Mini-Implants? Maximum Possibilities Incorporating practical and profitable procedures into your practice

Author : Dental Product Shopper
Published Date 06/28/2011
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Mini-Implants? Maximum Possibilities Incorporating practical and profitable procedures into your practice

A chicken sandwich at McDonald?s, Applebee?s, and Morton?s is very different in price, but each offers basically the same thing at lunchtime?a sandwich, fries, and a soda. The price is different and so is the time you may spend. The service deliverables, food quality, ambiance, and other aspects are clearly defined for each level of lunch you may choose. The highest price and quality is likely to be at least 4 times the cost of the fast food offering. Thank goodness we have the freedom to choose the best, the least, or an offering that strikes a chord in the middle.

Mini-Implants? Maximum Possibilities Incorporating practical and profitable procedures into your practice

A chicken sandwich at McDonald?s, Applebee?s, and Morton?s is very different in price, but each offers basically the same thing at lunchtime?a sandwich, fries, and a soda. The price is different and so is the time you may spend. The service deliverables, food quality, ambiance, and other aspects are clearly defined for each level of lunch you may choose. The highest price and quality is likely to be at least 4 times the cost of the fast food offering. Thank goodness we have the freedom to choose the best, the least, or an offering that strikes a chord in the middle.

Without mini-implants in the mix of choices for edentulous patients, there is really no middle. A patient could limp through life with a mucosally supported removable prosthesis that restores esthetics but lacks reasonable function. Or we could offer them 4 to 5 conventional implants, a lab-fabricated bar, and an excellent fixture-retained removable solution. The difference is going to be far greater than the chicken sandwich and there is no middle ground without mini-implants.

The Middle Ground

Small diameter implants (less than 4 mm) are the new middle ground for the 40+ million edentulous patients in our country today. For far less than the cost of a conventional lab-fabricated bar and surgeon-placed fixtures, a patient can have an implant-retained overdenture that allows him or her to eat and chew effectively.

General dentists can now place mini-implants with confidence. Using cone beam computed tomography (CBCT) and implant placement software, it has become easier and more predictable to add this important and profitable procedure into a general practice. The small diameter fixtures for overdenture applications and single tooth replacements are by far the most utilized applications.

Getting Started

Before you decide to incorporate mini-implants into your practice, you must consider procedure tolerance, system specifications, and case selection.

Procedure Tolerance

Your tolerance for certain procedures is a huge factor in determining the services you offer. If you do some endodontics or extractions, you probably have the comfort level to place implants. I know excellent dentists who have taken on new procedures and then found themselves unhappy when they looked at the next day?s schedule.

If you add a product or service because it is profitable but you hate doing it, you may be wealthy but stressed. Dentistry is stressful enough without having to do things we abhor.

System Specifications

System specifications differ greatly among the various mini-implant manufacturers. Smaller is not always better. At 2 mm to 4 mm in diameter and with a mucosally supported prosthesis that is implant retained, we can have an excellent result. When implants become too small, there is simply not enough surface area or strength to have the predictability we desire.

The prosthetic interface should include vertical resiliency so the implants are not required to carry 100% of the load. That would be appropriate for conventional fixtures and a bar. Small diameter retained appliances are designed to share the load with the mucosa. Without the ?give? that is found in some systems, the full occlusal load is transferred to the fixtures, which can increase failures.

When fixtures are placed at less than ideal angles, the ability to angle correct is important; otherwise, the site becomes useless. Design that allows for proper osseointegration with sequential loading (immediate or delayed) is more predictable than loading all of the fixtures at the time of placement.

Case Selection

Case selection is critical to success. It would be best to get started with simple cases that have more, not less, bone and patients who have worn dentures and will appreciate implants. In the beginning, I would avoid smokers and any patients with bisphosphonate issues. Make the incorporation of this life-changing procedure and technique fun in your practice. You want the most positive reinforcement and financial rewards you can get. Take on the more challenging cases when you have more experience, confidence, and training.

CBCT scans and implant placement software allow us to perform the surgery accurately and in a minimally invasive manner. Knowing that the surgical guide created from the software avoids the inferior alveolar nerve reduces the stress common with these types of procedures.

The Economic Impact

We are professionals and we are business people. Unrewarded altruism ultimately fails when we can?t pay the rent. When I add any new service to my practice, I need to understand my costs of doing business, how it will affect my annual business plan, and have metrics to measure, monitor, and manage those data.

If my target hourly office production is $488 ($750,000 practice, working 48 weeks and 32 hours per week or 1536 hours) and two-thirds of that is restorative revenue, I have to consider a target rate for myself of $325 per hour. I could use that rate to help me set fees for procedures and would include the appropriate lab and usual materials fees. Consider the following scenario:

? Single 4-implant overdenture, using the patient?s previous (good fitting but nonretentive) denture

? Two hours to place the fixtures and pick up the prosthetic interface on 2 implants

? Patient follow-up at 1 day, 3 days, 1 week, and 3 weeks

? Pick up fully osseointegrated implants at 3 months

All of this translates into 3 to 4 hours of face-to-face chair time. My lab/material costs would include implants at $59 to $159 per fixture, prosthetic parts of $100, and a surgical guide from the patient-paid CBCT scan of $400 to $600. A total of 4 hours of time and as high as $1300 in hard costs comes out to $2500, and that includes my normal hourly production. That fee is near the lowest I have seen. It is more common to see $3000 to $5000 per arch, making this one of the most profitable procedures in your office. And it fits the middle ground covered earlier.

Wait, There?s More!

The profitability of mini-implants includes more than dollars of production. We also profit from helping restore others to health and feeling more fulfilled as dental professionals. Patients profit from improved function and confidence. They feel more whole again and let you know how much this life-changing procedure has meant to them.

Although I can?t pay my bills with the behavioral profitability from mini-implant overdentures, I find it richly rewarding. So does my team. Changing lives is one of the most important things we get to do for our patients. Esthetics and function are easy to take for granted and yet so precious a gift for others.

Mark Murphy, DDS, FAGD, is the Lead Faculty for Mercer Advisors and serves on the Board of Directors and Faculty at The Pankey Institute. He lectures internationally on a variety of clinical, leadership, and management topics. Dr. Murphy practices on a limited basis in Rochester Hills, MI and can be reached at mtmurphydds@gmail.com.

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