Kiwi Smile Informed Consent & Agreement

As a general rule, informed and cooperative patients can achieve positive orthodontic results. While recognising the benefits of a beautiful healthy smile, you should also be aware that, as with all orthodontic procedures clear aligners have limitations and potential risks. These are seldom serious enough to indicate that you should not have treatment; however, all patients should consider the option of no treatment at all by accepting their present oral condition. You should also ensure that you have discussed all orthodontic alternatives available to you with the doctor prior to beginning treatment. 

About Kiwi Smile Clear Aligners 

Kiwi Smile aligners are comprised of a series of clear plastic, removable appliances designed to gradually adjust the position of teeth in small increments. These aligners are customised based on my doctor’s diagnosis and prescription, utilising advanced computer graphics technology to create a treatment plan tailored to my specific needs. Upon approval of the treatment plan, a personalized series of Kiwi Smile aligners will be produced for my orthodontic treatment.

The purpose of this document is to explain Kiwi Smile Limited (“Kiwi Smile”) clear aligners and also to inform you of potential risks associated with their use. Kiwi Smile clear aligners are an orthodontic treatment in which the patient wears a series of clear, removable aligners that gradually move the teeth to improve bite function and/or aesthetic appearance. This treatment is intended to provide the end benefits of traditional “wired” orthodontic treatment, such as straight teeth and improved bite function, as well as the following benefits that are only available when going wireless: 

-  The aligners are clear, so people may not even notice you wearing them. 

-  There are no cuts or abrasions from wires or brackets, so Kiwi Smile aligners are more comfortable than traditional braces. 

-  The aligners are removable, allowing you to eat, drink, brush and floss with freedom.

Although the benefits generally outweigh the potential risks, all factors should be considered before making the decision to wear aligners.

Potential Risks of Clear Aligners

As with other orthodontic treatments, clear aligners may carry some of the potential risks described below:

-  Treatment time may exceed your doctor’s estimates. Poor compliance to your doctor’s instructions, not wearing aligners the required number of hours per day, missed appointments, excessive bone growth, poor oral hygiene and broken appliances can lengthen treatment time, increase the cost, and affect the quality of the end results. 

-  Unusually shaped teeth can also extend treatment time. For instance, short clinical crowns can cause problems with aligner retention and slow or prevent teeth movement.

-  Tooth decay, periodontal disease, decalcification (permanent markings on the teeth), or inflammation of the gums may occur if proper oral hygiene and preventative maintenance are not maintained, whether wearing aligners or otherwise. 

-  Sores and irritation of the soft tissue of the mouth (gums, cheeks, tongue and lips) are possible but rarely occur due to wearing aligners. 

-  Initially, the aligners may temporarily affect your speech. Patients generally adapt quickly to wearing aligners and it is rare that speech is impaired for an extended period of time.

-  While wearing aligners, you may experience a temporary increase in salivation or dryness of the mouth. Certain medications can increase this. 

-  In cases of crowding, inter-proximal reduction (trimming the thickness of a tooth’s enamel) may be required to create enough space to allow teeth movement. 

-  Any medications you may be taking and your overall medical condition can affect your orthodontic treatment. 

-  Though uncommon, allergic reactions to the material used during treatment may occur. 

-  Tooth sensitivity and tenderness of the mouth may occur during treatment—especially when advancing from one aligner to the next. 

-  Bone and gums, both of which support the teeth, can be affected by wearing aligners. In some cases, their health may be impaired or aggravated. 

-  Oral surgery may be required to correct excessive crowding or severe, pre-existing jaw imbalances. All risks of oral surgery, such as those associated with anaesthesia and proper healing, must be considered before treatment. 

-  Wearing aligners may irritate teeth—previously traumatized or not. Though a rare occurrence, such teeth may require additional dental treatment such as endodontic treatment or other restorative treatment, the useful life of the teeth may be shortened or the teeth may be lost completely. 

-  Existing dental restorations, such as crowns and bridges, may be affected by wearing aligners. They may become dislodged and require re-cementation or in some instances, replacement. Before any dental restorations are replaced or added, consult your doctor, as they can affect the way your aligners fit. 

-  Teeth may supra-erupt from aligner use (come out of the gums more than other teeth) although this rarely occurs.

-  Root resorption (shortening) can occur during any type of orthodontic treatment, including clear aligners. Shortened roots are of no disadvantage under healthy conditions. In rare cases, root resorption can result in loss of teeth. There is no way to foresee if this will occur during your treatment and nothing can be done to prevent it. 

-  In cases of multiple missing teeth, it is more likely that the aligner may break. Contact Kiwi Smile or your Dentist as soon as possible to replace it. 

-  Because orthodontic appliances are worn in the mouth, accidentally swallowing or aspirating the aligner— in whole or in part—may occur. 

-  Though rare, problems may occur in the jaw joint, causing joint pain, discomfort, headaches or ear problems. Inform your doctor of any such problems immediately. 

-  Results may relapse if proper retainer wear is not followed as directed by Kiwi Smile. Difficulty removing aligners may occur if you have multiple engagers in place during treatment, and/or excessive crowding, and/or some particular bite patterns. The doctor will give instructions to assist you if this is the case. 

-  In some cases, due to the anatomy of the teeth, additional cosmetic dental procedures, for example, crowns, veneers, etc., may be necessary to complete treatment. There may be an additional cost to you if you require such procedures. 

Informed Consent and Agreement 

I have been given adequate time to read and have read the preceding information describing orthodontic treatment with Kiwi Smile aligners. I understand the benefits, risks, alternatives and inconveniences associated with treatment as well as the option of no treatment. I have been sufficiently informed and have had the opportunity to ask questions and discuss concerns about orthodontic treatment with Kiwi Smile products with my doctor from whom I intend to receive treatment. I understand that I should only use the Kiwi Smile products after consultation and prescription from an Kiwi Smile trained doctor, and I hereby consent to orthodontic treatment with Kiwi Smile products that have been prescribed by my doctor.

Due to the fact that orthodontics is not an exact science, I acknowledge that my doctor and Kiwi Smile Limited (“Kiwi Smile”) have not and cannot make any guarantees or assurances concerning the outcome of my treatment. I understand that Kiwi Smile is not a provider of medical, dental or health care services and does not and cannot practice medicine, dentistry or give medical advice. No assurances or guarantees of any kind have been made to me by my doctor or Kiwi Smile, its representatives, successors, assigns, and agents concerning any specific outcome of my treatment.

I authorise my doctor to release my medical records, including, but not be limited to, radiographs (x-rays), reports, charts, medical history, photographs, findings, plaster models, impressions of teeth, or intra-oral scans, prescriptions, diagnosis, medical testing, test results, billing, and other treatment records in my doctor’s possession (“Medical Records”) (i) to other licensed dentists or orthodontists and organisations employing licensed dentists and orthodontists and to Kiwi Smile, its representatives, employees, successors, assigns, and agents for the purposes of investigating and reviewing my medical history as it pertains to orthodontic treatment with product(s) from Kiwi Smile and (ii) for educational and research purposes.

By attending a Kiwi Smile Pro in-Clinic appointment, I acknowledge that if either myself or the child under my guardianship chooses not to proceed with treatment, I am liable to pay a $400 fee for the initial assessment. I also understand that the Kiwi Smile Pro in-Clinic Price serves as a foundational cost, and additional charges may apply for procedures such as IPR, Attachments, or Tooth Removal, as deemed necessary by the dentist. Additionally, there may be supplementary fees for any other services recommended by the dentist.

I have read, understand and agree to the terms set forth in this Informed Consent & Agreement Document as indicated by my purchase through the Kiwi Smile Website.