Thursday, December 10, 2009

Dental Implants: Marketing vs. Reality


Dental implants are now, the standard of care for tooth replacement, improving dental health of million of people with missing teeth. Implants have also greatly impacted dental economics with increasing number of dental practices and companies offering their services and products. To gain market share, many dental practices advertise dental implants in the newspaper, with mailers, or on the Internet, offering incentives to attract potential patients to their offices. Here are common advertisements:

"Implant for $1,095; Abutment & Crown for $950; We Guarantee Successful Placement!"
"Implants Starting at $995"
"Teeth-in-A-Day"
"One-Hour Dental Implants"
"No Pain, No Bleeding, No Sutures”
“Free implant with purchase of crown”

If these offers sound too good to be true, they usually are. Here is what you need to know before getting burned by misleading advertising.

"Implant for $1,095; Abutment & Crown for $950; We Guarantee Successful Placement!"

This is a very common advertising ploy. It does not tell you the whole story. An implant refers to the post placed in the bone. The abutment is the extension attached to the implant, supporting the crown. Such “special” fees do not correlate with cost of labor and materials for a level of precision and quality that implant supported crowns require. Here is the typical range costs to surgeon and restorative dentists to replace a single missing tooth:

Implant placement related costs to the dentist:
  • Dental Implant (reputable companies with well researched implants): $400 to $450
  • Healing abutment (a temporary extension that sits on the implant): $40 to $50
  • Surgical guide (a stent guiding accurate implant placement): $50 to $150
  • Drills (series of drills in various diameters necessary to prepare the bone for implant placement): $50-$100
Prosthetic (actual tooth) related costs to the dentist:

  • Impression post (to take impression of implant): $40 to $50
  • Implant analog (An implant duplicate used for models): $25-$35
  • Permanent abutment (supports the crown): Customized by lab: $225 to $450; Stock type: $100 to $150
  • Permanent abutment screw (holds abutment on implant): $50 to $65
  • Permanent Crown (made by a quality lab): $250 to $600

And for teeth replacement in the upper front area (smile zone) add:

  • Temporary Abutment (Necessary for support of temporary crown): $125-$175
  • Temporary Crown (Necessary for implants in the smile zone): $125-$175
As you can see, these costs to the dentist automatically add to $1,360 to $1,1950 just for the cost of materials. This does not include the impression materials, accessory materials, and personnel and administrative costs.

It is nearly impossible to offer such fees as $1,095 for an implant and $950 for a quality abutment and crown, and cover expenses for materials, labs, office, staff, marketing, and a leave marginal profit for the dentist. Here is the catch: Dentists employ common “cutting corner” strategies to offer a low fee and still make profit on this procedure.

Cutting Corner Strategies:
  • Placing “no-frill” implants: Implants are titanium posts that are placed into the bone and act as root support for the abutment and crown. There are some generic implants in the market that may cost $95 to $150. The catch: Important characteristics such as titanium composition, machinery, surface type, design, and sterility of these “copy” implants are not well documented. They also have not undergone evidence-based testing or trials. There is little or no literature on their success and healing. Complications such as infections, fractures, non-bony healing, and bone loss may be at increased risk.
  • Use of stock (generic) abutments: The abutment is the extension that is attached to the implant and supports the crown. Stock abutments are manufactured by the implant companies and are available in several standard sizes. These are cheaper than the recommended custom abutments. The catch: Stock abutments do not provide proper form and contour of a natural tooth. The cosmetic results are unpredictable and hygiene may be difficult. Custom abutments have clear advantages and are recommended by every experienced prosthodontist, dentist, surgeon, and laboratory technician.
  • Re-using implant drills that are used to prepare the bone where the implant is placed. Drill’s sharpness, sequence, and surgical technique are crucial to achieve a stable implant with healthy bone and proper healing. To save money, some dentists reuse old drills that have become too dull. This can result in heat damage to the bone, poor healing, and implant failure.
  • Use of inexpensive lower quality labs: It is commonly accepted that work performed by the lab is just as crucial as the work by the surgeon and the restorative dentist for long term success. Laboratory cost can be significant for quality prosthetic work, whether it's a crown, bridge, veneer, or denture. Some labs offer special fees to the dentists for doing the work, like a “$95 monthly special” for the crown. Here is the catch: Quality laboratory work requires careful attention to details, communication with dentist, precision fit, accurate margins, custom angulation and form of the abutment, and artistic porcelain work for a crown that looks good and functions well. All of this takes time and expertise, which is why a quality laboratory charges $225 to $350 just for the abutment and another $250 to $500 for the crown fabrication. The longevity and success of implant supported crowns depends on accurate and high quality work. Non-fitting components and poor quality materials will cause crowns or implants to fail.
  • Not using a surgical guide that is mandatory during placement of an implant for accurate positioning and angle. This requires custom impressions of a patient’s teeth. Next, study models are poured in stone and a guide is fabricated in the laboratory or by restoring dentist or surgeon. Many do not do this because it takes extra time, materials, and lab fees. The catch: While it saves time and money, it frequently results in poor implant placement that can be too close to other teeth, tilted outward or inward, or set too deep. The result is an abnormal looking crown that may be difficult to clean, cause potential gum recession and bone loss, and increase the risk of implant failure.
  • Same dentist placing the implant and the crown: Sounds convenient and nice, but here is the catch: Implant placement and fabrication of a crown are separate disciplines, and it is nearly impossible for any dentist to master both. It takes years of training and experience to place a dental implant. Similarly, in-depth knowledge and skills are required for the prosthetic part of the procedure. Implant dentistry is predictable, but not easy.

