By Tarun Agarwal, DDS, PA
When was the last time you gave thought to implant treatment through the eyes of your patients? Let's take a closer look at how most implants are being done compared to how they are being done in the 3-D implant practice. Then ask yourself which way you prefer.
Traditional implant workflow
Visit 1 -- Linda is in your office, and the conversation about replacing her missing tooth comes up. You discuss the various options to replace missing teeth, and you both decide to pursue dental implant treatment. Linda asks, "Doctor, can you do that for me?" You say, "We can give you the tooth, but you need to see a specialist to place the actual dental implant." You give Linda a referral and pray she actually goes for the consultation. (By the way, in my office we kept track of this for nearly five years, and only about 50% of our patients went for the consultation and only half of them actually had the implant placed.)
Visit 2 -- Linda takes time off work and visits Dr. Implant for a consultation. Since this was a new office for Linda, she had to search for the office and plan extra time in case she got lost. She has additional radiographs taken and maybe even a CBCT taken. Dr. Implant does a wonderful job of educating her about the wonders of implant treatment, and Linda decides to proceed with treatment. She leaves with a treatment plan for the implant fixture, but is a bit confused about whether this is for the total treatment or just the surgical part of treatment.
Visit 3 -- This time Linda takes the entire day off work and visits Dr. Implant for surgery. Everything goes extremely well.
Visit 4 -- Linda takes time off work again to visit Dr. Implant for a 10-minute follow-up visit to make sure everything is proceeding well. While this was only a "quick" 10-minute visit for Dr. Implant, Linda had to take nearly two hours off work -- leaving 45 minutes before her appointment to be on time, the actual appointment, and the 30-minute drive back to work.
Visit 5 -- Linda takes time off work again to visit Dr. Implant for her final evaluation of the implant and to have the implant uncovered and the healing abutment placed. She is instructed to return to your office in four weeks for her new crown.
Visit 6 -- Linda takes time off work again to visit your office to finally get her tooth. To her surprise she isn't there to get her new tooth, but to get a gooey impression taken to have her crown made. An even bigger surprise (of course, this isn't the case all the time) is that the fee she paid Dr. Implant didn't cover the tooth for her implant. You reassure her that you clearly discussed this at her initial visit some six months earlier, and proceed to stuff her mouth with impression material. This is assuming you have the necessary components to take her impression. If not, Linda needs to return for another visit for the actual impression.
Visit 7 -- Linda takes time off work again to finally have her implant restoration seated. If all has gone well (the case actually shows up and was made properly), you deliver Linda's shiny new implant restoration. Linda is elated, gives you a hug, and goes back to work. As you're thumping your chest, you glance over at the lab box and realize the lab bill was double what you anticipated because the implant wasn't placed perfectly and a custom abutment was necessary, and all these extra line items that go with implant restorations from the lab. You now barely broke even (take lab bill and chair time into consideration) and think to yourself how lucky Linda is to have found you to do this case for her.
Please understand there is some sarcasm in the sequence of events above. But it's not too far from the truth, and certainly the timeline is pretty darn accurate. So, to recap -- Linda needed seven appointments over a six-month period, asked her boss to leave work six times and took off one entire day, and needed to see two different dentists to replace her missing tooth.
I don't know about you, but if one of my team members asked me to take time off work seven times in six months, I'd likely tell him/her just to take a permanent vacation!
Digital implant workflow
Let's now take a look at the sequence of treatment in a finely tuned digital implant practice.
Visit 1 -- Linda is in your office and you discuss implant treatment to replace her missing tooth. After reviewing all the options, you both agree to proceed with implant treatment. Since you do both phases of treatment (surgical and restorative), you go ahead and capture all the necessary records -- CBCT and models. You or a qualified team member go over treatment procedures and finances with Linda, and she is appointed for her next visit, implant placement.
Visit 2 -- Since you are using guided surgery, there is less cutting and thus less postoperative swelling. For this Linda doesn't need to take off the entire day. You give her local anesthetic and guide the implant into place in about 30 minutes of her walking into your office.
Visit 3 -- Linda takes time off work to visit your office for a quick postoperative check to verify everything is progressing nicely.
Visit 4 -- Linda takes time off work to visit your office. Since your office uses CAD/CAM, you are able to uncover the implant, take a digital impression, and fabricate/deliver the final abutment and restoration in a single visit. Of course, this visit is longer than visit three, but Linda doesn't mind as she doesn't have to take more days off work.
Linda is already finished with treatment. There wasn't any confusion as to the cost of treatment since you were the single treating dentist. Linda didn't need to travel around town to see a second dentist she'd never met. I could go on, but I hope you're starting to see the point. I don't know how many of you have ever truly given thought to this process, but it's easy to wonder why patients ever go through with implant treatment under the traditional model.
Implant treatment isn't going away. In fact, it is growing in popularity! You may think you have no interest in learning to place implants because you work with a great specialist. But the day is here when Linda just googles a dental office that can do all of her treatment. You've lost not just the implant fixture, but the restoration as well. More importantly, you've likely lost Linda, her family, and her friends as patients for life.
Don't get left behind. When you get left behind, your patients suffer. When your patients suffer, your practice suffers. When your practice suffers, your family suffers. Take the time to educate yourself about modern implant dentistry. Your family, practice, and patients will be better for it. If there is anything I can do to help, please feel free to contact me.
Tarun Agarwal, DDS, PA, is a nationally recognized educator in the field of digital esthetic and implant dentistry. He offers general dentist-specific implant training using modern digital technologies that make implant dentistry safe, predictable, and profitable. He may be reached at [email protected].
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