Good quality dental implant treatment is expensive. Full mouth dental implant treatmentcost more than most medical or surgical treatment, including operations like coronary artery bypass graft surgery, hip replacement, knee replacement, etc. Currently, there are two diametrically opposed approaches in the continuing development of dental implant treatment protocol. On one hand, more implant manufacturers are competing for business and that has been driving the cost of the implant and components down. On the other hand, advances in diagnostic and treatment delivery systems to achieve better outcomes entailing the use of high technology drive prices even higher. It is increasingly difficult for patients to find the balance between cost and value. This blog post will try to throw some light on the subject.
First, all dentists have their own practice philosophy when it comes to pricing. Some believe in purely functional outcomes whereby the patient derives some benefits from having had the treatment but that is where it ends. The outcome is nowhere near ideal and certainly will not win the admiration of peers. But it is better than nothing. On the other end of the spectrum are dentists who think that patients exist just to carry a mouth for them to indulge in perfectly their dental art. Between the two ends, lies a wide spectrum and mixture of dentists of different inclinations. The reason why this entire spectrum of dentists exists is because there is such a spectrum of patients. The tricky part is how the right patient gets matched up with the right dentists.
Today, dental implants have been commoditized. In Singapore, it is possible to replace a missing tooth with a dental implant, including the crown, for less than $2000. At the other end, a single tooth implant can cost more than $10000. The cost of dental implants in Singapore is highly variable. Is the $10k dentist overcharging or profiteering? Well, it depends on what outcome the patient expects, and what standard the dentist holds himself to. Let me illustrate how this works out by breaking down the $10k implant
First, there is a consultation charge. Patients do not know the diagnosis, the procedures and risks involved, what alternatives are available, the pros and cons of each option, costing, longevity, maintenance, etc. To ensure that the patient understands what he is getting, a consultation visit may last about 30-40 minutes on average. After the consultation, impressions of the jaws are made and mounted on an articulator, a jaw simulator of sorts. The missing tooth is then waxed up and a radiographic guide is made from that setup. The patient then wears the radiographic guide and go for a CT scan. The CT scan gives a three dimensional perspective to the jaw bone where the implant is to be placed, enabling the accurate assessment of bone quantity and quality and the simulation of implant placement. In some cases, there is insufficient bone in the planned location and bone grafting is needed. Bone grafts can be harvested from the patient’s body and transfer to the deficient area or it can be bought from commercial sources. Commerically-sourced bone can be simple processed animal bone or state-of-the-art recombinant human bone morphogenetic protein. The bone graft is then left for a few months for it to integrate with the host bone. Some times, a soft tissue graft is needed. This can be done by harvesting gum tissue from the palate or using processed donor human skin. Implant placement can also be guided with CAD-CAM printed surgical guide that replicate the positioning of the implant in the jaw exactly as planned on computer or better still, using real time navigational surgery with 3D sensors placed around the patient.
And then there’s the prosthesis. There are many ways, techniques and material that can be used to make false teeth and that can make a huge difference in cost. Starting from the abutment, the connection between the implant and the crown. It can be stock abutments made by the manufacturer, or it can be custom-made for each implant. It can be made of different types of cast metal, between gold and chrome cobalt, or it can be made of milled zirconia. The treatment protocol can involve a provisional prosthesis to shape the soft tissue and perfect the emergence profile of the crown through the gum and fine tune the occlusion before duplicating it in the final porcelain bonded to gold or zirconia prosthesis. Together, the implant surgery and crown done using the best material and technique by the most experienced and skilled dentist makes the most expensive dental implant.
Alternatively, the dentist can just feel the jaw bone with his fingers, drill a hole, put a screw in and cement a crown over it. That can be the cheapest dental implant but is that what a patient really wants, if he knows the risks and benefits involved.
The point that I am trying to make is that all implants are not the same. Not all patients require state-of-the-art technology but certainly all patients deserve thorough planning and skilled treatment with an aseptic technique. Choosing an implant dentist purely on cost is a recipe for complications. A good implant dentist will be able to diagnose your problems and identify what are the crucial areas that need addressing to ensure a good outcome. I usually will work out an ideal plan first, one where money and time is no object, and then work back from there base on the constraints of the patient. Some things are good to have but are are essential. This way, the plan can be tailored accordance to the budget and the patient can see what he is forgoing when he chooses a less expensive option.