Consent Form for the Insertion of TADS During Orthodontic Treatment

Information regarding the procedure:

Course of procedure:

• Topical anesthesia
• Infiltration anesthesia
• Tissue punch at the insertion site
• Pilot drill
• Insertion of TAD – Temporary Anchorage Device or Mini Screw
• Coupling of the mini-screw to the orthodontic appliance
• Removal of the mini-screw (at the conclusion of treatment)

The potential risks and complications of the planned procedure and the resulting treatment have been
discussed in depth, especially the possibility of:

General Side Effects/ Complications:

After the procedure, pain may persist. Generally, it will wear off within a few hours after the
procedure.
- Bleeding or prolonged hemorrhaging are very rare but can occur, especially in patients with
hemorrhagic diatheses.
- Existing allergies or sensitivity (for example, from the anesthetic, disinfectant, latex) may lead
to transient swelling, itching, sneezing, skin rash, dizziness or other related reactions.
- Severe complications affecting vital functions (heart circulation, respiration, kidneys) or
permanent damage (for example, organ failure or paralysis) are extremely rare.

Specific Side Effects/ Complications:

- Root damage due to proximity of the mini-screws
- Soft tissue injury during placement
- Fracture, loosening or premature loss of mini-screw
- Inflammation of the soft and hard tissues surrounding the mini-crew
- Individual risks: ……………………………………………………………………………….

Post-operative Care Instructions:

- For 24 hours after the procedure, please refrain from smoking, drinking alcohol or exercising
- Do not eat while the area is still numb
- It is very important to include the area surrounding the mini-screw into your daily oral hygiene
routine according to the instructions received from your doctor. In the first days following the
insertion, the application of a disinfecting agent (mouth rise) may be required. Regular recall
of appointments will be necessary as part of the post-operative care.
- Immediately contact your doctor if you experience continuous haemorrhaging, severe
swelling, throbbing pain or other discomfort at the insertion site