Implant surgery not wise for most dentists

I have just read Dr. Christensen's response to the general practitioner who wanted his advice concerning implant surgery (September Dental Economics).

I have just read Dr. Christensen's response to the general practitioner who wanted his advice concerning implant surgery (September Dental Economics, page 118). I know that disagreeing with Dr. Christensen is tantamount to heresy, but I want to make some points that were overlooked in his rather simplistic answer.

First, I understand that we all, generalists or specialists, have a point of view from which we come in response to any question. Having placed more than 3,000 implants, I have had very few that went exactly according to the textbook examples given by the experts who give the implant courses. Of course, there are easy ones, but somehow I never know which ones they will be.

Dr. Christensen fails to explain how often a ridge that looks perfect before the flap is, in reality, knife-edged or smaller than expected. This requires ad-libbing and often the use of under-stocked implant sizes or CT scan information, as well as bone grafting with or without membranes. Implants never fail to provide surprises that require confidence gleaned from repetition and a great deal of experience.

I am sure he is correct (isn't he always?) in his legal assessment regarding the chances an inexperienced dentist has for a lawsuit. But just one permanently anesthetized or damaged patient is all it would take to change that. Dr. Christensen is, I am sure, a highly skilled practitioner. But his advice is, in my opinion, dead wrong for the majority of dentists who do not do surgery on a regular basis. It is, at best, overconfident; and, at worst, very dangerous.
Jeffrey Meltzer, DMD
Fayetteville, N.Y.

Formula for locating a practice

"Where should I establish my practice of general dentistry?" This important decision may be a life-long commitment affecting job satisfaction and ultimate happiness.

Many personal factors other than geography enter into the decision. Those factors vary with each individual and many are difficult, if not impossible, to quantify in a mathematical formula. Financial potential, however, can be numerically addressed by such a formula.

Taking into consideration that some people can achieve financial success regardless of the situation, the rest of us need the benefit of every consideration possible.

The formula for financial potential in a given area takes into consideration one's desired net pre-tax income. For example, if the desired income is $125,000 per year, it is possible to know what is necessary to produce $125,000 net income.

We know that about 60 percent of the population seeks dental care each year. The annual expense incurred per patient is about $180. If we know the number of dentists practicing in the area and allow for an average reasonable overhead expense of 60 percent, it is possible to determine the potential for obtaining the desired income in a particular geographical area.

Most of the figures in the equation are readily obtainable and can be influenced by the individual dentist. This figure of annual expenditure per patient is a statistic of an insurance company which insures a large number of middle-income clients. In this example, the analysis of an area would be:

Expenditure per patient ($180) x population (100,000) x percent who visit dentist (60 percent) x percent of production less overhead (40 percent) divided by number of dentists in the area (50).

$180 x 100,000 x .6 x .4 ÷ 50 = $86,400 average potential for an average dentist in a population of 100,000 and 50 dentists. If $125,000 is the goal, one must have lower overhead, above-average production per patient, or see more patients.

You cannot change the population, but you can locate in an area where the ratio of population to dentists is different, or you could increase the expenditure per patient, reduce overhead, or get a larger share of the available patients.

At least with a formula to work with, one can focus on specifics in making important decisions concerning the desired type of practice and its location.
Bill E. Taylor, DDS
Enid, Okla.

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