Click here to enlarge imageWhat happens if we speed this dentist up a bit and cut down operating costs? In Example 3, the dentist can charge $963 per veneer and still make the same profit as the doctor in the second example.
Rule of thumb myths
A rule of thumb I have always heard when it comes to setting fees is that you should base your crown and bridge prices at five times the lab fee. Five times our example of $120 would give us a $600 fee, which would allow the dentist in Example 3 to make a small profit, but would be disastrous for the dentist in Example 2.
Another often-quoted rule of thumb is to charge what everyone else is charging! This can be very dangerous, because you have no idea what everyone else is using as a standard for setting their fees. Other dentists could be charging far less than what you need to charge, or the fee could be more than your own skills justify. However, keep in mind that the paying customer does shop prices. Setting fees too high without having a tangibly superior product is professional suicide.
How to lose money on veneers
As you noticed in Example 3, shorter chairtime makes the procedure more profitable. Conversely, longer chairtime can be costly. When it comes to veneers, there are several "chairtime wasters" that can add up to a large loss of income.
The most common chairtime waster is the single anterior veneer. Getting porcelain to match natural teeth on either side is a very challenging task. A perfect match requires numerous photos, records, custom shading at the lab, multiple try-ins, remakes, and repeat visits. Many dentists and patients accept less-than-perfect results on single units; however, compromise does not build word-of-mouth referrals! I deal with the extra time involved by charging double my normal fee because they require twice as much time.
Another time and money-waster is the debonded veneer. Veneers occasionally come off if the occlusion is incorrect, the patient bruxes, or the cement fails. Cement failure can be caused by cementing without obtaining a dry field, operator errors in mixing cement or adhesive, or by a faulty curing light. Laboratory causes for failure come from uneven firing, internal stresses in the porcelain, inadequate etching of the internal surface of the veneer, or contamination of the etched internal surface.
To avoid these pitfalls, ensure that the gingival tissue is healthy and isolate the teeth properly to avoid moisture contamination. Check your curing light intensity frequently and don't skimp on curing time. Also, be sure the assistant who is mixing or dispensing for you is well-acquainted with the materials and that you are watching the materials as they are being mixed. For every patient — including the light or occasional bruxer — adjust the occlusion properly in centric, protrusive, and lateral excursions so that prematurities are eliminated. Then, supply a night guard for added protection. If the patient bruxes severely, it is wise to try some other type of restoration that has a bit more resistance to displacement, as well as fabricating a night guard.
Other than proper prep design, laboratory selection is the other most important factor in veneer success and profitability. A laboratory that can give you a crown or veneer with perfect margins, contacts, and occlusion can save you valuable chairtime. Conversely, margins that are shy, contacts that are too tight or too loose, and occlusion that is off, are the most frustrating waste of time that I can think of.
The "picky" or neurotic patient is the worst offender as far as lost time and revenue and increased stress. Take a cue from plastic surgeons and refuse to treat patients who have unrealistic expectations of what their dental restorations will look like or how a new smile will affect their lives.
The moral of the story is ...
Get your accountant busy figuring out your overhead per hour, cut down on your operating expenses without sacrificing quality, become better and faster at what you do, price your procedures accordingly (keeping in mind what the market will bear), and you'll make all the money you deserve.