A ridge expansion is a dental approach that involves expanding a part of the jawbone to make room for a dental implant. It is performed when there has been a considerable loss of jawbone tissue because of periodontal disease, trauma, or other circumstances. The degree of the treatment and personal healing times determine how long recovery takes following ridge enlargement. Patients often anticipate some discomfort and swelling for the first few days following the operation. They are instructed to refrain from eating anything tough or crunchy, using smoke, and drinking alcohol for a while, to promote appropriate recovery. The majority of patients normally continue their regular activities within a week of the treatment.
There are side effects to ridge expansion, but it is an oral operation that is safe and effective. They include the following; it is usual to experience swelling in the face and gums, which lingers for several days. Using cold compresses or ice packs on the affected area helps to control it. Some pain or soreness is normal in the postoperative period. The patient needs to have acetaminophen or ibuprofen, two over-the-counter painkillers, to treat discomfort. Bleeding is a regular occurrence both during and after the procedure. Patients are recommended to refrain from physically demanding activities and adhere to their dentist's post-operative care guidelines in order to reduce bleeding. Bruising is a small amount of bruising that occurs close to the incision area. However, it is typically absolutely transitory. Numbness is when the lips, tongue, or chin experience temporary numbness or tingling because the treatment involves separating the jaw's bone from its soft tissue. Infection occurs with any surgical treatment. Antibiotics are provided to assist in preventing infection before and after the procedure. It causes momentary sinus issues such as tension or congestion if the upper jaw is used for ridge expansion.
It is crucial to go through any worries or inquiries with the dentist about any prospective side effects of ridge enlargement before having the surgery. The dentist provides more details about the procedure's advantages and disadvantages then the patient decides on it wisely.
Recovery following ridge expansion varies depending on the patient and the amount of treatment. There are some broad recommendations for ridge expansion recovery. Swelling is typical after surgery. It is controlled by using ice packs or a cold compress on the afflicted area for 20 minutes at a time. Swelling usually reaches its height and starts to go downhill after 2-3 days. Some discomfort or pain is anticipated following the surgery. Pain is managed with over-the-counter analgesics such acetaminophen or ibuprofen.
A soft food diet is advised for the first several days following the operation. Avoid foods that are rough, crunchy, or sticky since they irritate the wound or cause the blood clot to break up. Maintaining good oral hygiene is crucial following the treatment. Carefully brush the region surrounding the incision, then rinse with a saltwater solution. Avoid heavy lifting or severe exercise for at least 24 to 48 hours following the treatment. Blood pressure rises as a result and to avoid incision site haemorrhage for heavy activities. Plan a follow-up appointment with the dentist to check on the healing and make sure the implant is positioned as intended.
It is critical to carefully adhere to the dentist's post-operative instructions to encourage good healing and reduce the danger of difficulties. Contact the dentist right away for any extreme pain, bleeding, or other problems following the surgery. Ridge enlargement has potential dangers, just like any dental surgery.
There are some dangers and issues connected to ridge expansion. There is a danger of infection during each surgical procedure. Antibiotics are provided before and after the procedure to assist in preventing infection. Bleeding is frequent during and after the surgery. Patients are recommended to refrain from intense activities and adhere to their dentist's post-operative care guidelines to reduce bleeding. Damage surrounding the nerves results from the procedure's separation of the jaw's bone and tissue. The lips, tongue, or chin become temporarily or permanently numb or tingly as a result of nerve damage. It results in momentary sinus issues, such as pressure or congestion, if the ridge expansion procedure is done on the upper jaw. The ridge expansion occasionally offers not enough bone support for the implant to integrate effectively, leading to implant failure. An allergic reaction to the anaesthetic or other medications used during the treatment in certain patients. There are likely some pain and discomfort after the procedure but typically be managed with over-the-counter painkillers.
It is crucial to talk about any worries or inquiries with the dentist regarding the dangers and side effects of ridge enlargement. More details on the procedure's advantages and disadvantages need to be discussed by the dentist, who assists patients with well-informed choices.
What is Ridge Expansion?
A dental technique known as ridge expansion is done to widen the jawbone in order to accommodate oral implants. The surrounding osseous tissue starts to deteriorate once a tooth is lost or pulled, making it challenging to place an oral implant there. Ridge expansion provides a solution to the tissues by allowing for greater implant space in the jawbone.
