Implant dentistry: An economic perspective

May 1, 2011
Is it time to get in or time to get out?

Is it time to get in or time to get out?

by JoAn Majors

For more on this topic, go to and search using the following key words: treatment options, implants, edentulous, continuing education, team, JoAn Majors.

I find that getting into or out of implant dentistry is on the minds of many dentists.

I am on the road a lot of the time, talking with many clients, visiting dental practices and presenting to doctors and teams at conferences, dental meetings, and study clubs. Everywhere I go in our industry, it seems I am asked, “Is implant dentistry the right move to make for my practice?”

On first blush, implant dentistry may seem a no-brainer for an ambitious doctor and team. It’s a high-end service, especially for the well-qualified patient who can afford it and who can repeat and refer more implant business. So, financially speaking, there is indeed great reward potential. In addition, there is the wow factor.

For the edentulous patient, whether partial or total, implants can produce highly satisfactory results that are nothing short of miraculous. After all, you are replacing what nature took away with a man-made root that adheres to the jawbone and becomes stronger than anything nature could have produced in the first place.

For any patient, but especially one over 60 — that is, a baby boomer who knows that health follows a downward spiral with age — this spells hope. For many, the transmission of hope is part of the mission of the practice. Hope, you might say, is the best of what we give and what we give the most.

The importance of satisfied patients

There is no question that being around happy, hopeful, satisfied patients who love what you can do for them makes it fun and inspiring to go to work in the morning. Inspired patients certainly can have a positive impact on your team, and that matters a great deal because the dental team member is so often the first line of contact for a patient.

I don’t just mean while you’re at the office, on the phone or in the treatment room; I mean when you are at the softball game, school concert, church picnic, and in the supermarket check-out lane. Team members — not doctors — are the ones that the public sees as less frightening and more approachable, especially about something new or unknown.

We are the ones patients will often direct their questions to. Often, our answers are not only repeated verbatim, but some patients swear that the words came directly from the doctor’s mouth. Because an implant, unlike a crown or a bridge, can be more of a “want to” than a “have to” service, it really needs to be described, discussed, and offered in the beneficial manner it deserves.

That’s why so many practices make the investment more manageable by offering CareCredit® patient financing. As a result, most team members become a meaningful part of the education of implant patients. For the doctor and dental team that communicate well and have a deep rapport, implants can really build a sense of teamwork.

Which practices benefit from implant dentistry?

So it’s natural to think that the scales are tipped in favor of every practice adding implant dentistry to its treatment options. However, we really must look closer because every apparent benefit also contains the seed of its potential opposite.

Let’s start with the young, ambitious doctor looking for ways to stimulate practice growth. If cashing in on the latest or most expensive procedure is the motive, adding implants to your treatment options is not a very good idea. Implants can be challenging on all levels, in spite of what some folks say. I know because I go to dental meetings, too. To hear some tell it, it can certainly feel like you are missing out on the gravy train.

Many doctors at these gatherings speak up, but they don’t always tell the whole story. They don’t want to risk looking looking bad or foolish. Well, that can be contagious. After hearing from some beaming doctor about his added production numbers with implants, the scientist-detective in us can drop our guard. Since we don’t want to risk looking bad or foolish, we don’t think to ask basic questions such as, “How long did it take before you stopped struggling and made an actual profit?”

We’re often too overwhelmed by a doctor’s alleged success to find out that these numbers may actually be the result of many years in the trenches. Nevertheless, just because most won’t acknowledge publicly that the results vary, we still need to ask. For the record, the answer — as with any investment of time, money, and talent — has a lot to do with a commitment to excellence and a willingness to learn.

As for creating inspired patients and a dental team with excellent communication skills, those values need to be in place before you can expect favorable outcomes. Positive results are not automatic just because you perform implant dentistry.

I underline this obvious fact because I’ve been on site with teams where as many as six different implant systems sat neatly on the shelf collecting dust. Often, the doctor is waiting for something — a different team, a “perfect system,” an ultimate service rep, or the most complete technical course. In the meantime, of course, nothing much is happening.

The inexperienced dental team, often lacking both the technical training and the training on the soft side of implant dentistry (that is, the people skills), can unintentionally turn patients off to the procedure. It’s particularly a shame when patients, who are already full of misunderstandings and apprehensions about this expensive option, only become more confused. It turns out that many of those misunderstandings begin in the dental office.