"Implants Starting at $995!"

This is the “a-la-cart” approach. Sounds cheap, but here is the catch: Frequently, every aspect of the treatment, component, materials, and services are itemized. This means, you'll probably pay for the consultation, every X-ray, every screw, every part, and material used. And this does not include the crown or abutment. In addition, if something happens and an implant has to be replaced, you'll end up paying for it again. Add this to the money-saving strategies discussed, above and you'll see how it’s offered at low cost.

“Teeth-in-A-Day”

This has become a new craze, and yes, I believe, it’s largely a marketing fad. Teeth-in-A-Day means you have your teeth removed, implants placed, and receive crowns, bridges, or dentures all in one day. Here is the catch: While promising, the current science, knowledge, literature, research, and expertise is not sufficient to achieve predictable results in every individual. The approach may be successful, but only in very few candidates who present with no infection around their teeth, have great amount of bone, and all conditions are ideal. If conditions were this perfect, why would they need to have their teeth extracted to begin with? Many commercial “implant centers” do a hard sell to fit a patient into a treatment plan. Healthy natural teeth end up being extracted in order to place multiple implants and connect them with an immediate prosthesis on the same day! There are some evidence-based studies on this approach, but there are too many variables not yet thoroughly understood. While successful in some, use of this approach in poor candidates results in high rates of failure and implant loss.

"One-Hour Dental Implants"

This is a frequent advertisement and it means absolutely nothing. Every patient is different with varying needs, different complexities, and treatment approach. Even in the most ideal conditions, procedure can take 15 minutes to several hours based on the treatment which can and should vary from patient to patient. Even Domino's pizza no longer guarantees delivery of a pie in 30 minutes or less.

“No Pain, No Bleeding, No Sutures”

Yes, this is possible, but a few things need to occur! First of all, there is always some discomfort with an implant placement, although mild in most cases. A surgery without bleeding or sutures means that a dental implant was placed without an incision and gum tissue flap. This is absolutely possible. But here’s the catch: The team must use a CT-scan for 3-D work-up, and fabrication of a special guide to aid the surgeon for precise implant positioning. I have used this technique many times with great success. It does add to the cost, though, often by as much as $750 to $1000. It is well worth the extra cost if there are multiple implants, compromised bone anatomy, and a need for great accuracy in difficult cases. To have no bleeding or suture, without use of this technology, requires a “blind” implant placement that is difficult and challenging, even in the hands of most skillful surgeons. Even if there is bleeding, it usually stops in a few hours and sutures fall out in few days. I don’t recommend compromising implant positioning and accuracy to avoid slight bleeding and sutures.

“Free implant (with purchase of crown)”

This offer suggests that patients get a free dental implant when they pay for their crown. The '”free” offer is a common marketing tactic designed to hook a consumer into trying a product. This may be all right for marketing a new facial moisturizer, but not for dental implants. Here’s the catch: First it implies that implant placement and the crown are being done by a single ‘super-dentist,’ and as already discussed it is practically impossible for one person to have mastered both disciplines. Also, it suggests possible use of no-frills implants and itemizing all other aspects of treatment to make up for the ‘free’ implant cost. This means you'll pay for every X-Ray, part, piece, visit, replacements, etc. In most instances, you will end up paying more for the ‘free’ implant.

The reality is that implants work. While it’s a highly successful and predictable procedure, it’s not simple, requiring the skills of a trained specialist and restorative dentist working as a team. Implants have a more than 98 percent success rate when performed by the right team of dentists that use quality implants, customized components, and reputable labs. This saves patients money by preventing complications and re-dos, and improving longevity.

The old rule “If it's too good to be true, it probably is” applies to dentistry too. When looking for tooth replacement options, do not fall victim to misleading marketing tactics. Do your research, ask the right questions, and know what you are getting. It’s a lifetime investment and shouldn’t be taken lightly.

In part 2 of this report, we will discuss the right questions patients should ask when searching for implant treatment providers.


Please send all correspondence to:

DC Alliance for Dental Implant Awareness
4825 Bethesda Avenue, #310
Bethesda, MD 20814

hrkazemi@mac.com

51 comments:

  1. It is good that there are dental implants (Lexington) that can substitute lost tooth. You really can't predict when accidents might happen. It is still better that you should add extra care for yourself.

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    Replies
    1. Apparently implants are pretty common to replace lost teeth. That's good to know that they are kind of expensive too. What other options are there for replacing lost teeth? http://www.andresendds.com/what-is-a-prosthodontist/

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  3. Dental implant might seem painful, but sedation dentistry (Raleigh, NC) has made it possible to do procedures pain-free.

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  6. Dental Implant placement usually takes two surgical appointments:

    - During the first surgical appointment the implant site is prepared to receive the implant following strict aseptic procedures. The selected size of the implant is placed in the prepared site. The gum tissue is sutured over the implant. The implant takes 4- 6 months to fuse with the bone.

    - During the second surgical appointment the implant is uncovered and the appropriate post is attached to which the replacement tooth is anchored. An impression of the post is taken and sent to the lab for the fabrication of the implant crown. During this time a temporary crown is placed. Once the final crown is back it is cemented with permanent cement.

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  7. A dental implant is a form of cosmetic dentistry used to replace missing teeth for a look and feel that is natural. They are surgically placed below the gums over a series of appointments..A dental implant is a small titanium cylinder that is gently placed into the bone of your jaw to act like the root of a tooth supporting a crown, bridge or perhaps a special custom-made denture.

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