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Embracing Implant Dentistry in Tough Economic Times

Issue: Summer 2010

It is easy to be stressed about open spots in an appointment book that once always seemed to be filled. I have found in my 22 years of practice that, when the economy ebbs, it is a great time to expand the services that you provide to your patients. Taking advantage of the additional time that you have to learn new ways to serve your patients, will decrease the stress of the moment and lead to increased productivity and profitability as you utilize your new skill.

We have been heavily involved in the restoration of Dental Implants and recently chose to learn the surgical aspects of the procedure. Although our plan was to maintain a solid relationship with our Oral Surgeon and Periodontist, our goal was to keep the simpler surgeries in house. As our experience grows, we can pick and chose the cases within our comfort zone. We chose to focus on this area of Dentistry, because unlike many of the routine cosmetic services we love to provide, patients are still very motivated to receive implants. This article looks at 6 factors we have utilized to add implant surgical procedures to our busy restorative practice.

1.) Find a mentor

Although there are many ways to learn new things, nothing will shorten the learning curve, and provide you with more confidence, than a good mentor. I met Dr. Baxter Perkinson before I went to dental school. He was my brother’s Dentist. He was not only the one who encouraged me to go to The Medical College of Virginia, he was the person I did my first full-mouth reconstruction with; the one who encouraged me to study with Pete Dawson; the one who talked me into doing my first lecture; and the one I called when I wanted to learn how to place implants. In short, no one has had a more profound impact on the direction of my career.

A good mentor has to be an expert on the subject you are interested in, and they must have the time as well as the desire to help. Baxter has been involved with the surgical and prosthetic phases of implant dentistry for 30 plus years. He also is a close personal friend, and after a couple of conversations agreed that he had the time and the desire to be my mentor. Even though his practice is in Richmond, two hours away, he was still the best person for the job.

Do not underestimate the importance of this person to the success of your endeavor. Find a person from your past that you have a good relationship with, and is an expert on the subject. If the best person is a few hours away, it is worth a car or a plane ride to have the right experience. I have utilized Dr. Perkinson by going to his office and observing very difficult implant surgeries as well as arranging transportation for him to come to my office and be with me for my first surgeries. Nothing is more valuable than having your mentor next to you for the first several cases, so you will be full of confidence prior to going solo!

2.) Create a timeline and a budget

One of the early discussions to have with your mentor is get an idea of the time as well as the cost involved. The economic impact needs to include the additional equipment you will need, the continuing education required, the training of your team, the travel costs involved with CE/visits to your mentor, and the time away from the practice.

Getting involved with implant dentistry is not cheap. We found, however, that many of the implant manufacturers were extremely helpful in putting together a surgical kit that had all the necessary instruments, the surgical (internally irrigated) handpiece, and a nice supply of implants to get me started. They also created a payment plan to pay this over several months, so that our increased production easily paid for the initial investment.

Time involved for continuing education and visits with your mentor also has to be considered. Keep in mind that your greatest expense is the time away from your practice. If you can arrange your CE and time with your mentor on days your practice is not usually open, it will have the least financial impact on your business. Get a calendar that will allow you to see a full year ahead. First block the days that you need to work. Then put in the days for continuing education recommended by your mentor. Lastly, put the days you will visit your mentor (once a quarter is a good place to start). By doing this you can easily do the training that will be required and still work a healthy number of days. Be patient with the learning process. You need to invest in both dollars and time, prior to seeing the return on the investment. Gaining the necessary skill, will decrease stress, and increase both the predictability as well as the profitability of your newfound skill.

3.) Become an expert at treatment planning and occlusion

There is not another discipline in dentistry that will test all aspects of the Dentist’s knowledge then the placement and restoration of dental implants. Esthetics, occlusion, tooth position, neutral zone, anatomy, flap design, surgical technique, laboratory communication, restoration selection, and business acumen all have to be completely understood. Prior to even thinking about placing an implant we have to be completely clear about where the teeth need to be in space for ideal esthetics and ideal function. Proper implant placement is first a prosthodontic process and secondarily a surgical process.