Determining return on investment

Regarding return on investment, the leader should know just how much of a financial investment is involved ahead of time. Since implant dentistry is a team-driven, patient-centered procedure, there is the reality of the entire dental team’s learning curve to consider. Moreover, when costs are high and training extensive and spread over a long time, things can get lost, tabled for later, or they just fall through the cracks. Halfway through the course or almost to certification doesn’t count!

New team members need to be trained and attitudes may need to be adjusted to see that everyone crosses the finish line together and on schedule. Never underestimate how huge a commitment this is for everyone on the team.

With all due respect, implant dentistry is not like offering a new prep technique; it is a huge investment of time, money, dedication, and patience. Teams who have a doctor who received training at a nationally recognized surgical or prosthetic curriculum, purchased a system with a proven track record, and who has strong representative support are more likely to understand the investment needed to achieve some level of success with implants.

Furthermore, the actual technical training continues to evolve. Many of the best lecturers over the last decade have changed their positions on different treatments and implant designs due to new case studies. The literature on this procedure is changing exponentially, thanks to the Web.

The importance of continuous learning

Here’s what international lecturers and implant authorities are sharing about continuous learning:

Dr. Carl Misch of the Misch International Implant Institute says, “To stay adept, I remind my attendees of G.V. Black’s statement to be continuous students. Though most of the benchmark material in my course does not change significantly from year to year, it may come as a surprise to some that I update each lecture prior to its presentation. There is just a wealth of new information coming in from research as well as my own clinical experience.”

Dr. Michael A. Pikos of the Pikos Implant Institute notes, “I constantly emphasize the importance of ongoing CE to my course attendees, as the half life of our noncore material is less than three years. A total commitment to learning is needed to develop the knowledge and skill set required to avoid, minimize, and treat clinical misadventures. This, in turn, allows us to provide safe and optimal patient care.”

Discussing the role of the team, Lynn Mortilla, executive director of the Association of Dental Implant Auxiliaries (ADIA,) writes, “Extensive research and new technologies make implant dentistry incredibly dynamic. Years ago, the auxiliary programs we gave were updated once a year. Now, they are updated prior to every presentation. Years ago we did two programs a year.

Now, we’re hosting over 50 per year worldwide. The techniques and theories we taught 10 years ago are no longer the same. The teams that represent us when giving our programs must be up to date on all aspects of implant therapy, especially relating to auxiliaries.”

My husband, Dr. Chuck Majors, is the guy next door practicing in small-town America. He has 20 plus years in implant dentistry, and believes that the most important quality for success is the doctor’s desire to study and grow professionally. “If you don’t have a quest for learning,” he says, “then implant dentistry is no place to be.” Chuck recognizes that the more he learns, the more he is required to learn.

So, to find those most successful, look for a subtle but crucial change in the doctor’s point of view — from an “I already studied all that in dental school” certainty to what I would call the joy and responsibility of becoming a lifetime learner. Chuck often reminds me of what Oliver Wendell Holmes said: “The mind, once expanded to the dimensions of larger ideas, never returns to its original size.”

Additional considerations

Beyond the doctor’s transformation into a lifetime learner, there are a few additional considerations before deciding to get into implant dentistry. Start with a self-examination.

Evaluate where you are in your practice and how many more years you wish to practice. Measure the number of years you plan to practice against the initial investment to add this service to your practice. Many doctors report that investment can run from $30,000 to $60,000 for implant training and the initial set-up. We haven’t even begun to explore on-site CT imaging or cost out of your practice.

You need to figure out how long it could be before you see a decent return on investment. Adopt a model of “rigid flexibility” — i.e., you must be staunch in remaining flexible in your thinking to stay at the top of implant dentistry.

One of the questions I routinely get asked in my travels is, “What are other practices doing with respect to implant dentistry?” Many things differ according to beliefs, geography, and (lack of) training, but there is one thing that is consistent: if you are not willing to commit the time, energy, patience, and money to this treatment modality, your patients won’t either.

In other words, you can’t really “get out” of something that you never really committed as a team to “get in.” It takes more than taking a course to be successful in implant dentistry. It takes a constant evaluation of where you are, where the industry is, and where you want to be. Our patients will see a consistent message about implant dentistry if we commit to giving them one.

JoAn Majors is a registered dental assistant, published author, and professional speaker. In addition to her speaking, she leads team training for the Misch International Implant Institute. For a free copy of “10 Tips for Implementing Implant Dentistry” and more on her seminars and her latest book, “Encourage Mentors: Sixteen Attitude Steps for Building Your Business, Family and Future,” please send an email to [email protected]. You may also visit or call (866) 51-CHOICE. “The time is now ... the choice is yours!”

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