Summer 2003 Dental Practice Building Strategies

A Montage Media Publication

Implant Profitability and the Restorative Practice Roger P. Levin, DDS, MBA

The Restorative-Driven Surgical Practice —Building Success by Creating SuccessStanton R. Canter, DDS

Implant Treatment — The “Best Option is the First Option”Craig Ford, DDS

Implant Profitability and the Restorative Practice Roger P. Levin, DDS, MBA

The Restorative-Driven Surgical Practice —Building Success by Creating SuccessStanton R. Canter, DDS

Implant Treatment — The “Best Option is the First Option”Craig Ford, DDS

Laurence K. FishmanOwner, PresidentTrident Dental Laboratories

Dear Doctor:

In these uncertain economic times, maintaining practice profitabilityrequires dental professionals to expand their restorative capabilities.One frequently overlooked option is the utilization of implants.

Many clinicians may be apprehensive about incorporating implanttreatment into their practice, however, the Easy Abutment® system hastransformed implant dentistry into a simpler, more profitable alterna-tive. With the Easy Abutment System, dentists can develop a “com-fort zone” for implant treatment. Given the high success rate ofimplants, this means greater satisfaction for your patients and morereferrals for your practice. At Trident Dental Laboratories, fabricationsof implant restorations are now as easy as crown and bridge work.

In this issue of Perspectives, prominent industry leader, Dr. GordonChristensen discusses the selection and use of abutments in implantdentistry. Also presented are methods by which surgical practi-tioners can benefit from converting their practice into a “restorative-driven surgical practice.”

Enclosed please find a special coupon for $50.00 off your nextProcera® case, as well as an offer for a free Procera display modelfor your office. If you have not yet taken advantage of our comple-

mentary practice development kits, please feel free to contact us at 1-800-221-4831 and one will beimmediately sent to you.

We hope you enjoy Perspectives, and that you discover many useful products and techniques which willbenefit not only your practice but also your patients.

As always we sincerely value and appreciate your business, and welcome your comments regarding howTrident might serve you even better.

Sincerely,

Laurence K. Fishman

Letter From the President

Dental Practice Building Strategies

▲Volume 2 2 Number 2

Standard of CareWhile implants are not literally a “stan-dard of care,” it could be argued thatthey should be. Based on today’s98.3% success rate, dental implantsshould be offered as a treatment optionto every patient with missing teeth. Ifevery candidate for dental implants issimply presented with the opportunityto have a complete implant consultationand exam, practice case acceptancewill grow significantly. Once patientslearn about dental implants, manymake the prudent choice of havingthem performed in order to achieve abetter quality of life. As the number ofcases begins to grow and patient refer-rals increase, an implant profit centercan be developed.

Most dentists know that there is nocomparison between a standard den-ture and an implant-retained denture.Along those same lines, most dentistswould opt for an implant—rather thana 3-unit bridge—to avoid cuttingdown teeth on either side of an exist-ing space. Therefore, dentists mustgive patients the opportunity to choosedental implants—the optimal treatmentsolution with a positive impact on theiroral health and quality of life.

Perhaps the best feature of implantdentistry is patient satisfaction, whichis usually extremely high due to the98% success rate mentioned earlier.In the rare instances when an implantfails, the failure occurs prior to therestorative phase of treatment.

Dentistry’s MostPromising Service Due to the enormous potential of implantdentistry, dentists are encouraged to eval-uate its benefits more closely. Implantdentistry is advantageous to patientsas well as productive and profitablefor practices. Levin Group empiricalanalysis demonstrates that many restora-tive cases involving implant dentistry

One area of dentistry that is intu-itively understood, but rarelydiscussed, is implant profitability.

It seems that most individuals promotingimplants are discussing them strictly froma quality standpoint or from a case-acceptance perspective. Although bothfactors are important, one implication ofadding implants to the service mix isoften overlooked—profitability.

Implant dentistry is beneficial forboth an implant surgical practiceand a general practice. Over 98%of the implants placed utilize a teamapproach based on collaborationbetween a specialty practice and arestorative doctor. This column limitsits focus to the impact of implants onthe restorative practice.

In the last 25 years, restorative den-tal practices have experienced agradual shift from a steady flow ofpatients to a higher volume model.Dentists today see more patients thantheir predecessors did 25 or 30 yearsago. The increase in patient flow hasresulted mainly from the need toaccommodate growing demand andto maintain income. Statistically, incomeper patient has actually declined in thepast decades. In order to maintainincome levels, practices have had tocompensate for this trend by increasingthe volume of patients treated.

