Dental Implants Questionnaire


Are you a candidate for dental implants?
In order to be a suitable candidate for dental implants, you must meet the following criteria:

You have sufficient bone density in your jaw to accommodate the implant

You must be willing to invest the 3-6 months it takes to complete the dental implant procedure

You do not have periodontal disease‎‎‎

You do not have any health conditions which may adversely impact your ability to heal‎‎‎‎‎

1. Which best describes how you feel? I do not smile as often as before because…

There are some visible spaces in my smile.

I chew differently because of the missing teeth.‎‎

I notice people stare at my mouth more frequently.

One or more teeth are becoming loose.

The condition of my mouth is getting worse.

2. Are you concerned about gum recession around any of your teeth?

YesNo

3. What are your goals or priorities for the health, function and appearance of your teeth and mouth:

Preserve my teeth & avoid dentures

Be free of mouth pain & tenderness

Avoid removable bridgework‎‎

Regain the ability to smile with confidence‎‎

Replace my lost tooth/teeth‎‎

Have a healthy and hassle-free mouth‎‎

4. Do you have any insurance coverage for dental implants?

YesNo

5. If everything works out, when would you like to start dental implant treatment?

1-30 Days

2-4 Months‎‎

5-12 Months‎‎

1-2 Years‎‎

6. How much research have you done?

I have just started my research and have not had a dental implant evaluation‎‎

Had an implant consultation and would like a second opinion‎‎‎‎

I am ready to schedule an appointment to start dental implant treatment. I just want to know the time needed and the payment options.‎‎

I am undecided whether to have a bridge or an implant‎‎

7. Have you ever been told that you were not a candidate for dental implants?

YesNo


If you answered YES to ANY of the questions above, there are often several alternatives to improve your teeth and smile. To receive a personalized response to your smile analysis, please complete the form below.

You can have the smile you’ve always wanted! contact us today to schedule an appointment.