At The Dawson Academy (www.thedawsonacademy.com) our core curricula is devoted to teaching doctors the process for teaching doctors how to create and sequence optimal treatment plans. Treatment plans should provide both an ideal occlusion and an optimum esthetic result. This kind of analysis is required so that it can be determined if there is even enough bone to do an implant supported restoration. In short, as with all aspects of dentistry, a thorough understanding of occlusion and treatment planning is where it all begins. Be sure to keep this on the list of “must-learns” if implant placement is something you want to pursue.

4.) Embrace technology that allows you to do your best work

Technological advances like Cone Beam Computerized Tomography as well as digital radiography are incredibly important advances when it comes to the surgical placement of implants. Having the ability to see the mandibular and maxillary structures in three dimension is the standard of care when it comes to the planning and placement of implants.

We soon realized that Cone Beam technology takes the guess work out of surgical placement. If we go through a proper treatment planning process and figure out where the teeth go, surgical guides can be created to guide the surgery. Digital radiography, such as DEXIS, which we utilize, is also an excellent adjunct to take instant radiographs after the pilot drill has been used for the initial ostectomy. Verifying that you are in the correct position, space wise, will eliminate problems with poor placement that may happen at the time of surgery. If only the pilot drill had been used, it is simple to correct the angulation issue.

Although you don’t necessarily need to have all the latest technologies within the walls of the practice, if you are going to place implants, be sure to begin by getting a scan on your patient. It is the standard of care.

5.) Create a support team to facilitate the growth

Creating a support team when you are initiating something new in the practice is hugely important. Part of my evaluation of the different implant systems, was the quality of the support on a national, regional and local level. I wanted to make sure that I had direct access to knowledgeable people who were interested in helping me. There are so many parts and pieces involved with implant services that I wanted to make sure I had a representative with me during my first surgeries. Prior to purchasing any system, meet with your local and regional representatives. Find out how long they have been with the company, and ask for recommendations—and check them.

Make sure you have a good relationship with a laboratory. Lars Hanson who works with Bayview Dental Lab, works with me to create the diagnostic workup, reading the CT scans, and creating the surgical guides. I simply cannot do these cases without his help. Remember that implant treatment is a reverse- engineering process. Figure out where the teeth need to go first, then evaluate the bone to see if it requires grafting and, ultimately, figure out the optimum place for implants. The lab can also be a valuable resource on who they think the best implant companies are to work with. The better labs work with these companies day in and day out, they know the ones that will be most helpful.

Sitting down with your Henry Schein equipment specialist is also a good idea. Keeping them up to date on the vision and direction of your practice, will allow them to make the appropriate equipment recommendations. Having a coordinated plan on the timing of technological implementation is critical for the financial health of the practice.

Lastly assign one team member in your office responsible for the ordering and organizing your implant supplies. You will want him/her to be at all the early meetings with the implant company that you choose and that he/she has a good working relationship with both the lab and the representative. Make sure your team is fully on board with this endeavor—it is a big job!

6.) Control your schedule for optimum focus and quality

Once you are ready to implement the new service into your practice, it is often best to do them on days that you are not usually open. Keep in mind that when you are doing something for the first dozen times, you have no idea how long things take. Whenever I am doing something new I will go in on a day that I don’t have hygiene and just to 2-3 procedures of this type. Give yourself lots of time to focus on the nuances of doing it 100% right. If you have the opportunity to photograph the steps along the way, even better, as it will give your mentor the opportunity to coach you. As you and your team get comfortable with the procedure, you can start scheduling it within the confines of your normal day.

When the economy turns south, it always creates anxiety within the walls of every small business. It is important to remember, however, that the economy will always cycle. There will be great years and there will be challenging years. What I have observed is that economic slow downs are the ideal time to invest on the research and development of your practice. Whether it is attending the courses at The Dawson Academy to master occlusion, learning to do molar endodontics, or getting comfortable with the surgical placement of implants. The process is exactly the same. If you follow the six steps outlined in this article, you will soon have a new and productive procedure that you can offer your patients Not only will it ease the pain of the economic slow down but it will set you up for explosive growth when the economy turns around.

Dr. John C. Cranham is an internationally recognized clinician. He resides in Chesapeake, Virginia and has a private practice that focuses on solving complex functional esthetic problems. He is a Clinical Director of The Dawson Academy and as an educator has presented over 750 days of continuing education throughout the world.