In 2000, the dental implant business was not exceptionally lucrative for general-practice dentists. According to a study published in 2016 by the National Institutes of Health (NIH), the prevalence of dental implants at the turn of the century was estimated to be around 0.7 percent—small enough to be easily handled by specialists, and not be worth the time or money for a general clinician.1
That landscape has changed. The NIH found that in 2016, that number had risen to 5.7 percent—and is expected to keep climbing. Increased availability of implants and improved technology are making implants more attractive to patients who want to regain as close to natural feel, look, and function as possible.1 Given how common tooth loss is (a reported 69 percent of adults ages 35-44 have lost at least one tooth) his rising demand means that adding implant services to a general practice could be very profitable indeed.2
But before a practice jumps on the implant train, there are several things to consider. Will it increase revenue? What investments will the clinician need to make? And, eventually, how in the world do you go about getting the word out that you are offering implant dentistry?
The implant investment
The first step to figuring out if you should expand to offer specialty care like implants in your practice is to know if you have the volume to make it worthwhile. Identifying how much work you’re currently referring out will let you determine if bringing those offerings in house makes sense financially. If the lost revenue isn’t substantial, it may not be worth the investment necessary to increase implant offerings.
Crunching these numbers can seem like a headache, but there are ways to simplify the process. Refera, a dental referral management program, offers clinicians a simple dashboard that outlines how many patients were referred to external specialists, allowing the clinician to easily extrapolate what they are referring out and how many. In the future, says Sam Ahani, DDS, a private-practice clinician in California and founder and owner of Refera, the company also hopes to add referrals by specialty types and track how many dollars a practitioner is referring, so they can make more informed decisions.
“Refera’s online platform keeps track of all your referrals in one place,” he explains. “You can quickly see how much production you have referred to specialists. This information wasn’t available when we did paper referrals.”
When it comes to spending money to make money, the level of financial investment in increasing implant offerings depends on how involved you want to be in the process. If you want to do the surgical aspect of the implants, Brian J. Jackson, DDS, diplomat of the American Board of Oral Implantology and fellow and president-elect of the American Association of Implant Dentistry (AAID), says clinicians can expect to shell out some big numbers on an extensive surgical setup.
“Upfront you’ll need things like CBCT and surgical kits, and then as you mature, you’re going to want to add other things like maybe Versa units,” he says. “These different, more specialized aspects of surgical instrumentation are going to be more expensive. And then of course you’re going to have to buy a lot of materials like bone graft material and barriers and implants themselves and all the parts and pieces, so it’s a pretty significant investment if you want to do the surgery.”
And these tools and materials aren’t optional. You’ll need them to provide appropriate care. For example, Dr Ahani says, you’ll need to have a CBCT so that you can properly diagnose. “Remember,” he says, “you will be held to the same standard of care as specialists, so you need the right tools.”
These costs are a big reason why Dr Jackson says clinicians can’t just “dabble” in implants—it’s simply not practical (and you can’t provide the best possible care). However, if dentists are only interested in taking on the restorative end of implant cases, it’s a smaller investment. You’ll still need to purchase a handful of tools for particular systems, but you leave the bigger purchases to the surgical specialist.
Making the determination about expansion is just the first step before you can begin building increased implant business. Before you can promote your offerings, you need to figure out what you’re doing. The bottom line: Education is key.
“The number one thing is that you need to get training,” Dr Jackson says. “You can't just talk to talk; you have to walk the walk. Before you decide that you want to get into the field of implant dentistry, you have to commit yourself to the fact that it's going to be a lifelong learning, and that you're going to have to commit a certain amount of time to some serious education in order to meet patient expectations and be able to have successful outcomes.”
This lifelong-learning process means staying abreast of the latest technology, honing your skills, committing to ongoing continuing education, and perpetually practicing—a commitment that’s probably too great for clinicians who just have dollar signs in their eyes.
“It’s not a field where you’re going to be a dabbler,” Dr Jackson says. “If you decide that you want to be an implant dentist, you're going to have to get education, you're going to need to get training—it's going to require a tremendous amount of time on your part in order to be proficient at it. If practitioners want to be involved in implants and do it at a very serious level that they need to get educated.”
And the education doesn’t stop at the clinician. Hygienists, dental assistants and even the front-desk staff need to understand what increased implant business entails.
“It’s not just you that has to be educated,” Dr Ahani says. “It’s everyone in the office. This will automatically increase your cases going forward.”
If a clinician is serious about ratcheting up their implant business—and skills—the AAID is a good place to start. Established with education in mind, the association is still based in non-biased education. Through maxi courses, annual meetings, and endless other continuing education opportunities, clinicians can develop a framework for implant dentistry. And the education doesn’t stop at the conference door: The AAID mentorship program connects clinicians with specialists for additional support.
