By Dr Dermot McNulty, FFGDP BDS DIPIMPDENT RCS(Eng)
When out shopping or browsing for a car we can look at different brands, model and styles, as well as the options list. Now, we can also look at whether it is powered by an Internal combustion engine (ICE) or Electric( EV). We can even specify a Hybrid model. We might even begin to understand why a metallic finish might cost more than a standard finish. At the end of the process however, although one car brand might cost 50% more than another the fact we simply wish to own and drive brand A rather than brand B is often the deciding factor.
This is despite the fact that, very often, the less expensive brand might be more reliable, less costly to run and insure, and still is just as efficient in transporting you around the town and country.
Nonetheless, it is possible to visualise and decipher why one brand costs more than another.
So what is so different with the provision of dental implants?
The main difference is that the final product is less definable than the standard production car, or so many other consumer choices. It is almost impossible for the non-dental professional to measure the ‘quality’ of the dental treatment in their mouth apart from:
Can I chew with them, are they comfortable, and do they look good?
The provision of dental implants has revolutionised dentistry in the past 30 years or so. From being pioneering treatment in the 1980s and early 90s, it is completely mainstream, predictable and life-changing. The process in supplying patients with new teeth has become streamlined and efficient as technology has dramatically altered how this is achieved.
It is now very more likely that your implant treatment is all planned digitally without ever having the dreaded gooey impressions taken inside your mouth. The planned images of the final teeth can be shared with you in advance of your treatment, just like the planning of your new kitchen or car, using bespoke CAD CAM software, an the new prototype teeth can even be tried in you mouth after being milled or 3d printed.
The treatment itself can now be carried out using Guided techniques which enables the implant dentist to position the new implants precisely where they were planned on the planning software. Treatment times have been reduced drastically as has discomfort and the need to take time off work.
Why does the cost of dental implants vary?
The main issue is that although dental treatment has been around since the 1980s, only recently has a degree of standardisation has been reached. Yet therein lies the problem.
The use of these planning software packages, milling and 3d printing, integration of scans of the bones of the jaws, teeth and gums takes a long time to master, even without the surgical understanding necessary to deliver this sort of treatment. It is simply not possible to use a standard process to adapt treatment to each individual as one might deliver different versions of the same vehicle.
Much of the skill in delivering the final result will depend on many factors:
- The training and skill of the surgeon (Implant Dentist)
- Their experience in this area
- What sort of training have they had. (It is possible to achieve a Masters degree in Implantology in the UK without placing a single dental implant in a live patient!)
- Do the dental team have the training to support the delivery of this type of care?
- What is the support to the patient both before, during and after the treatment?
- Does the laboratory selected to deliver both the prototype (temporary) and final bridges, have the capability and experience to deliver consistently restorations which both fit and are aesthetically pleasing?
- Do they have the understanding of the various options regarding materials which can be used?
- What sort of guarantees are in place and they are realistic?
- What are the expectations for the patient (and restrictions). Just as if the customer purchases a new vehicle there are certain expectations on servicing and maintenance, it is only prudent to expect the same with dental implant restorations. A lack of maintenance schedule available might suggest a less than comprehensive package.
- Has the patient been given the information necessary to maintain the implants in a high state of health? Do they understand their responsibilities as well?
Just to achieve the objectives requires a significant amount of training for all the of the dental team and laboratory partners, and this is the bare minimum.
In addition the manufacturer chosen to supply the implants and components can vary hugely in cost. There are ‘premium brands’ whom command a higher fee and many many others. The premium brand companies have often been present for many years with a proven track record and a history of R&D. The cheaper brands will often work just as well, but the quality of the product might not be just as reassuring and frequently not readily available. The implants themselves are manufactured all over the world.
Choosing a dental implant clinic
Dental implant treatment can be life changing and in the majority of cases is extremely successful. However if not well planned executed and maintained can lead to misery and further expense. Many dental teams will be unwilling to take on potentially expensive and complex failures which are invariably not well documented and sometimes impossible to trace original components.
The disaster stories regarding dental tourism and ‘turkey teeth’ are unfortunately in many ways accurate but often not because of the poor treatment process. It is well nigh impossible to deliver consistently high-level treatment in impossibly short timeframes of a week or so, and equally impossible to implement a follow up package. Many of those who travel overseas are interested in only the bottom-line cost and appearance rather than quality of the final treatment, let alone the requisite follow up and maintenance. The clinics delivering these treatments are often advanced and employ very competent surgeons and administrative staff. Yet assessing a new patient overseas and then delivering treatment in such short timeframes is the reason for the all-too-common failures.
Unfortunately, these stories are not just restricted to dental tourism. The variation in the standard of implant dentistry in both UK and Ireland varies hugely for the very same reasons. Failures are becoming commonplace and a lack of knowledge of how to deal with complications is apparent.
Therefore, those interested in dental implants will need to be somewhat careful in choosing whom to deliver this advanced care. The general dentist will be able to ‘refer’ to a dentist who carries out implant dentistry. This might be someone who has many years of experience or someone who does not even possess a postgraduate degree in implant dentistry.
There are very few restrictions imposed by the General Dental Council as to whom can carry out dental implant treatment. A ‘specialist’ in Implant Dentistry does not exist and those who refer to themselves as ‘specialists’ are at risk of been caught out.
The patient should receive a proposal for their treatment which should identify all the stages involved as well as the risks and benefits. This is all referred to as ‘The Consent’.
Although onerous, this must be examined and signed prior to dental treatment commencing. If the patient is not 100% clear of what is involved then this MUST be discussed prior to commencing. If still in doubt then a second opinion must be sought. Prices WILL vary and sometimes significantly. The point mentioned above are the reason for this variation. Questions that could be asked are:
- How many implants have you placed?
- How many years have you been placing implants and where did you do your postgraduate training?
- Who are the team you are working with and where was their training?
- Who manufacturers your implant system and what guarantees ( if any) might you offer?
Implant dentistry is really life changing in the benefits it can offer, it can transform someone who is unable to speak, smile or eat with confidence to someone whose life has been transformed.
But just like going shopping for a car, some homework on the provider of the treatment is advised to ensure that not only the cost is understood but also the process and the long term maintenance.