Composite Bonding Consent Form

Dental bonding, also known as composite bonding, has been used in dentistry for many years. It is an excellent way to repair cracked, chipped and discoloured teeth as well as replacing silver amalgam fillings. Dental bonding can also be used to close gaps and reshape misaligned teeth, providing a straighter, more uniform smile.

Although the material used in dental bonding is somewhat stain resistant, it does not resist stains as well as crowns. Another disadvantage is that the bonding materials do not last as long nor are as strong as other restorative procedures, such as crowns and veneer. Additionally, bonding materials can more easily chip and break off the tooth.

Because of some of the limitations of dental bonding, it is best suited for small cosmetic changes, for temporary correction of cosmetic defects, and for correction of teeth in areas of very low bite pressure.


Bonded teeth do not require special care. Simply follow good oral hygiene practices. Brush teeth at least twice a day, floss at least once a day, and see us for regular professional check-ups and cleanings.


The lifespan of bonding materials for the teeth depends on how much bonding was done and your oral habits. Typically, however, bonding material lasts from 3 up to about 5 years before needing to be touched up or replaced. A Night time Appliance (Splint) should be worn to help protect your teeth.

The process of the composite bonding treatment has been fully explained to me, including any risks involved. I have been informed that complications might include, but are not limited to:


  1. Some of the enamel from my teeth will be removed.

  2. Local anaesthetic may be required and radiographs/x-rays taken as needed.

  3. Some of my opposing teeth or my occlusion (bite) may be altered.

  4. Some of my teeth may remain sensitive upon completion of treatment & long term I may require and root canal treatment.

  5. There may be chipping, fracture, and discoloration as time progresses, which might not be reparable. Replacement, at my expense, may be required.

   6. There is no guarantee as to how long the bonding's will last, and I have been instructed in oral hygiene methods.

Alternatives to suggested treatment

Reasonable alternatives to Composite bonding have been explained to me. These include Invisalign treatment or Porcelain restorations. I have tried or considered these methods, however have decided to proceed with Composite bonding.

Necessary follow-up care and Self-care

I agree to follow instructions related to the daily care of my mouth. I understand the importance of my oral hygiene care & attending regular six monthly maintenance appointments. I also understand I may be required to have an Occlusal night guard/splint fabricated & inserted after the completion of my bonding to ensure the best long term success.. I am aware I may also need to return to the practice following the completion of my treatment for further reviews or adjustments.



I voluntarily consent to Composite bonding. I further authorise you to use methods of treatment you may find necessary during the procedure which may have not been known to me before the procedure began. I have chosen  bonding over the alternatives that have been explained to me. I have had an opportunity to ask questions and am fully satisfied with the answers I have received. I have also been given instructions in care and maintenance regarding this procedure and agree to follow the instructions carefully.   


All of my questions have been answered by the dentist and I fully understand the above statements.

Thanks for submitting!