The question of whether you should incorporate implants into your dental practice is not a difficult one to answer. In a nutshell, it is a resounding yes! But “In what way?” is the more difficult one. What I mean by this is, should you only restore or should you place and restore?
All practices should offer and restore dental implants. It is the best treatment for an edentulous space and should be part of the overall treatment options presented to a patient.
WHY PLACE IMPLANTS IN YOUR OWN PRACTICE?
In the United States, the dentist population is growing slower than the implant market,1 and the penetration of implants is rising 25% to 35% (Straumann proprietary study based on approximately 5,000 respondents, conducted by AFG Research in 2011).
Let’s look at the statistics:2
- 210,187 dentists in the United States as of October 2015
- By 2020, 73% will be general practitioners (GPs) = 153,436
- 18% to 20% of all US dentists place implants = 39,392
- Dentists place 55 to 60 implants per year on average
- That totals 2,245,344 implants placed per year
- United States to hold 25% of the world implant market.
The global dental implants and prosthetics market is forecasted to grow at a compound annual growth rate of 5.35% during 2016 to 2021, driven by rising adoption of implants by dental clinics, increasing inclination of the adult population, growing cosmetic dentistry and technological innovation.3
What does this mean? Well, it means that by incorporating implants into your practice, the opportunity is there to be busier than you ever imagined.
MAKING THE DECISION A REALITY
Why should you do it? The most common new procedure that the GP is bringing into the general practice office is implants (Figure 1).4 This treatment, which has been historically the domain of the specialist in the United States, is now a part of most GPs’ repertoires.
The following are a few reasons why you, as a GP, should consider placing your own implants:
- Make dentistry more fun
- Keep the patients in the office and provide a needed service
- Take advantage of huge number of potential cases
- Increase profitability of your office
- Place implants so they can be predictably restored.
These are all very important and pertinent reasons that should convince you that incorporating implants into practice is a good decision. You first must decide whether this is really what you want to do. Implants are not something that I would recommend going into half-heartedly. Look at your practice. Are you already too busy doing conventional dentistry? If so, let someone else place your implants while you keep going in the direction you are. I do not recommend just dabbling in this arena. If you do this type of treatment infrequently, you will not only take a long time to develop your skills, but it will feel like starting over every time you do a case.
To be successful, the clinician must do the following:
- Have an adequate and proper skill set
- Find a good implant system
- Get and continue postgraduate education
- Get experience placing implants
- Have a strong commitment to make implants an important part of your practice.
Skill Set
Any dentist who graduated from dental school and has passed his or her national and state boards should have all the skills necessary to incorporate implants into the practice. Now, as with any potential type of treatment in dentistry, there are varying levels of case difficulty. However, every dentist is capable of successfully placing implants in straightforward cases. The mechanics of cutting 2 abutment teeth to achieve a common path of insertion for a 3-unit bridge is more complex than the placement of a single implant in a fully healed edentulous space. The key to this easy predictable placement is properly treatment planning the case with appropriate radiologic and clinical exams.
A Good Implant System
Let me begin with the fact that all implant systems work. There is not a single system on the market today that does not work. Just about all of them are made with the same titanium alloys, use a limited number of proven surface treatments, and are all sterile. Anyone who puts one system down as not being successful is just trying to sell a specific system.
The differentiating factors among systems come down to a few key points, and these are the questions you should ask. Does the system’s surgical protocol follow sound principles and work in your hands? It is usually instrumentation and/or prosthetic accuracy and complexity that lack from one system to the next. Is the system manufactured in an ISO-certified facility? Are there quality control mechanisms in place to help ensure that you do not get any unpleasant surprises during the surgical or restorative phases of treatment? Is the system that you are going to use backed by a reputable company that provides great customer service and will be around to support you in the future, should you need assistance? Never forget that you are establishing a long-term relationship in this doing implant work. You will place implants into your patient and your patient will likely be your responsibility for a long time, so make sure the manufacturer you go with is one that you have vetted with the questions posed above.
Gaining Knowledge to Start and Ongoing Continuing Education
Every day we are all bombarded with advertisements via magazines, mail, and email for courses presented by implant companies and a variety of independent practitioners/lecturers. Education is a never-ending, long-term process. Start out by getting a basic education from one of the many reputable implant companies, and then start placing implants. You will quickly find out where you are lacking in education and will be able to spend your money wisely to address any remaining deficiencies. Another option is to find (or hire) a mentor to work with you. This type of one-on-one mentoring can speed up the learning process and flatten out that potentially steep learning curve.
