Cry for Help…

August 31, 2009

The Washington, DC Metropolitan area’s Oral Surgeons and Periodontists – at least those who place implants – have adopted a method of rewarding their referring dentists which, in the end, costs their patients more money and all but guarantees inferior results.

The practice – supplying referrals with all the components  necessary to complete a given case (implant impression copings, implant replicas and UCLA-type abutments) – began innocently enough as a few surgeons-turned-businessmen advanced the idea as a way to entice restoring dentists to use their services.  Soon enough, it was hard to find any surgical practice in our area  not copying what seemed like a great idea for everyone.  Even the labs were happy – we didn’t need to maintain an extensive inventory of components for multiple systems, nor spend valuable production time divining which parts were needed for each case.

Now, however, is a different story.

With the advent of  various CAD/CAM solutions from Atlantis, Vericore, Lava and NobelProcera this marketing gimmick is actually serving to drive up the costs to the patient while providing him or her with a product of lesser quality.

First, we have to assume that the cost of the implant surgery includes the cost of the components – there is no free lunch – we’ll say $150 for a single UCLA cast-to abutment (Forget about the impression coping and implant replica as they have to be purchased anyway).  Add the labor cost of $125 to wax, cast, finish and polish the abutment plus another $100 in alloy and you have a final abutment cost of $375.

Second, we have to agree that its quite possible that what was once a pristine milled interface surface of the UCLA abutment has now been altered by the casting and finishing process, even if only at the microscopic level.

My argument would be that using a milled titanium abutment fabricated using one of the afore-mentioned systems would be less expensive (by as much as $75-100 per implant because we’re not using expensive gold alloys) and of a higher quality (the milled interface of the CAD/CAM abutments are not exposed to the trials of  lab processing).  And, we haven’t even covered what happens when the restoring dentist elects to use a zirconia abutment (I don’t think it would be very cost effective to use a cast-to component to wax a scannable abutment facsimile, if one should be required as with the Lava and Vericore abutment solutions).

So, why does this marketing idea continue to drive how implants are restored in our area?  Wouldn’t it be simpler if the surgical practices worked with the labs, say, to offer a voucher to their referrals that could be redeemed against the cost of a CAD/CAM abutment or overdenture bar ?  The surgical practice would no longer have to maintain an inventory of components, yet they could still “reward” their referring clients, and the patient would ultimately win through lower costs and higher product quality.

If you’re one of my clients reading this, and it makes sense to you – please have a word with your surgeon about the voucher idea.  It could mean greater profitablity for you and better service for your patients!

© 2009, Jeff Saylors. All rights reserved.