A tiny incision is created in the gum tissue to show the jawbone during the surgery. The dentist gently splits the bone and makes room for the implant using a specialized tool. Bone grafting substances occasionally be introduced to the area to offer more support and encourage the formation of new bone. The area is given time to recover after the ridge extension process prior to placing the oral implant. It enables the bone that has just grown to mature and have the strength necessary to support the implant.
Ridge enlargement is carried out at a dental office and is frequently done while being given a local anaesthetic. Patients who have been informed they are not candidates for dental implant techniques benefit from the operation, which has a high success rate, because of their low bone density.
Ridge Expansion Dental Implant Techniques
The precise approach employed depends on the needs of the individual patient and the dentist or oral surgeon. There are various methods for ridge expansion in dental implant operations like Osteotome technique, Piezoelectric surgery, Ridge splitting technique, and Distraction osteogenesis.
The osteotome procedure involves stretching the bone with the aid of specialized devices called osteotomes. The osteotomes are gently tapped into the bone to cause small fractures in order to expand the bone and provide room for the implant. The procedure is carried out with local anaesthetic and is minimally invasive.
The osteotome technique aids in reducing stress on the nearby bone and soft tissue, which results in quicker patient healing and recovery. However, it is not appropriate for all implant cases and takes a high level of ability and competence to conduct successfully. The dentist or oral surgeon helps a patient to decide whether the osteotome procedure is the best choice based on the unique requirements and dental health situation.
A technique that expands the bone by using ultrasonic vibrations. The bone is precisely sliced using a technical handpiece so that it is enlarged without damaging the tissue around it. Piezoelectric surgery is carried out under local anaesthetic.
Periodontal surgery, implant insertion, and bone grafting are among the dental and medical treatments that use the minimally invasive piezoelectric surgery approach. It includes using an ultrasonic tool that cuts through bone and other hard tissues while protecting the soft tissues around it by using piezoelectric vibrations. A thin, vibrating tip is used in piezoelectric surgery to make exact, controlled cuts in the bone without harming the surrounding tissues, nerves, or blood vessels. It promotes quicker recovery and less discomfort with better accuracy and less harm to the patient.
Delicate treatments like sinus lifts and the extraction of impacted teeth are accomplished with increased accuracy and safety using piezoelectric surgery. The technique aids in reducing bleeding and oedema both before and after the treatment because it generates less heat and vibration than conventional surgical methods. Piezoelectric surgery, however, is not appropriate for all dental and medical treatments because it takes specialized training and skill to conduct appropriately. The dentist or oral surgeon helps the patient to decide whether piezoelectric surgery is the best option.
The ridge-splitting technique is a procedure that entails cutting the jawbone vertically, and then extending the two pieces of the bone. The spot is then given time to recover before the implant is inserted after the enlarged bone has been supported with bone graft material. The gum tissue is cut in a small incision during the ridge-splitting procedure to reveal the jawbone ridge. The ridge is then broken in half by making a precise cut in its middle with a specialized tool like a chisel or saw. Bone grafting material is used to enlarge it due to the space between the two portions of the ridge being created.
The ridge-splitting method is an efficient strategy to increase the amount of available space for dental implants when bone breadth is restricted. It lessens the need for more intrusive bone grafting surgeries, speeds up the healing process, and lessens pain for the patient. Ridge splitting needs specialized knowledge and skill to conduct properly, much like any surgical technique, and not be appropriate for many patients.
Distraction osteogenesis is a surgical operation that is used in extending or reshaping bones, specifically in the jaw and face. Bone tissues are slowly stretched for several weeks or months, allowing fresh bone tissue to grow and fill the gap created by the stretching. Congenital flaws, facial irregularities, and irregularities of jaw length are all treated with distraction osteogenesis. It is used to expand the area available for dental implants or to fix bite issues.
A bone cut is produced, and on either side of the cut, a distractor is fastened to the bone. The distractor is then gently adjusted over time, typically over the course of a few weeks, to slowly move the two bone portions apart in the void left by the stretching. The procedure encourages the development of new bone tissue, which finally fills the opening. The dentist or oral surgeon assesses unique circumstances and suggests the best dental implant technique.
When is a Ridge Expansion required?