“If you’re a dentist that practices in New York and you want to learn how to do implant dentistry, you can go to the AAID and call a member dentist and say, ‘can I come and watch you do implant surgery,’ or ‘can you look over my shoulder and help me with this case?’” Dr Jackson says. “It’s a very welcoming and supportive academy, and I think that’s a great opportunity for those who are just starting out.”
Build good industry relationships
The relationships clinicians can build through AAID aren’t the only ones that will be beneficial when increasing implant offerings. To build a successful implant practice, you need to develop industry relationships with other implant dentists, specialists, and of course, your lab.
“You have to have a great relationship with your lab because, again, these are highly sophisticated prostheses we’re talking about, and they require a great deal of sophisticates on every end—in the surgery, restorative, and laboratory aspects,” Dr Jackson says. “So, your relationship with your lab is critical and so you have to be able to trust that everybody is on the same page as to what is expected.”
In addition to being critical to case success, labs are a valuable resource for implant questions. Many labs work with multiple brands or systems of prostheses, and can give advice on which is best for a particular case. Lean on your lab partners for information and recommendations, and build that relationship; relying on their technical knowledge frees you up to focus on the clinical aspects instead of wading through product marketing materials and spec guides.
Another key component is case selection, and knowing when to call in a specialist. Having a good relationship with a local specialist can help you produce better outcomes for tricky cases.
“You’ll need to decide if you are going to do the care or if you are going to bring in a specialist,” says Dr Ahani. “If you want to do it, you have to get some great education and learn how to pick very, very easy cases—not do just any case—and still refer the hard ones out. This will keep you out of trouble and also leave your relationship with your specialist intact in cases where you may need their help.”
“If you’re bringing specialists in house, you’ll obviously want to make sure they’re a good one, and figure out a way to have them review cases before they come in to do them,” Dr Ahani adds. “One issue that often arises is that they don’t have enough information before coming in.
Quality over all else
Just because a clinician knows how to do implants, doesn’t mean they always do them as thoroughly as they should. This can be catastrophic both for the patient and the practice. One area where Dr Jackson sees problems arise is pressure to finish cases more quickly.
“There's a tendency for our patients to want everything done very quickly,” he says. “As a result, there’s a competition in the marketplace where you know, the guy next door does it in 3 visits instead of 5.”
This, Dr Jackson says, creates a “speed-it-up” mentality for a lot of dentists, which results in cutting corners. Maybe they start to reconstruct on implants that aren’t fully integrated, or perhaps they say, “yeah that's not that important, I think I can go right to the final prostheses rather than having a prototype made.” It could even be as simple as not understanding—or taking the time to understand—some of the more sophisticated approaches on how to take impressions. There are a lot of potential aspects with this that can go wrong, and the dentists who succeed are the ones that progress through all steps of the implant process with care.
“I think the dentists that are the best are very strict to their protocols and they do things a very, very specific way, all the time,” Dr Jackson says. “You have to avoid the compulsion to just do things to finish cases faster. If you do, you’re going to have setbacks.”
Once a clinician starts a case, in many ways they are married to it, so it benefits everyone for them to do it well the first time. If thing don’t go well—especially very early on—then patients expect the clinician to correct things—and usually for free. “This takes implant dentistry from becoming a profitable aspect of your practice, from a business point of view, to a very, very non-profitable aspect very quickly,” Dr Jackson says.
This means that doing things right the first time and not having to correct things or perform revisions is certainly a win-win all the way all around, both in terms of time, patient confidence, and revenue, as you won’t be forced to redo things at no cost.
Marketing by mouth
The aforementioned patient confidence becomes even more critical when you consider marketing. When it comes to marketing your implant offerings, traditional methods may not be the most effective. Unless you are a corporate practice where you’re doing a lot of scattershot advertising on radio or television, rave patient reviews are your most powerful marketing tool. While increased target marketing—like pay-per-click advertising—for implant care may bring in a little new business, it most likely will cost way more than a practice will be willing to pay.
“Most practices build by word of mouth,” Dr Jackson says. “Whether you live in a big city or a small town, you’ll have a ‘small community’ of patients. And within that community, your patients will tell their friends about their experience at your practice and that can make or break your business.”
This makes providing exceptional patient care and a consistently successful end product equivalent to the best marketing campaign that could ever run—but once again, it means putting in the time.
“It comes back to the time commitment,” Dr Jackson says. “If you’re serious about upping your implant abilities, you’ve got to commit to it and do it right. There’s a great sense of responsibility to our patients; implants are not inexpensive and are not something to take lightly. If we’re going to take their money and provide a service, you can’t be guessing about what you’re doing. You need to know how to do it.”
At the end of the day, building implant cases in your practice can’t be a spur-of-the-moment decision. It’s going to take time, money, dedication, and a lot of happy patients to truly expand your business.
“In deciding to increase your implant business, make sure you factor the added costs of marketing, education, equipment, specialists, and tools into the equation,” Dr Ahani summarizes. “A lot of people will just think about what they will get per case, or how much they’ll have to pay the specialist, and not the investments you’re making just to get each case.”