As the saying goes, “There is safety in numbers,” and, in that spirit, organizations such as the International Congress of Oral Implantologists and the American Academy of Implant Dentistry can be other fantastic resources to further your education. Get involved, decide whether getting your fellowship or mastership is for you. This process not only makes you invest a bit more time into your education, but gives you even more credibility when presenting implant treatment to your patients.
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| Figure 1. Implants are the No. 1 growth area for general practitioners.4 | Figure 2. Specialized drilling unit for implants (Aseptico). |
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| Figure 3. A mobile unit/cart (Aseptico) can make your life easier. | Figure 4. Implant surgical kit (Hahn Tapered Implant System [Glidewell Laboratories]). |
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| Figure 5. Surgical instrumentation (a variety of instrument manufacturers represented here). | Figure 6. Cone beam unit (Vatech America). |
Get Real World Experience
Experience, in and of itself, does not necessarily make one a better practitioner in the way one might think. What it does is give us the skills to address clinical situations that are not perfect and still succeed. You will never get better at anything unless you do it over and over, and the placement of dental implants is no different. You need to do cases to not only to get quicker and more accurate, but you need to do cases to address and identify the need for more education as previously stated. Think about your ability to cut your first crown preparation in dental school compared to how you do it now. You have likely gone from a 3-hour appointment, filled with apprehension and uncertainty, to a routine procedure with much less stress thattakes less than an hour. Now, this is not to say that you will not be nervous with your first (or first few) implants, but that will quickly pass.
Commitment to Implants
Not only do you have to be 100% committed to incorporating implants in your practice, but so does your dental office team. You must be diagnosing and treatment planning for implants with complete confidence and with a patient’s specific needs in mind, knowing it is the optimal choice when indicated. If you are wavering or floundering at all, your patient will immediately sense your discomfort and you will most likely not be placing many implants.
Your dental office team is even more important when it comes to getting your patients to say “yes” to any treatment in your practice. You may think of yourself as The Big Kahuna in your office and, in fact, you are the doctor; however, patients view the suggestions and opinions of your dental office team differently than yours. They look at you as the expert, the dentist, and even though they know you are healthcare provider, they also know you have a direct stake in whether they accept or deny treatment. In other words, their treatment directly puts money into your pocket and this sometimes can be a negative factor in case acceptance. This is human nature, and it is the reality. Your team members are viewed as individuals who do not have a direct stake in the outcome of the treatment planning decisions, so the natural trust level can be higher.
Your dental office team, especially your hygienists, have a captive audience for 45 minutes to an hour and are the perfect people to discuss the benefits of dental implants along with selling other treatment. The clinician needs to invest in the time and money to also get the entire team properly trained. Take them with you to your implant courses. Take the time to teach them what you know in your own office. Get them excited not only about what you want to do, but what a great service this is for the patients.
Now that you have decided to jump into the implant arena, what is it going to do for you, and what will it take?
What Do You Need to Place Implants?
If you choose to provide complete dental implant treatment options from surgery to restoration, then there a few things you will need to consider, and processes that you will need to put into place (Table).
A question that I’ve received numerous times in the past 10 years of working with doctors has been, “Do I need to invest in expensive equipment to do implants?” The simple answer is no. Certainly, one must make some financial commitments, but the return on investment is almost immediate. Let’s start with a surgical system and motor. I highly recommend having a dedicated surgical motor when it comes to placing implants (Figure 2). This will ensure that you will have a sterile water supply and a handpiece that is specifically designed for implant procedures. If you are running electric restorative handpieces already in your office, then it is possible to just get a 20:1 implant handpiece. However, if there is not a way to run a sterile water supply, this will not work. Get a cart that will hold your drilling unit so you can roll it from operatory to operatory as you get busier (Figure 3).
You will need a surgical instrumentation kit that is specific to the implant brand you settle with (Figure 4), along with a restorative kit, some surgical instruments (Figure 5), and a small inventory of implants. If you are just starting out, this investment will run you between $5,500 to $10,000, depending on the system you choose. If you already have a surgical drilling unit, then it will cost around $3,200 to get into a system with surgical and restorative kits, along with a selection of implants. With the average dental implant treatment in the United States running approximately $3,000 to $4,000 per tooth (from start to finish), you can plainly see that it does not take long to recoup your investment.
