Why different clinics charge differently for dental implants?

Since the advent of the modern day dental implants which started fifty years ago, many patients who have lost teeth had benefitted tremendously from this technology that replaces teeth that look and feel like natural teeth. Along with advances in technology and the predictability of outcome, the cost of dental implant treatment has also come down. However, there is still considerable variation among different clinics. What contributes to this variability? Is it a case of you get what you pay for? This article will shed some light on why there is wide variation in cost and how you can go about assessing what is best for you.

I will breakdown the variables into the following parts:

1: Brand

This this probably the easiest to understand. There are many different brands of dental implants available commercially. Probably more than 100 different brands from different companies. There are implants from Europe, America, South Korea, China, etc. Here in Singapore, due to the stringent laws governing medical devices, the number of implants are limited. The commonly used implants in Singapore are mostly either from Europe, the United States and in recent years, South Korea. Traditionally, the European and American manufacturers charge a premium for their product. The Korean implants then to be more competitively priced to compete against the more established brands. However, the critical question is, does it make a difference to the patient in terms of success rates and safety. The short answer is no. Price of that titanium screw is not an indication of whether it will serve you better. What is most important is that the dental implant must have passed stringent regulatory controls such as the Food and Drug Administration of the United States or the Health Sciences Authority of Singapore. These agencies are responsbile for ensuring that that dental implant does no harm. Once it is approved, it is fair to say that it is safe for use. As to how well it does the job of replacing missing teeth, it is a question of the specific design of the implant, the needs of the specific patient, and of course the experience and skill of the dentist. Since there is no significant difference between success rates of dental implants that are FDA or HSA approved, does that mean that we choose the cheapest one? Not necessarily. We choose the dental implant that is most suited to the needs of that particular patient. Sometimes, the need may not be a medical need but a social one. For example, if a European patient who is a medical tourist or temporarily residing in Singapore needs a dental implant, I would normally use a European brand that dentists practicing in Europe are familiar with, and can provide the long term care of that patient. It may be a bit more expensive but it is also better for the patient in the long run. 

2: Needs of the case

Some patients have ideal conditions to receive dental implants, eg no medical condition that compromises healing, good bone quality, good oral hygiene, ideal bone shape, etc. For this group of patients, treatment is straight forward and the cost can be kept low. However, some patients do not have such ideal conditions and additional work is needed eg bone graft repair, soft tissue grafting, hospitalization, etc. For this group, treatment involves more stages and consequently cost more. There is no one size fit all solution and as such, the cost can vary tremendously. 

3: Expertise of the Team

Dental implants in Singapore as well as in many parts of the world are done by a wide variety of dentists with different training background. Some are provided by a team consisting of an oral surgeon and a prosthodontist. The oral surgeon is responsible for the surgical part, namely, the insertion of the dental implant into the bone and any additional procedures like bone grafting that may be needed. Once the implant has integrated with the bone, the oral surgeon hands over to the prosthodontist who will then construct the crown on the implant. Both are dental specialists who have additional 3-5years of specialty training beyond the standard four-year dental school education. Having a specialist team like this generally cost more than having a single dentist doing both the surgery as well as the crown. However, that's not to say that only a specialist team is the only way to go. There are many highly competent general dentists who can perform both the surgery and crown. A specialist team is generally needed for complex cases that call on more specialised knowledge and experience.  Not all dental implant treatment are the same. Different cases require different level of expertise and consequently, a difference in cost.

4: The ambience of the clinic

There are many dental clinics in the private sector as well as restructured hospitals in Singapore that provide dental implant treatment. Beyond professional competence, the setup of the clinic is also an indication of the fees. In general, restructure hospitals may charge less than private clinics as there is a element of public service in restructured hospitals. Among private clinics there are also a wide variation in the level of service and ambience. Some private clinics prides themselves on exclusivity and charge a premium for a premium level of service. 

5: Technology

Scientific advances are made constantly to improve on the quality of care and success rate. The use of low radiation cone beam CT scanners improves diagnostic accuracy while CAD-CAM technology improves the precision of fit of the prosthesis. Platelet rich plasma may also improve the healing and recovery of wound. Such advances aim to reduce pain and downtime associated with surgery, improve accuracy and fit of the prosthesis etc. Naturally, they also add to the overall cost of treatment. 

6: Medisave

Medisave is Singapore's national healthcare savings plan. All working SIngaporeans and permanent residents contribute part of their monthly salary to Medisave. Money in our Medisave account can be use to pay for surgical procedures within certain guidelines. A clinic that is accredited by Medisave can help you draw on your Medisave account instead of paying out of pocket. However, the amount is fixed for each specific procedure. In the case of dental implant treatment, the surgical fees can be partially paid through Medisave but the crown cannot be financed by Medisave. As different codes have different withdrawal limits, the actual out of pocket expense can be highly variable.

CONCLUSION:

At the end of the day, suffice to know that there is indeed a wide variation in the cost amongst clinics in Singapore. The cheapest may not always be good for you. Understand your own needs first and then decide on what you want based on the information that you gather from your consultation. Don't be afraid to get a second opinion. Last but not least, you need to be comfortable with the dentist that is going to carry out the treatment for you.