Over the past decade, therehave been many improvements indental materials and technologies.This stated, very few new categoriesof service have been added to den-tistry during this period. For thisreason, dental practices are not likelyto increase their treatment volume orto improve their financial situation sim-ply by waiting for new categories ofservice to come along. Instead, den-tists must better utilize and expandservices available today. Implant den-tistry stands out as an ideal service topursue more aggressively.

Implant Profitability and the Restorative Practice

Dental Practice Building Strategies

Roger P. Levin, DDS, MBA

▲Volume 2 3 Number 2

have a 30% to 40% higher productionthan the same case without dentalimplants. In other words, if your denturefee is $800, your implant fee should be$1,040 to $1,120. The higher feerepresents a range of 30% to 40%increase in production. This increase inproduction guarantees that the practicemaintains a 40% profit margin on theimplant services without a complexanalysis of the cost of every componentin the implant case.

Restorative doctors do not havetime to analyze every implant case indi-vidually and set commensurate fees. A30% to 40% higher production percase will not only maintain the profitmargin of most practices, but will actu-ally significantly increase real profit.This ultimately translates into increaseddoctor income.

SummaryDental implants provide an excellentquality service to patients and a lucra-tive profit center for restorative practices.This optimal treatment option needsto be supported by solid manage-ment systems and through properpatient education. �

Stanton R. Canter, DDS

Our practice has always striven totreat patients with the highest lev-els of professionalism and skills.

Approximately five years ago, we recog-nized the need to continue our growthand differentiate our practice from otherqualified oral surgeons and periodon-tists. In order to accomplish these goals,a unique core-operating model had tobe developed based upon a key set ofprinciples that created success for othersas well as ourselves. The concept of therestorative -driven surgical practice wasborn. This philosophy of creating suc-cess for others first is based upon the fol-lowing core principles:

� All energy is derived from thepatient.

� Whoever comes in contact withthe patient has an impact onthat energy —in most cases, therestorative dentist.

� The restorative dentist should offerthe Implant Treatment Option (ITO)whenever indicated.

� ITO is offered by practicing “BestOption/First Option” in every casepresentation. Based upon these core principles,

our group adopted this operating belief-”As a restorative - driven surgical prac-tice, we place the abutments and takefixture-level impressions. This allows ourrestorative referral base to achieve sim-ple, esthetic crown-and-bridge solutionsin the vast majority of cases.”

Dental Practice Building Strategies

The Restorative-Driven Surgical Practice—Building Success by Creating Success

The Restorative-Driven Surgical Practice—Building Success by Creating Success

to deliver the definitive restoration. For ourreferral network, the Easy Abutment iscrown-and-bridge.

Commitment Beyond EasyAbutment PlacementTo truly be a restorative-driven surgicalpractice, the commitment must gobeyond the simple placement of anEasy Abutment. While the patient isanesthetized, any gingival contouringis performed to create the ideal gingi-val esthetics. When appropriate, animplant level impression is taken at thetime of initial implant placement whilethere is direct visualization. Our officethen works directly with the laboratoryfor the placement of the final abutment.In these cases, Procera® custom abut-ments are chosen as a result of the per-sonalized abutments in virtually anyshape and material (alumina, zirconia,or titanium) required for the case. Thefinal ceramic crown can also be deliv-ered through the Procera® laboratory,if desired. Once the initial fixture-levelimpression is taken, the restorative den-tist can choose to receive the finalabutment in place and ready for tem-porization or to work with the labora-tory to obtain the placement of thefinal abutment and a custom provision-al crown. In reality, the restorative refer-ral network is seldom more than astandard crown-and-bridge impressionfrom the final restoration.

The restorative-driven surgical prac-tice recognizes what every successfulrestorative dentist knows—”all patientsmake decisions based upon a want. Thisis then converted to a need on which aneconomic value can be placed.” �

Stanton R. Canter, DDS, writesand lectures on the building ofsuccessful practices and maintainsa private practice in periodonticsin Woodland Hills, CA.

Converting to aRestorative-DrivenSurgical PracticeIncorporate Efficient SolutionsTo be successful as a restorative-drivensurgical practice, efficient restorativesolutions must be implemented intodaily operations. Manufacturers suchas Nobel Biocare provide solutions tosuccessfully offer high-quality services toour referral network. This includes acomplete line of implants and simpleabutment solutions, as well asadvanced esthetic solutions for restora-tions on implants and natural dentition.This is key to the success of a restorative-driven surgical practice.