A ridge expansion is necessary if the jawbone is insufficiently wide or tall to accommodate a dental implant. There are various causes for it to occur like the loss of a tooth wherein the jawbone in the area eventually begins to degenerate when a tooth is lost. A thinner ridge that is not wide enough to sustain an implant arises from it. Gum disease is when bone loss brought on by gum disease results in a narrower ridge. Trauma causes when a jaw injury causes bone loss, which results in a smaller ridge. Some individuals simply have thinner jawbones by birth, which makes implant placement more challenging.
A ridge expansion is required if the existing ridge is too weak or frail to sustain an implant. The ridge is strengthened with bone graft material before the implant is inserted. The oral surgeon or dentist assesses the particular circumstances to decide whether a Ridge Expansion is required. CT scans are needed to evaluate the quality of the jawbone and determine whether there is enough bone to sustain an implant, X-rays. They go over the process in great detail with the patient and address any concerns they have if a Ridge Expansion is needed.
What are the Ridge Expansion procedures?
Ridge expansion treatment usually takes 30 to 60 minutes depending on how much bone has been removed and whether a bone graft is required. The procedure has a high success rate and significantly increases the opportunity that a dental implant is going to be safely placed.
There are eight procedures for Ridge Expansion. First is Evaluation, the dentist assesses the patient's dental health prior to the treatment and performs X-rays or CT scans to assess the degree of bone loss and the ideal placement for the implant. The success of the procedure depends on careful planning and evaluation before and after the surgery. There are some of the key aspects of evaluation in ridge expansion like medical history, dental exam, radiographic evaluation, treatment plan, and follow-up care.
The second procedure is Anesthesia. The patient is given a local anaesthetic to make the area where the treatment is being done numb. There are kinds of anaesthetics, local anaesthetic, sedation anaesthesia, and general anaesthesia.
The third procedure is Incision. The dentist creates a little incision in the gum tissue to reveal the jawbone. There are a few typical incision methods for ridge expansion, horizontal incision, vertical incision, and Flap incision.
The fourth procedure is Bone separation. The dentist carefully separates the bone using a specialized tool to make room for the implant. Some of the main features of bone separation are planning, anaesthesia, incision, widening the bone, closure, and post-operative care.
The fifth procedure is Bone grafting. A dental practitioner occasionally fills the newly formed area with bone grafting material to offer extra support and enable the creation of new bone. Bone grafting is frequently done in conjunction with ridge expansion methods to offer additional aid for dental implants or to aid in the healing of the jawbone following ridge expansion treatments. The jawbone is broadened during ridge expansion to make more room for dental implants or to enhance the fit of dentures. The new bone growth is supported by bone grafting, which helps to maintain the jawbone's stability and strength.
Bone grafting and bone separation have the same components that need to be remembered. Some of the most important components of bone grafting are planning, anaesthesia, incision, widening the bone, closure, and post-operative care.
The sixth procedure is Closure. The dentist sutures the incision site closed and applies a bandage to protect it when the ridge expansion is finished. Some of the key aspects of closure in ridge expansion are suturing, Gum tissue healing, follow-up appointments, and healing time.
The seventh procedure is Recovery. The patient needs to take it easy after the surgery so the area heals immediately. Doctors recommend painkillers to alleviate any discomfort. The general principles that help to know what to anticipate throughout the recuperation process are immediately after the procedure, in the first few days, In the first week, during follow-up appointments, and in long-term care.
The last procedure is Follow-up. The dentist arranges a follow-up appointment to check on the healing process when the implant is placed. Some of the things that patients expect during follow-up appointments are the evaluation of healing, removal of sutures, oral hygiene instruction, pain management, and monitoring progress.
A ridge expansion is an effective way to prepare the jawbone for dental implants or restorative treatments, but it is important to work with an experienced dentist to ensure safety and effectiveness.
What kind of Dentist should I see for a Ridge Expansion?
A Ridge Expansion is a special dental technique that calls for knowledge of both implant dentistry and oral surgery. It is advised to consult an oral surgeon or periodontist for a Ridge Expansion surgery. A dental specialist with training in operating on the mouth, jaw, and face is known as an oral surgeon. They have a great deal of experience doing Ridge Expansions and installing dental implants as well as other bone grafting treatments. A dental specialist known as a periodontist or oral pathologist specializes in the early detection, treatment, and prevention of gum disease as well as other disorders that affect the mouth's soft tissues. They execute Ridge Expansion operations because they are skilled in implant dentistry to prepare the jawbone for implant implantation.
