Transitional Implant Program

Implant Dentistry Program: Converting Lower Dentures to Implant Supported Overdentures

/ This is a limited program designed to help those patients who are already wearing a lower denture and would like to gain additional support and stability for their lower denture.

/ It involves a very basic implant services and utilizes the patient=s existing denture whenever possible.

/ More extensive restorative and implant services will be significantly more costly.

Cost of Service: $995.00

Service Provider: Boca Prosthodontics, Inc.

The Service: If the patient=s lower denture is satisfactory for this procedure and the patient is medically and dentally acceptable for the non-surgical placement of transitional, ongoing dental implants, two transitional implants will be placed in the front portion of the lower jaw. The implants will be attached to the existing denture by means of resilient attachments. It is not know at this time how long these implants will last.

Terms: Fees for this service are payable at the time of agreement to the service. If the service is not performed, the patient will get a 100% refund. Once the implants are placed, there will be no refund of monies. If an implant fails within one year of placement, it may be replaced at no additional charge. If an implant fails after the first year of function, it may be replaced at an additional fee. The patient is entitled, with respect to the $950.00 fee, to three follow-up visits within one month of completion of treatment. Additional follow-up visits will be charged out at a minimum of $35.00 per visit.

Unsatisfactory Denture:

If the patient presents with an unsatisfactory denture, $1500.00 will be added to the fee to construct a new denture. Denture relines are charged out at $350.00 per denture. The patient may have a new denture constructed or a reline performed elsewhere and resubmit for this treatment at the $950.00 fee.

Signature: __________________________________ Date: __________________