Can the average dentist afford to do quality implant dentistry? In terms of time and technique, it might be more expensive than some clinicians imagine. I contribute to a 15-day course that provides information to general dentists who wish to place implants. It covers all facets of implantology, from case evaluation through fabrication of final restorations and maintenance. The course emphasizes a precise, step-by-step approach, and one of the main goals is to give attendees the tools to identify patients who are appropriate for their level of clinical expertise. In practice, the multistep process we teach requires an investment in chairtime and effort, and thus adds to the cost of therapy.
PROVIDING QUALITY IMPLANT THERAPY IS DIFFICULT AND TYPICALLY REQUIRES CONSIDERABLE TIME, EFFORT AND EXPENSE
I also lead a study club for general dentists who place implants. At one of our meetings, a dentist approached me, saying she wishes to do quality implant dentistry, but wants to make it economically feasible for her patients. By the time she does an appropriate workup, radiographic template, cone beam computed tomography (CBCT) and surgical template, the patient’s insurance (assuming the procedure is even covered) is often used up. She says that when patients are told about the cost of treatment, they often refuse to move forward.
Naturally, it’s frustrating when patients are unable to accept therapy because of economic constraints. In an effort to reduce costs, this clinician has been using a discount mobile CBCT service that exposes the tomogram and helps with digital planning. She asked if I would review a CBCT and digital plan provided by the company for an implant in the mandibular first bicuspid position. The scan was of poor quality and difficult to read. Unfortunately, the recurve of the inferior alveolar nerve mesial to the mental foramen frequently seen in this area had not been traced. As a result, the proposed implant placement likely would have resulted in nerve damage. When I inquired what training the individual helping plan the case had received, the dentist was unsure, and said she used the service only because it was less expensive than others.
Additional attempts to reduce costs included use of a so-called “value implant.” When asked about the criteria for choosing this system, the dentist replied that some colleagues had used it with good short-term results. A literature search, however, failed to turn up any longor short-term studies supporting this particular system. In addition, the implant was coated with hydroxyapatite, which has shown mixed long-term results in previous studies — yet the clinician was unsure about the pros and cons of this particular coating.
What is the takeaway message? First, providing quality implant therapy is difficult and typically requires considerable time, effort and expense. Compared to other approaches, however, it usually produces better long-term outcomes. Although containing costs for the patient and practice is an economic reality, clinical decisions should be based on scientific data and applications of appropriate planning and placement modalities. Barring this, patients, providers and outcomes are at risk.
Thomas G. Wilson Jr., DDS
Editor in Chief
From Decisions in Dentistry. March 2017;3(3):8.