Scott Froum, DDS
Not a day goes by without a radio, television, internet, or newspaper ad promoting dental implants to the public at significantly discounted prices. These ads often offer the implant, abutment, and crown for a price that is slightly more than the cost associated with the lab fee and materials, along with a treatment expiration date.
Much to the chagrin of practicing dentists in proximity to these discount offices, dental implants are being used as a loss leader—a service offered below market price to entice new patients into a practice with the goal of later selling more profitable services.1 Various dental groups on social media have tried to tackle the topic of discounted dental implants—usually with contentious debate. Phrases such as “commoditization of dental implants” and “race to the bottom” are used to describe practitioners and offices that advertise discounted implants.
Some dentists have condemned discount dental implant centers as providing cheap, low-budget dentistry. Many of these dentists have kept a business-as-usual approach and kept their normal treatment costs. On the other hand, some dentists have reduced their dental implant price to compete with discount dental implant offices and not “lose out” on potential patients.
Before you decide on what approach you will take, let’s look at the history behind the growth of dental implants while keeping a few scientific and economic principles in perspective.
According to the literature, dental implants typically enjoy a high survival rate. Although complications can occur, they appear to be decreasing.2 In fact, of all implantable medical devices in the body, dental implants have some of the highest long-term survival rates reported in the literature. A pivotal study made implants much more accessible to the practicing dentist when it demonstrated that implants placed in a clean office setting had the same success rate as implants placed in a sterile hospital setting.3
In addition, technology has made dental implant surgery easier for clinicians. Technology has helped decrease the stringency of surgical protocol, as well as enabled the modification of implant surfaces for more predictable integration.4 All of this has increased the incentive for general practitioners to become involved in implant dentistry.
A recent report by the Millennium Research Group discussed the changes in marketing that are occurring in the dental implant industry. The report states that by 2023, the majority of marketing done by dental implant companies will focus on general practitioners rather than specialists as a means of increasing dental implant sales.5 Recent numbers released by iData Research reflect that trend. By 2020, it is estimated that 3.5 million implants will be sold in the United States.6 This information should be coupled with a recent report by the American Dental Association that showed the number of consumers in the United States willing to pay for dental care is decreasing.7 If we analyze this using the economic law of supply and demand, we should expect a drop in the price. In other words, the supply of those placing implants is increasing even though the demand is decreasing, which should ultimately lead to a decrease in implant price, particularly if implants are thought to be a commodity.
The question then becomes, “Are dental implants a commodity?” If the answer is yes, we should not be shocked that implant price points are decreasing. In economics, the definition of a commodity is an economic good or service that has full or substantial fungibility: that is, the market treats instances of the good as equivalent or nearly so with no regard to who produced it.8 Therefore, if you take this definition and apply it to dental implant therapy, if an implant is a true commodity, the clinician who places or restores the dental implant is not important in the overall equation of determining price point. Looking at this from a simple economic perspective, if patients believe implants are a commodity, the doctor’s training, staff, location, and office environment will play no role in determining acceptance of price point.
A recent online report by Colin Hung highlighted the potential dangers of commoditizing health care: “Some fear that the commoditization of health care will lead to a cold and impersonal experience for patients. I believe this sentiment is correct. With commoditization there can be a loss of the one-on-one experience that some patients have with their primary care provider. It is also possible that with the increase in volume doctors will need to sustain, diagnostic and therapeutic outcomes may be diminished.”9
On the other hand, if the answer is no, and you believe implants are not a commodity but rather a medical treatment where success is dependent upon interpersonal relationships between doctor and patient, then price point would be influenced by the individual doctor and office. There are those who believe that patient education is the key to transforming the commodity sentiment patients have toward implants and creating an intangible value behind the care given.
Alternatively, CEO of Spreemo Health Ron Vianu believes that commoditization can be a good thing because it can eventually lead to consumerization, where educated patients make treatment decisions based on research: “Americans, increasingly financially responsible for their care, will demand greater insight into quality in order to best understand value. Physicians will be forced to demonstrate quality by providing greater access to outcome data and treatment methodologies, which could involve insight into postoperative success rates or a deeper understanding of the correlation between CBCT equipment and diagnostic accuracy, as just two examples.”10
With this information in mind, you the clinician typically have three options to compete with discount implant centers.
- The first option is to lower your dental implant fee to be competitive on price with those in proximity to your office. Mike Elvis Calderon, DDS, the CEO of Calderon Institute, says that when implants were offered by a nearby dentist at 30% cheaper costs than his own, he lowered his fee by 20% but tried to make up the difference by placing more implants and increasing time efficiency.
- The second option is to keep your implant treatment price the same regardless of what another dentist will charge. This often involves patient education, especially for patients from internet referral. The dental practice must foster the idea that implants are not a commodity, but rather a medical service. According to Paul Banks, DDS, a practicing general dentist in New Jersey, patient education and consultation can make the patient realize that they are not only buying a dental implant, but your expertise, office hospitality, and follow-up care in order to ensure a healthy long-term result.
- The third option—a practice that has been adopted by the author—is to become a center for implant complications and advanced rescue of implant problems. Becoming a rescue resource for surrounding implant dentists can benefit your practice production as well as become a good service for implant patients in need of assistance. Most of the implant cases the author treats are either complicated tissue augmentation cases that his referrals need built up prior to placing implants or fixing complications that dentists have encountered while placing or restoring implants.
In summary, because of the law of supply and demand, dental implant prices will continue to trend downward. Many dentists now offer implant dentistry as a loss leader to attract patients in hopes of providing other profitable services. Clinicians will be challenged to deal with price-competitive dental centers and price-conscientious patients.
References
1. The American Heritage Dictionary of the English Language. 4th ed. Boston, MA: Houghton Mifflin Company; 2000.
2. Levin L, Sadet P, Grossmann Y. A retrospective evaluation of 1,387 single-tooth implants: A 6-year follow up. J Periodontol. 2006;77(12):2080-2083.
3. Scharf D, Tarnow D. Success rates of osseointegration for implants placed under sterile versus clean conditions. J Periodontol. 1993;64(10):954-956.
4. Buser D, Janner SF, Wittneben JG, Brägger U, Ramseier CA, Salvi GE. 10‐year survival and success rates of 511 titanium implants with a sandblasted and acid‐etched surface: a retrospective study in 303 partially edentulous patients. Clin Implant Dent R. 2012;14(6):839-851.
5. Lim V. Medtech 360 dental implant market insights report (North America). Decision Resources Group website. https://decisionresourcesgroup.com/report/574719-medtech-dental-implants-medtech-360-market-insights. Published November 2017.
6. iData Research report: Dental implant fixtures and final abutments. iData Research website. https://idataresearch.com/product-category/dental/dental-implants. Published 2017.
7. Vujicic M. Where have all the dental care visits gone? Journal of the American Dental Association website. https://jada.ada.org/article/S0002-8177%2815%2900494-8/pdf. Published June 2015.
8. Firzli MN, Bazi V. Infrastructure investments in an age of austerity: the pension and sovereign funds perspective. Revue Analyse Financière. 2011;41(10):37-39.
9. Hung C. Commoditization in health care. Healthcare Leadership Blog website. http://ojs.library.queensu.ca/index.php/qihi/article/view/6069/5742. Published April 3, 2017.
10. Vianu R. Is the commoditization of healthcare bad? LinkedIn website. https://www.linkedin.com/pulse/20140620134207-10141663-is-commoditization-of-healthcare-a-problem/. Published June 20, 2014.