Do you need a CBCT machine? The good news is that the cost of these machines has decreased dramatically in recent years. It is now possible to get a machine that can take a panoramic radiograph and a 3-D scan for around $55,000 (Figure 6). I will have to admit that CBCT has huge advantages when treatment planning and facilitating implant treatment, but at this point it is not standard of care and may never be classified as that. (I am not going to go into the long discussion that could ensue over the legalities of CBCT exams.) I currently scan all my patients, and I would never go back to placing implants without this technology. Remember though, millions of successful implants have been placed around the world without the use of a CBCT, and you can do it too. I did it for the first 14 years in my own practice. If you take good 2-D radiographs, ridge map intraorally, and treatment plan conservatively, it is possible to safely and predictably place implants without taking a CT. It should be noted that the option to get a CBCT exam for any patient is easy if you do not have or want one. There are radiologic labs that can do it for you and there are likely specialists in your area that likely offer this service at a nominal charge.
Finding the First Patients
So, you have made the decision to jump in, and you have purchased your instruments and implants. Now what? Who will be the “guinea pigs”? Well, they are all there in front of you, if you know where to look.
An excellent source of first patients is your own dental office team members and their families. The additional bonus of doing an implant on one of your staff members is that they will instantly become first-person advocates within your practice. Nothing sells a treatment faster than your assistant saying, “Our doctor did an implant for me 3 months ago and it was a piece of cake. You should do one too.” This kind of advertising is priceless and works extremely well. Their family members are good options too, as they will be very relaxed since their son or daughter (employee) has trust in you. Your own family members are also a good source too, but remember that if it does not go right, you might be reminded of it every Thanksgiving for the rest of your life!
Comb through your existing patients for those you can reward or those who always wanted an implant but could not afford one. Give them a break on the cost and they will not only be appreciative, but they will become a great spokesperson for you and your practice for years to come.
CLOSING COMMENTS
Surgically placing dental implants is a straightforward procedure for the most common cases one will encounter. Local anesthesia is easy to accomplish, making this a painless procedure for the patient. And, with proper treatment planning and proper instrumentation, it is a relatively quick procedure; a clinician can surgically place a dental implant much faster than doing a crown preparation, an endo procedure, or MOD composite resin restoration.5
As the GP, you will be in complete control of the cases you wish to take on and you can always refer out the cases that you do not feel comfortable tackling. This is the beauty of being a GP. As with all other aspects of dentistry, there is always a specialist that you can utilize for the cases that are beyond your comfort level. Develop good relationships with your specialists and, if they are not supportive, find specialists who are.
Your patient may need a sinus augmentation prior to implant placement, and if that procedure is not within your comfort level, then there is no shame in referring the patient out to have the augmentation. After the site heals, you will place the implant. Know that it is important to be honest and straightforward with your intentions and treatment plan when referring and communicating with your specialist so there are no misunderstandings as to whom will do what.
In closing, I truly believe that placing implants can be one of, if not, the most rewarding aspects of your dental practice and can transform your own career very quickly. Now is the time to take that step and never look back.
References
- ADA Survey Center. 2010 ADA Dental Workforce Model 2008-2030. Chicago, IL: American Dental Association; 2010.
- Achermann G. How will dentistry look in 2020? Presented at: Capitals Markets Day; May 16, 2012; Amsterdam, The Netherlands.
- Dental implant and prosthetics market—5.35% CAGR forecast to 2021. RNR Market Research. May 11, 2016. prnewswire.com/news-releases/dental-implant-and-prosthetics-market—535-cagr-forecast-to-2021-578922011.html. Accessed January 30, 2017.
- Akel M. Specialty care in the general practice. Decisions in Dentistry. November/December 2015;1(2):64. decisionsindentistry.com/article/specialty-care-in-the-general-dental-practice.
- Malcmacher L. Why don’t general dentists place more implants? Dent Today. 2013;32:8-10.
Dr. Schlesinger, a graduate of The Ohio State College of Dentistry (1996), is a Fellow of the International Congress of Oral Implantologists. He completed a general practice residency at the Veterans Administration Medical Center (VAMC) in San Diego and then became the chief resident at the VAMC in West Los Angeles, completing extensive training in oral surgery, implantology, and advanced restorative treatment. He then maintained a general practice in San Diego focusing on restorative and implant dentistry. In 2012, he relocated to Albuquerque, NM, to become the director of education and clinical affairs for OCO Biomedical. In 2013, he took over as chief operating officer along with his clinical responsibilities. In 2016, he left OCO Biomedical and founded The CD Schlesinger Group to help practitioners gain knowledge and experience with implants and became a key opinion leader for the Hahn Implant System. Additionally, he continues to provide comprehensive implant care to patients in a private practice setting in Albuquerque. He can be reached at cdschlesinger@gmail.com or by visiting thecdschlesingergroup.com.
Disclosure: Dr. Schlesinger is a key opinion leader for the Hahn Implant System (Glidewell Laboratories).
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