The Easy Abutment™ (Figure) hasenabled our practice to reach new levelsof growth and to fulfill the building blocksof success for the restorative dentist. Inmany cases where adequate interoc-clusal space and good quality bone exist,

an Easy Abutment and white healing capare placed at the initial surgery appoint-ment. The final restoration is maderestorative simple by the Easy Abutmentimpression kit that is provided with theabutment. The restorative dentist gentlyplaces the impression coping, injectsimpression material, and obtains a stan-dard crown-and-bridge impression. Oncethe model is poured, the laboratory alsoemploys standard crown-and-bridgetechniques to fabricate the crown. At thefinal appointment, the dentist uses con-ventional crown-and-bridge procedures

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Figure. The Easy Abutment™ eliminates thedifficulty of implant treatment.

required a standard crown-and-bridgeimpression and could be forwarded to astandard crown-and-bridge laboratory.He explained that restoring the majorityof implant cases was simply accomplish-ing what was performed daily in ourrestorative practices. With the plastic sur-gery model—one of the great benefitsof implant dentistry, dental professionalswill not be held captive to insurance-limited dentistry.The development of den-tal implants such as the Easy Abutment

provides the opportunity to practice the“Implant Treatment Option” for everyedentulous space, where indicated, asthe “Best Option, First Option.”

Case acceptance of implant treat-ment in our practice now mirrors that ofcrown - and- bridge cases.Whereas clini-cians had been hesitant or apprehensiveto perform implant treatment, the simplici-ty of the Easy Abutment enables implantcases to be implemented every day with-out fixture-level impressions, gingivalbleeding, tissue contouring, and the

need to further anesthetize the patient.Since all of the components are includ-ed with the Easy Abutment, there is norescheduling of patients due to unavail-ability of the proper component.

Since implant treatment is now as predictable as crown-and-bridgecases, treatment profitability, too, ismore predictable. Implant treatmentcan be accomplished in nearly half thetime with fewer patient appointments(Table). The acceptance of large, case

treatment plans can be routine, and thetruly complex implant cases will notbe charged until consultation with thesurgeon and the laboratory is complete.

With the implementation of the firststage of the restorative-driven surgicalpractice, we eagerly await the introduc-tion of the second and third generationsat the next study academy meeting. �

Craig Ford, DDS, maintains aprivate practice in general den-tistry in Woodland Hills, CA.

Craig Ford, DDS

A bout five years ago at a studyacademy meeting (conductedby Drs. Robert Shuken and

Jeffery Foltz), Dr. Stanton Canter intro-duced the concept of a “Restorative-Driven Surgical Practice.” In truth, veryfew at the meeting understood the con-cept or the impact it would have onour practices. Considered by many tobe a visionary in creating successfulpractices, Dr. Canter predicted thatone day the majority of implant caseswould be sent to the dental labora-tory for standard crown-and-bridgefees, not the implant case surchargesthat were standard industry practice. Itwas doubtful that anyone in that lec-ture hall thought that day would evercome. He also presented the operat-ing principle of the restorative-drivensurgical practice by asking “How canwe make your practice more success-ful?” and by observing the procedureperformed first and foremost throughthe eyes of the restorative office — thecrown and bridge.

The Easy Abutment™Treatment OptionDuring the meeting, Dr. Canter statedthat in 80% of the implant cases per-formed, there was no distinguishabledifference between an implant abut-ment and a natural tooth eruptingthrough the gingival tissue. In addition,the majority of these implant cases

Dental Practice Building Strategies

Implant Treatment—The “BestOption Is the First Option”

Implant Treatment—The “BestOption Is the First Option”

Conventional Restorative-DrivenImplant Treatment Surgical Practice

Restorative Dentist Restorative Dentist

Healing abutment placed by surgeon Easy Abutment placed by surgeon

Easy Abutment placed by surgeon

Appointment #1 – 45 min Appointment #1 – 30 minRemove healing abutment Remove cover capPlace implant-level impression coping Place plastic impression copingTake an x-ray Take crown-and-bridge impressionTake implant-level impression Replace cover capReplace healing abutment

Appointment #2 – 45 min Appointment #2 – 30 minRemove healing abutment Remove cover capPlace final abutment for try-in Deliver crownTry on crown copingRemove final abutmentPlace healing abutment

Appointment #3 – 45 minRemove healing abutmentPlace final abutmentTorque screw to 35NcmDeliver crown

Total Time Total Time2:15 hrs – 3 Appointments 1:00 hr – 2 Appointments

▲Volume 2 5 Number 2

T o some degree, most dentistshave become involved withdental implants. However,

many may feel that the concept is toodifficult and/or expensive and haveresisted incorporating implants intotheir practices. Those general dentistsinvolved with implants usually haveaccomplished the prosthodontic aspectsof implant dentistry; some have evenbecome proficient with the surgicalportion of implant dentistry. AlthoughI am a prosthodontist, I accomplishboth prosthodontic and some surgicalportions of the procedure. This deci-sion has enhanced my ability to diag-nose and plan treatment for implantdentistry and has increased my refer-rals to surgical specialists for some ofthe procedures. I suggest a similarorientation for any practitioners inter-ested in broadening the service pro-vided to their patients and introducinga high level of excitement and satis-faction into their practices.