Various kinds of dentists have specialization in a certain area of dentistry. The types of dentists are general dentists, orthodontists, periodontists, oral surgeons, and cosmetic dentists.
General Dentists offer routine examinations, cleanings, fillings, and further oral care procedures. Pediatric Dentists: They are experts in providing dental care for babies, children, and teenagers, including cavity treatment, preventative care, and education on good oral hygiene. Orthodontists are experts in treating dental and facial anomalies, such as crooked teeth or misaligned jaws, with braces, retainers, or other devices. Periodontists are experts in the earlier detection, restorative, and prevention of gum diseases and other problems that affect the soft tissues and jawbones that support the teeth.
Wisdom teeth extraction, dental implants, and reconstructive surgery are all performed by Oral Surgeons on the mouth, jaw, and face. Cosmetic Dentists use methods including veneers, dental bonding, and teeth whitening to improve the appearance of teeth and gums. A Prosthodontist is a dentist who specializes in using bridges, dentures, or other prosthetic devices to repair or restore missing or damaged teeth. Lastly. Endodontists are specialists in the identification and management of issues involving the interior of the teeth, including root canal therapy.
It is important to choose a dentist for a Ridge Expansion who has the education and practical knowledge required to carry out the treatment safely and efficiently. Either conduct some internet research to discover a qualified specialist in the region or contact the normal dentist for a recommendation to an oral pathologist or periodontist who specializes in Ridge Expansions. It's a good idea to study testimonials and look up credentials to make sure to select any of the dentist types with a solid reputation and a history of successful Ridge Expansion procedures.
Is the Ridge Expansion procedure painful?
Yes, the ridge expansion procedure is painful but it is only after the procedure. There is going to be a great deal of discomfort during and after the Ridge Expansion operation because it is a surgical procedure that necessitates creating incisions into the bone and gums. The oral surgeon or dentist undoubtedly takes precautions to lessen the discomfort and agony throughout the treatment. The patient receives a local anaesthetic prior to the procedure in order to make the area around the surgical site painless and to prevent any pain or discomfort during the procedure. The oral surgeon or dentist offers sedative options including IV or oral sedation to increase comfort and relaxation throughout the procedure.
The patient feels some discomfort and agony in the treated area after the treatment. The patient receives advice from the dentist or oral surgeon on how to manage the pain, which involves using over-the-counter or prescription painkillers. They suggest ice packs or other DIY remedies to help with pain and swelling. It is crucial to carefully adhere to the dentist's or oral surgeon's post-operative recommendations to reduce pain and encourage healing. The patient needs to abstain from some meals and activities and needs to keep the treatment site clean to avoid infection.
How long does it take to recover from a Ridge Expansion surgery?
The length of recovery following a Ridge Expansion depends on the patient and the difficulty of the treatment. The full recovery after the operation takes a few weeks. Patients experience some bleeding, oedema, and discomfort right after the procedure. Patients are given detailed instructions by the dentist or oral surgeon on how to treat their symptoms, which involve painkillers, ice packs, and rest.
The patient needs to avoid strenuous physical activity, such as exercise, and stick to a soft food diet, for the first few days after the surgery. Patients need to refrain from smoking since hinders the healing process. The dentist or oral surgeon schedules a follow-up appointment to check on the progress and remove any stitches after a week. The patient is able to resume normal activities, but still avoid anything that put pressure on the treated area.
The bone graft material used in the Ridge Expansion begins to blend with the existing bone tissue over the next few weeks. Maintain good oral hygiene to avoid infection and encourage healing during the recovery period. The entire healing and integration of the implant with the bone generally take many months. The dentist or oral surgeon provides detailed instructions for caring for the implant during the time, and they schedule a follow-up meeting to monitor the progress.
What are the things to do to ensure the recovery after Ridge Expansion?
Listed below are the things to do to ensure the recovery after Ridge Expansion.
- Gargling with warm salt water: It helps to reduce inflammation and promote healing in the mouth. It is recommended by a dentist or oral surgeon as part of post-operative care following dental procedures, such as extractions or implants. It is not a treatment for ridge expansion.
