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Dental Implants: Affordable vs. Expensive
What are the Differences Between Expensive Versus Affordable Dental Implant Care?
Table Of Contents
· Introduction
· What are Primary Differences Between Expensive and Affordable Dental Implants?
· What Does Research Indicate About The Outcome Of Expensive Versus Affordable Implants?
· What is the Dentist Cost Basis for Providing Expensive Versus Affordable Dental Implant Care?
· How Might Marketing Affect the Cost of Dental Implants?
· What Exactly is the Profit to the Dentist Providing And Restoring a Single Dental Implant?
· What are my Dental Implant Costs? Is it Good for Patients to Shop Around for Dental Implant Care?
· What Constitutes a Good Outcome of Dental Implant Therapy?
· Conclusion
· Exhibit 1: Diagram of dental implant, abutment, and dental crown
· Exhibit 2: Table I: Estimated Costs to and by a Dentist to Place a Single Implant, Abutment, and Dental Crown
· Exhibit 3: Table II: Range of Fees for Various Scenarios of Restoration of Dental Implants
Introduction
Dental consumers sometimes think that a dentist who charges more may provide the best dental implant care. This attitude stems from the often-held belief that if something is expensive it is automatically better. I do not believe this logic is applicable in choosing from whom and where you will obtain dental implant care. Excellent dental implant care can be done with low dental implant cost.
You, the potential dental consumer, should learn what exactly you are paying for, especially when you select high dental implant cost versus affordable dental implant care. You should also acquaint yourself with facts that truly identify successful outcomes of implant dental care.
The following narrative is intended to shed light on important information related to dental implant cost that is not usually available from dentists to prospective patients.
What are Primary Differences Between Expensive and Affordable Dental Implants?
Robert Davidoff, DMD, FACPA is also an implant dentist. I am using selected information from his website (Dental-Implants.com) to serve as a basis for some of my discussion below.
Articles or editorials authored by Dr. Gerald Niznick are also referenced. These can be found by looking for “Niznick versus Nobel” in a search engine such as Google.
Dr. Davidoff explores the basis for prices of dental implants sold to implant dentists in a section of his website titled “Excessive Fees.” Therein he indicates that “the cost of manufacturing a dental implant is somewhere between $6.00 and $9.00.” Dr. Niznick published a similar fact about 10 years ago, but added that “with packaging and sterilization the cost of a dental implant jumps to $12 a unit.”
Dr. Davidoff goes on to explain that most dental implants "are made of Titanium... The procedures for forming [titanium] into dental implants are well known and basically universal in their applications…Nevertheless, companies manufacturing dental implants sell their product to dentists for anywhere from $85 to $500, or even more.”
According to doctors Davidoff and Niznick, the differences in dental implant costs to dentists is mostly affected by the cost of advertising and other marketing expenses of the manufacturers which amount to little more than “hype.” In addition, Dr. Niznick advises “Implants are implants and all the hype (defective or pseudo science) and controversy that is generated by dental implant companies is only directed at selling product to us. What determines the success of a dental implant? Four things: 1. Patient selection 2. Good surgical technique 3. Good prosthetic technique 4. Good maintenance. The body does not care a twit about what kind of implant you use and if anyone thinks there is a real difference in the manufacture of these devices, you are really misinformed.”
What Does Research Indicate About The Outcome Of Expensive Versus Affordable Implants?
Research on the outcome of using specific brands of dental implants today is largely done in university environments. Most of this research is funded by the companies whose dental implants are being tested, creating a situation with obvious potential for conflict of interest. The majority of these studies are very short in duration, and exist primarily to promote the new implant products benefactor companies are anxious to bring to the dental marketplace as soon as possible. These types of “self-serving” studies are of little value except for marketing.
What is the Dentist Cost Basis For Providing Expensive Versus Affordable Dental Implant Care?
