Denture Repair Consent Form

I hereby authorize Island Dental Associates to perform a repair on my existing full or partial denture. I understand and agree that payment is due in full at the time of service, and that dental insurance is not accepted for same-day denture repairs.

I understand that this procedure involves repairing an existing dental prosthesis, not fabricating a new one. As such, I acknowledge that the repaired denture may not meet the standards, fit, function, or esthetics of a newly fabricated prosthesis.

I have been informed that denture repair is a limited and non-ideal solution, and that in many cases, fabrication of a new denture may be the recommended treatment.

Same-Day / Rush Service

I understand that:

• If I request or require same-day or expedited repair service, an additional rush fee will apply
• The rush fee reflects priority laboratory processing and scheduling accommodations
• Same-day completion is not guaranteed, as it depends on the condition of the denture and laboratory feasibility
• Even with rush service, the repair may still require additional time or follow-up visits

Risks, Limitations, and Expectations

I understand and accept the following:

• The repaired denture may feel different after repair and may require adjustment
• The fit, function, and appearance may change
• The color of the repair material may differ slightly from the original denture
• Teeth added or repaired will be matched to the closest possible shade, but may not be an exact match
• The denture may not fit, function, or appear exactly as expected
• There is a possibility the repair may fail, fracture again, or require additional repairs
• The repair may require follow-up visits and adjustments
• I may be without my denture while it is being repaired

Changes in Oral Condition

I understand that:

• If I have had recent extractions, my gums and bone may continue to shrink during healing, which can cause a gap between the denture and the gum tissue
• This may require adjustments, relining, filling in areas, or complete remake of the denture for proper fit
• If the denture is not worn consistently, teeth and oral structures may shift, causing the denture to fit and feel differently over time

Material & Structural Limitations

I understand and accept that:

• Metal clasps on partial dentures that break may not be repairable
• Flexite (flexible) partial dentures, once repaired, will not be as strong as the original appliance
• Valplast partial dentures cannot be relined
• Certain repairs may be limited by the condition, age, or material of the denture

Laboratory & Repair Limitations

I understand that:

• The dental laboratory may determine that the denture cannot be repaired, and it may be returned without repair
• Repair timelines may vary and may be affected by lab workload or availability
• Additional or unforeseen work may result in additional fees

No Guarantee

I understand that denture repairs carry no guarantees or warranties, and outcomes depend on the condition of the existing prosthesis.

Island Dental Associates will make every reasonable effort to achieve a satisfactory result; however, no specific outcome is promised or guaranteed.

Alternative Treatment

I understand that I have been advised of alternative options, including fabrication of a new denture, and that I may choose to pursue treatment elsewhere.

Acknowledgment & Consent

By signing below, I confirm that:

• I have read and fully understand this consent form
• I have had the opportunity to ask questions
• I understand the risks, limitations, fees, and alternatives
• I voluntarily consent to proceed with denture repair