- Brushing: Preventing infection and accelerating healing requires keeping the surgery site clean. Patients receive specific oral hygiene instructions from the dentist or oral surgeon following the procedure, such as using a particular mouthwash or refraining from brushing the area that was surgically treated.
- Flossing: It is a critical factor in maintaining good oral hygiene. It aids to remove plaque and leftover food particles from between the teeth and gums, stopping cavities and gum disease. Flossing alone does not help to expand the ridge. Maintaining proper dental cleanliness helps boost the success and durability of dental implants. It is crucial to follow the dentist's recommendation on how to manage implants, flossing, and other dental hygiene routines.
- Eat soft foods: It is advised to follow a soft food diet during the first few days after the operation to relieve pressure on the surgically treated spot. Avoid meals that are crunchy, firm, or sticky since they aggravate the surgery site.
- Taking antibiotics and prescriptions: Observe the advice on any prescribed drugs. Antibiotics or painkillers are administered to patients to treat discomfort and eliminate the disease. It is essential to take the medicine just as prescribed by a dental practitioner.
Patients need to follow the steps to help ensure a successful dental implant recovery after a Ridge Expansion procedure.
What are the things to avoid after and before Ridge Expansion surgery?
It is essential to carefully follow the directions that were given by the dentist or oral surgeon to get the best results and decrease the likelihood of difficulties both before and after ridge expansion surgery.
Listed below are the things to avoid after and before Ridge Expansion surgery.
- Blood-thinning medications: The dentist advises a patient to avoid certain medications, such as aspirin or blood thinners, as they increase the risk of bleeding during surgery.
- Smoking: It is advised to give up smoking prior to surgery as it slows the body's capacity to heal and raises the risk of infection.
- Alcohol: The patient needs to abstain from alcohol at least 24 hours before the surgical operation.
- Eating and drinking: It is crucial to abide by the dentist's or oral surgeon's recommendations for what to eat and drink prior to the surgery. The dentists instructed the patients to abstain from meals and liquids for a particular amount of time before surgery to avoid difficulties during anaesthesia.
- Physical activity: Patients require to avoid any strenuous physical activity or exercise for at least 48 hours after the surgery as it boosts the threat of bleeding and slows the restoring procedure.
- Eating and drinking: It is vital to refrain from smoking, alcohol, and spicy meals for a few days after ridge expansion surgery. Patients need to eat only soft foods for a few days until the swelling goes down.
- Oral hygiene: Maintaining proper dental hygiene is crucial after the operation, however, patients need to refrain from brushing the treated region for a few days to avoid irritation.
- Medication: Patients are given painkillers or antibiotics after the procedure. It is crucial to adhere to the dentist's or oral surgeon's pharmaceutical recommendations to ensure optimal recovery.
A ridge expansion is a helpful method of making the jawbone ready for restorations or dental implants, but it's important to consult with a qualified dentist to guarantee safety and effectiveness. The pointers help a patient recover from dental implant surgery successfully and comfortably so that the patient takes advantage of the new smile for years to come. Patients anticipate success from dental implant recovery and the advantages of a completely functional and natural-looking tooth replacement with the necessary care and follow-up.
How much does a Ridge Expansion cost?
The complexity of the process, the location of the dental clinic, and the dentist's experience are some of the variables that affect the price of ridge enlargement surgery. In addition, the price differs based on the required level of ridge expansion, the materials utilized, and whether other procedures like bone grafting are required.
Surgery for ridge enlargement costs between £700 and £3000 for each arch in the United States. It is preferable to speak with a dental expert to acquire a personalized estimate for the price of ridge enlargement surgery depending on the particular requirements and region. Dental insurance pays all or part of the procedure's expenses depending on the patient's policy and coverage.
What are the Advantages of Ridge Expansion?
The list below shows the advantages of Ridge Expansion and its example.
Allows for dental implants: Advantage 1
A ridge expansion is an option to make room for dental implants, enabling them to be placed. Dental implants are a common treatment for tooth loss, but they need a specific quantity of bone structure in the jawbone. The area is being created through ridge extension, enabling the installation of dental implants.
John is a 50-year-old man who has lost several teeth due to periodontal disease and asked the dentist if implants are an option.
Improves oral health: Advantage 2
Ridge expansion enhances oral health by enlarging the jawbone. It makes gum disease prevention and tooth cleaning simpler.
A dentist recommends ridge expansion for John to create spaces for implants to improve oral health.