When placing or restoring dental implants, it is important to consider the total dental implant cost--in fact, the final cost of dental implant care by the dentist to you is determined in a very subjective manner. By subjective, I mean that the out-of-pocket dental implant cost for a dentist to purchase a dental implant, place it, and restore it, is largely limited to:
1. What the dentist elects to pay for materials.
2. Elective costs for direct and indirect forms of advertising decided upon by the dentist.
3. The dollar amount EXHIBIT2 that the dentist wants to charge for his or her time to complete a dental-implant-related service. This fee is essentially based upon what the dentist wants to make as profit. It is a feeling, not necessarily based upon competitive factors.
I have prepared Table I (EXHIBIT2) to graphically present a breakdown of dentists’ dental implant expenses. A range is depicted of the elements necessary to complete delivery of a single dental implant, abutment, and dental crown from the first visit until the last visit when the restoration is approved. (For a visual representation of dental implant parts EXHIBIT1
I have borrowed figures from Dr. Davidoff’s previous effort to estimate the range of the dental implant cost for the dental implants themselves. Dr. Davidoff advises that his own figures are not scientifically valid, and that they are just his impressions to be used by the consumer as a guide. Additional costs included in Table I are similarly my best-informed estimate.
The data presented in Table I support the conclusion that the dental implant costs and materials related to restoring them need not be very different, are elective, and do not affect outcome. The exact numbers used may not be precise, but these do not detract from the conclusion.
Table I reveals the extent to which dentists’ profit determines the overall dental implant cost of a single restored dental implant. This manner of determining what to charge patients has little to do with the actual cost to the dentist to deliver dental implant care.
In consideration of the above, consumers should not automatically conclude that expensive dentists—dentists who use expensive implants and materials, practice in expensive facilities, and expend a great deal of money on other various forms of marketing—provide implant care that is superior because it is expensive.
Remember, marketing is not just the use of commercial media; it involves the location of an office, the type of equipment displayed, and other elements which may enhance ambience in general. All of these potential marketing tools are nice, and very important to some consumers, especially those not worried about high dental implant costs. However, none of this “hype” affects the long-term outcome of dental implant care. Elective costs, if identified, are likely of less concern to those with limited discretionary income. Regular people probably prefer outcomes that are affordable.
Don’t let excessive dental implant cost prevent you from obtaining quality dental implant care. Shop wisely. If you seek ambiance by all means pay for it, but don’t confuse ambiance with outcome.
How Might Marketing Affect the Cost of Dental Implants?
Accumulation of dental implant costs that may make charges for dental implants more expensive begins when manufacturers support research that helps sell their products to dental professionals as being superior, new, or improved.
Doctors Niznick and Davidoff have examined one company in particular: Nobel BioCare. They assert that Nobel started out with one particular type of implant, claiming it was the best and selling it at a premium. Both doctors also claim that for a short period of time Nobel seemed to have a corner on the market of dental implant sales. Dr. Niznick states on his site “In the very beginning, [Nobel] would only train oral surgeons and prosthodontists to place and restore their implants. You could not buy their product unless you took their courses, so about 90% of the dental profession was barred from using their components.” (http://www.osseonews.com/responsetonobel-responds-to-dental-implant-critics/)
Dr. Niznick’s obervation is important, keeping in mind that at the time Nobel was one of the major—if not the major—supplier of implants in the world. By limiting provider access to their product, dental implant costs would go up for the consumer because of the predictable effects of supply and demand. This also effects competition among dental professionals.
According to Davidoff (Dental-Implants.com), Nobel, in order to continually drive sales in the long run, would make it a practice to periodically alter the design of their implant slightly and market it as “new and improved.” Davidoff further opined that Nobel also secured sales by making claims that implants manufactured by other companies or techniques of dentists not following Nobel protocol were inferior to theirs.
The ultimate irony of the Nobel saga chronicled by Dr. Niznick is that Nobel had their implants banned from the United States for a period of time for numerous quality issues.
