate candidate for DMA aligner treatment, but that I am a candidate for more – advanced clear aligner treatment, I hereby consent to having all of my records in DMA’s possession (including without limitation dental impressions, digital scans, photographs, and medical history documentation) sent to Smilefast* for further review and treatment planning, including, but not limited to, contacting me to refer my case to a Smilefast – certified provider.

I hereby acknowledge that I have read and fully understand the treatment considerations and risks presented in this form. I also understand that there may be other problems that occur less frequently than those presented, and that actual results may differ from the anticipated results.  I have been asked to make a choice about my treatment. I hereby consent to the DMA aligner treatment proposed and authorise DMA to provide the treatment. I also authorise DMA to provide my health care information to my other health care providers.  I understand that my treatment fee covers only treatment provided by DMA, and that treatment provided by other dental or medical professionals is not included in the fee for my Aligner Treatment. 

*Smilefast refers to the dental treatment of crowding under the smilefast process, which involves indirect bonding of brackets and wires to teeth. comprising of full upper and lower fixed braces.

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