Improves appearance: Advantage 3
Ridge expansion makes a smile look better by giving the jawline a more proportionate and symmetrical appearance.
John's jawbone is widened to accommodate dental implants, which fit securely and look natural, restoring the smile and improving oral health.
Minimally invasive: Advantage 4
Ridge enlargement is a minimally invasive operation that is carried out under local anaesthetic in a dental clinic. No need for a long recuperation period because the operation is pretty short and simple.
John is experiencing pain that is tolerable with the help of the prescribed medicines.
Cost-effective: Advantage 5
Ridge enlargement is comparatively inexpensive when compared to other dental procedures. It is a one-time operation that has the potential to improve oral health and attractiveness over time.
John is happy with the result, even if the cost is a bit expensive. The procedure helps him a lot, especially in boosting self-esteem and leading a healthy life.
A dentist or oral surgeon assesses each situation to identify the best course of action because ridge expansion is not appropriate for everyone.
What are the Disadvantages of Ridge Expansion?
The list below shows the disadvantages of Ridge Expansion and its examples.
Pain and Discomfort: Disadvantage 1
Ridge enlargement is painful and uncomfortable both during and after the treatment. Prescription or over-the-counter painkillers are used to treat it.
Jane recently had ridge expansion for a dental implant procedure. She went through a painful and uncomfortable healing process that made it hard for her to eat and speak. Jane took the medicines prescribed by the dentist to manage the discomfort.
Swelling and Bruising: Disadvantage 2
Some swelling and bruising are typical after ridge expansion. It is unpleasant and does not go away for a few days.
Jane had a hard time dealing with the swelling and bruising in the affected area following her ridge expansion procedure.
Infection: Disadvantage 3
There is a danger of infection during any dental procedure. Ridge expansion, which necessitates bone manipulation, raises the possibility of infection. The risk is reduced by adhering to the recommended post-operative care recommendations.
To prevent an infection that could prolong recovery, Jane followed her surgeon’s advice regarding post-operative care.
Nerve Damage: Disadvantage 4
The operation can harm the jawbone's nerves, either permanently or temporarily. This damage can result in numbness or tingling in the mouth and face.
Jane experienced numbness in her jaw area due to nerve damage during her ridge expansion procedure.
Insufficient Expansion: Disadvantage 5
Ridge expansion occasionally falls short of the intended level of expansion, necessitating extra steps.
Jane was concerned that if the expansion was insufficient, she might need to undergo another procedure.
Cost: Disadvantage 6
Ridge enlargement is costly, even though it is typically thought of as being cost-effective, particularly if other treatments are necessary.
The cost of Jane's procedure was covered by insurance, so she did not have to worry about the expense.
It is crucial to carefully consider the potential advantages and disadvantages of the dentist or oral surgeon before deciding.
Is Ridge Expansion Needed for Dental Treatment Implant?
Yes, ridge expansion is definitely required when doing dental implants. Ridge expansion surgery is done to broaden the jawbone sufficiently to adjust the implant. The bone is sliced, and then it is slowly expanded to form a wider and thicker ridge. Bone grafting elements are added to the extended area to better support the implant.
Ridge enlargement is a common oral operation that is always advised, particularly if the patient's jawbone is not wide enough to hold the implant. It is essential that there be enough jawbone to keep the implant appropriately anchored before it is safely inserted.
Is Ridge Expansion has a high success rate?
Yes, ridge augmentation is a well-known dental surgery with a high rate of success. The patient's oral health, the dentist's experience and skills, and the patient's ability to follow post-operative instructions are all important variables that affect how well the treatment goes. Several studies have revealed that ridge expansion has an implant insertion success rate of up to 95%. The patient's age, general health, and the type and amount of jawbone that is present all have an impact on the procedure's outcome.
A ridge expansion is a safe and efficient method to increase the amount of jawbone space available for dental implants and other restorative dental operations. It is crucial to carefully follow all pre-and post-operative instructions to guarantee a satisfactory outcome. It is advisable to go over the predicted success rate, potential risks, and issues with the dental specialist before undertaking any dental procedure.
It is crucial to discuss any worries or inquiries a patient has about the prospective side effects of ridge enlargement with their dentist. More details on the procedure's advantages and disadvantages are given by the dentist, who assists the patient in making a well-informed choice.