What Part Does Hype Play in Driving up Dental Implant Cost?
Doctors Davidoff and Niznick admonish that anyone buying into the hype of a superior dental implant design and product is only further funding the efforts to create and sell those products through distinguishing factors that Davidoff and Niznick believe do not really exist.
I also believe that the hype of marketing companies artificially drives up the dental implant cost to dentists--dentists who themselves re-market the expensive implants and then pass the extra dental implant costs onto consumers. Those dentists justify the extra dental implant costs by repeating marketing hype--which is, or may likely be no more than hype--and may have no relationship to outcome of dental implant care.
What Exactly is the Profit To The Dentist Providing And Restoring a Single Dental Implant?
The total dental implant costs for a single dental implant to be placed and restored vary considerably. Dr. Davidoff estimates this range is $3,000—$6,000 per restored implant, with the average cost being around $4,500. Please consider the following:
1. Assume for argument that at your initial appointment the dentist spends 30 minutes examining you, making a treatment plan, and going over informed consent. Non-dental staff can finish these tasks by taking study models, preparing contracts, and memorializing the arrangement made between you and the dentist.
2. Next, assume the dental implant surgical suite is set up by an assistant in about 30 minutes. The surgical materials used in that suite cost about $50.
3. Then assume it takes an implantologist perhaps 30 minutes to greet you when you are about to receive an implant, to numb the implant recipient site, and place a single implant at that site.
4. Finally, assume restoration of a single dental implant (placing a crown on top of the implant which replaces a lost tooth) takes two half-hour visits.
5. Conclusion: It takes about 2 hours to complete delivery of a single dental implant, abutment and dental implant crown.
Now, please refer to Table I. ( Exhibit 2)
If it takes about 2 hours for a dentist from the beginning to the end of placing a single dental implant then (considering the total dental implant costs ranges suggested by Dr. Davidoff) the approximate hourly profit of dentists range from $1,692 to $2,312 per hour.
With regard to my hourly fee, I charge $2,300 per single dental implant, abutment, and dental implant crown. I estimate my dental implant costs to deliver those services to be about $615. Therefore, I make about $847 per hour to complete all the steps necessary during the process of placement of a single affordable dental implant crown.
What are my Dental Implant Costs? Is it Good for Patients to Shop Around for Dental Implant Care?
First review Table II (Exhibit 3). My dental implant costs as compared to the estimated ranges of the dental implant costs of others by Dr. Davidoff are disclosed.
As you can see from Table II, I charge no more than $2,300 per dental implant and dental crown including the abutment that joins them. This amount is less than even Dr. Davidoff’s low estimate, but as the dental implant field becomes more competitive I believe that dental implant costs in general will become more reasonable.
In my practice, the dental implant cost to you per implant is $990 for the first implant, and about $790 for each additional dental implant. I charge $825 for a dental implant crown. I charge different prices for abutments, but I always charge less than $500 each. Rarely, there are situations where I will charge more for unusually complicated care, which almost always involves restoration of multiple upper front teeth.
I know that when I place more dental implants and dental crowns consecutively amongst back teeth, the total dental implant cost is less for each one restored. Therefore, when I place two consecutive dental implants (i.e., those that are next to each other amongst back teeth), dental crowns and abutments, I charge neither $4,600 (twice my single implant fee) or the expensive fee of $12,000 cited by Dr. Davidoff. I charge $3,900. When I place three consecutive dental implants, dental crowns, and abutments I usually charge $4,900. I charge $5,900 if I place four consecutive dental implants, dental crowns, and abutments. For multiple non-consecutive dental implants or implants amongst front teeth I also usually charge less, but the fee is decided on a case-by-case basis.
The dental implants I usually buy (Hi Tec from Dennis Slawsby) are reasonably priced, (about $150 for all the parts). I purchase surgical room setups and materials for the same amount as everyone else. In all, I conclude that the average dental implant cost to me is $615 to place and deliver a restoration for a dental implant and increasingly less for each additional implant up to four.
