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Dental Implants in the Dental Practice, Part Two

Issue: Fall 2009
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In this article, I will illustrate the bottom-line effects of providing this high level care – namely, profitability.

 As you may recall, there are two types of potential implant patients: those who are already missing teeth and those who will be missing teeth. Patients who are already missing teeth desire a more secure restoration, possibly even a fixed restoration. The novice implantologist may believe that unpredictable implant sites, more difficult diagnosis, and more demanding treatment plans–as well as the continuing education needed to perform the necessary treatments–will offset the increases in production associated with these types of cases, thus making them too difficult to complete in a profitable manner.

Tooth #30 has been endodontically treated, hemisected, and treated with individual crowns on each root.  Note the lingual fistula on the mesial root.

However, a lower denture secured by two implants with Locators is certainly within the novice’s scope of care. These straightforward cases help build confidence as well as provide great patient satisfaction if they are “sold” with the proper expectation of securing a lower denture. The added production of implant placements, abutments, and denture construction is easy to add up. Lab costs are low for this type of procedure. And once the dentist becomes proficient at these types of cases, chair time is also reduced, further bolstering the bottom line.

Let’s consider cases on patients who will be missing teeth. These are the cases that a new implantologist can reasonably and predictably undertake early in the development of their implant training, the simplest example being the replacement of a single missing tooth. Let’s look at the three possibilities for tooth replacement from a production standpoint, using average fees in my area of the country.

Option 1 is a removable partial denture for $1,500. Option 2 is a traditional three-unit bridge at $3,000 (two retainers at $1,000 each, plus a pontic at $1,000). Option 3 is a single tooth implant for $3,284 (implant placement $1,822, abutment $462, and crown $1,000).

Quadrant after extraction of #30, socket augmentation and implant placement.

The implant offers an increase of $284 in gross production over the three-unit bridge, which is no big deal. However, you have provided a better and more permanent solution for your patient. Note that this example assumes that no extraction is needed, no site preservation is needed, there is good bone both vertically and horizontally, and adjacent teeth are not in need of restoration–essentially a perfect situation! This rarely presents itself in my practice. So, let’s consider a more realistic example, specifically the case that was presented pictorially in the last article. You may remember the “tired” molar that was failing with a fistula and hemisected roots. In that case, the patient would not entertain any removable solution, so I presented her with these fixed solutions for comparison:

Option 1: Traditional Three-Unit Bridge, $3,319 (including extraction at $121, two retainers at $1,000 each, pontic at $1,000, plus core build-up for distal retainer at $198). Option 2: Single Tooth Implant, $4,753 (including extraction at $121, site preservation $150, implant placement $1,822, abutment $462, crown $1,000; plus core build-up $198 and crown $1,000 to restore distal tooth).

Option 2 increases gross production by $1,434, or 43%! Now that is worth talking about! But perhaps more important is that you are offering your patient a better solution–one that is more permanent, offers better function, doesn’t result in bone loss over time, and won’t have to be replaced in five to ten years.

You may be thinking that you’d like to treat these types of cases, and understandably so. The allure of providing the “New Standard of Care” is a strong one. But how do you know when to treat ANY case, let alone a more difficult one? The answer truly lies within the numbers. How much production per hour do you need to produce to meet your practice’s goals? How long does it take you to complete the procedures that we are discussing? Are you willing to not produce at the levels you need to for the sake of learning a new procedure? Once you answer these questions, you will be better equipped to make a decision based upon objectivity and not surmise.

If you add implantology to your practice–perhaps doing the simple, straightforward cases yourself, and continuing to refer out the more complicated cases– you can benefit your patients and benefit your practice’s bottom line. For most dentists, that’s why adding implant dentistry to the practice makes “sense” as well as “cents.”

Mark A. Iacobelli, D.D.S., graduated from Case Western Reserve University School of Dentistry in 1982. Since then, he has achieved and maintained his Fellowship with the Academy of General Dentistry by completing numerous hours of continuing education. This continuing education has been highlighted by completing multi-year programs in orthodontics, neuromuscular and TMD treatment for jaw and head pain, aesthetic, and cosmetic dentistry, implant placement and restoration, and a one-year program for conscious sedation (intravenous anxiety control) with Advanced Cardiac Life Support. In addition to being recognized by The Straight Wire Orthodontic Studies Organization for his commitment to continuing education for orthodontics, TMD treatment, and neuromuscular dentistry, he has also received his Fellowship from the International College of Dentists and The Midwest Implant Institute. Dr. Iacobelli is on the board of directors of the Midwest Implant Institute Fellows, and maintains a private practice in North Royalton, Ohio.

Find Part 1 of Dr. Iacobelli’s article online at www.sidekickmag.com.

 Learn more about the techniques discussed in this article by attending an Introductory Implant course sponsored by Henry Schein and Camlog. Dr. Iacobelli and other clinical educators offer courses nationwide to increase your knowledge of Implantology. Contact your Henry Schein Dental Field Sales Consultant for more information.