One of the most frustrating chal-lenges in implant dentistry has beenselection and use of abutments whenreplacing a single tooth and restoringmultiple missing teeth. The selectionof abutments has been both perplex-ing and difficult; hence, some labora-tories have ceased to construct implantprostheses. Questions about abut-ments were less frequent in the early

Dental Practice Building Strategies

portions. For high-quality laboratoryservice, it is desirable to work with full-service laboratories that can follow aspecific case from start to finish.

Many dentists are hesitant to offerimplant dentistry to patients who maybe perceived as unable to afford suchtreatment. In many of these situations,upon presentation of the treatment plan,implant therapy may be accepted with-out reservation. Every patient who couldbenefit from the significant advan-tages of implants should be offeredthis opportunity. If treatment plansare presented honestly and thorough-ly, many patients will obtain the finan-cial resources to afford the treatment.

Implant prosthodontics hasimproved significantly over the pastseveral years. For any dentist who hadbeen previously discouraged aboutincorporating implant dentistry or whodoes not perform this important part ofdentistry due to past technique frustra-tions, it is time for reevaluation and theaddition of this invaluable service intodaily practice. �

Gordon J. Christensen, DDS,MSD, PhD, is the Director,Practical Clinical Courses and co-founder and senior consultant,Clinical Research Associates. He maintains a prosthodontic practicein Provo, Utah.

development of dental implants, sincemost of the restorations were providedfor edentulous patients. Esthetic accept-ability was much less critical when oralreconstruction was performed withmodified complete dentures. Currently,many implant restorations are fabri-cated for single teeth, and abutmenttype is essential for acceptable esthet-ics, and strength, and long-term func-tion (Figure 1).

Clinical Research Associates hasconducted research in CAD/CAMrestorations for many years. What wasonce an interesting novelty or hobbyhas progressed into a remarkably use-ful tool for quality dentistry. The customProcera® Abutment, whether alloy orceramic, allows optimum estheticacceptability (Figure 2). Upon place-ment of an all-ceramic Procera® crownor a precision-fitting porcelain-fused-to-metal crown, the results can beexcellent. Additionally, the greatly sim-plified Crown & Bridge & Implant(C&B&I) concept from Nobel Biocarehas made implant dentistry faster, eas-ier, and better. Any new techniquerequires a learning period, but oncemastered, both laboratory techniciansand dentists can readily comprehendthis technique.

Some laboratories infrequentlyaccomplish implant prosthodontics oronly construct fixed or removable

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Implant Dentistry Made EasyImplant Dentistry Made Easy

Figure 1. Abutment type is essential for opti-mum esthetics, strength, and long-term functionas shown by implant-supported crowns onteeth #7 and #10.

Figure 2. Abutments such as the custom Procera®

abutment can allow optimum esthetics.Gordon J. Christensen, DDS, MSD, PhD

M any years ago, a highly revered professor of oper-ative dentistry repeatedly lectured our dental classon how dentists were artists as well as scientists. Art

had never been my strong suit, hence, throughout my 40-yearcareer, I strived to maintain procedures that were as routineand mechanical as possible.

Since shade taking is basically an art form, this was oneprocedure that defied a mechanical approach. However,with contemporary advancements in technology, precisetooth shade can be measured electronically. In addition, thismeasurement tool eliminates guesswork and improves com-munication between the dentist and laboratory.

With due diligence, I opted for the Shade Vision™System from X-Rite®. Using the detailed training video, thesystem was easy to install on my computer. The shade-taking process is also simple; just point the cordless,

handheld instrument at thetooth and shoot to calculatethe shade values. The imagescan then be forwarded to thelaboratory via e-mail or savedto a disk. The Shade VisionSystem provides the laboratorywith objective color informa-tion to fabricate the restoration.

The Shade Vision Systemenabled me to transform the art ofshade taking into a science. Formore information, contact X-Riteat 866-617-4233 or via e-mailat info@shadevision.com. � David Fishman, DDS

▲Volume 2 7 Number 2

Wet Finger Report