The variable factor is my self-worth (what I feel I should charge per hour of my time) that allows me to substantially decrease the total dental implant cost that I charge for dental implant care, making it more affordable to you. I don’t charge less because I feel my value as a dental implantologist is less, but because I believe that my services shouldn’t be out of reach.
Price savings increase also because of economy of scale, i.e., up to four dental implants, the more implants I place the less it costs me for each and the greater the savings to you. I do this without affecting quality or long-term outcome of care.
I believe the prudent consumer seeking dental implant care needs to educate themselves to make good decisions in choosing who to take care of them, now as well as in the future. Educated shopping is consumers’ responsibility to themselves.
What Constitutes A Good Outcome of Dental Implant Therapy?
In his book Contemporary Dental implant Dentistry, Carl E. Misch (the deserved godfather of implant dentistry) reviews criteria for success of dental implant care in great detail. He defines levels of success of dental implants and their prosthetic restorations as ranging from optimal to survival. His main criterion for successful dental implant care is that the patient has no pain and the dental implants are not loose in an up/down direction.
Furthermore, Misch believes the outcome of dental implant care success starts by getting treatment from a skilled dental implant surgeon and restorative dentist. However, location of the dental implant in the jaw, quality of the jawbone (dense vs. porous), and quantity (thickness or height) of jawbone remaining are also very important, as they too affect outcome. The quality of restoration, including its fit, appearance, and ease to maintain are all additional important criteria.
Personal and professional maintenance are also essential to long-term success, as is health of the patient. Habits like smoking and grinding of teeth, as well as systemic disorders like diabetes and depressed immune systems, compromise outcome.
By comparison to all of the above considerations, the brand of the dental implant (expensive or affordable) or the ambiance of the office have little do with the successful outcome of dental implant care! What is charged for the dental implant is really not relevant at all to whether dental implant care (including follow-up) is to be successful.
Conclusion
I believe every citizen has a moral duty to try to produce a service or product that will improve the quality of life for their fellow citizens. Whether you are an unskilled laborer or a brain surgeon, the opportunity to exercise this moral imperative is always present.
As a dentist I want to be a skilled surgeon (technically as well as scholarly). I also want to be a good businessperson who advocates for my patients by giving them as much value for their money as possible, while still making a fair living for myself and my family.
One way I can improve the outcome of dental implant care is by controlling all related dental implant costs, including setting my hourly fee (by far the largest cost for dental implant care) to be within the reach of regular people. I achieve this without compromising quality of service or self-sacrifice.
By writing this section I hope to have shed some light on many aspects of dental implant care that consumers often know very little about. I have provided information and cited information from a few very important others that isn’t always readily available from dentists to prospective patients.
My ultimate message to you about obtaining dental implant care is this: don’t pay large sums of money in hopes that by paying more you will be ensured a successful—or even better—outcome, than that which can be obtained by checking out options. Don’t avoid shopping for affordable dental implant care. Instead, inform yourself about practitioner track record, education, and overall dental implant costs to ensure that you find a great fit for you and your wallet.
Exhibit 1:
Diagram Of A Dental Implant, Abutment, And Dental Crownn
Exhibit 2-Table I:
Estimated Dental Implant Costs To And By A Dentist To Place A Single Dental Implant, Abutment And Dental Crown
· Note profit increases as costs are spread over multiple units.
Exhibit 3 - Table II:
Range Of Dental Implant Costs For Various Types Of Restoration Of Dental Implants
*This table is adapted from Dental-Implants.com, by Dr. Robert Davidoff. Dr. Barbanell’s fees have been determined by himself.
** Not included in Dr. Davidfoff's table.
*** The fees for upper appliances are given on a case by case basis depending upon availability of bone and gum that remains and the position that the implants can be placed.
****This fee commences 8/1/2009 and is subject to change at any time. It applies to new patients only
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