The Perio Perspective

DF2 Uncategorized

The Perio Perspective
Spring 2017


Your Choice


Clear Choice is coming to Woburn. The “teeth-in-a-day” implant franchise that has been hugely successful and profitable across the country is expanding into New England. Expect to see advertising extending from the Boston market to our region. In fact, as I am writing this, there is a Clear Choice ad on the TV across the room. Seriously.


Clear Choice works. There are many reasons, but the principal explanation is that their business model provides predictable, fixed (hybrid) prosthetic treatment for people with failing dentitions and/or dental phobia. They have a rigorous, systematic approach to diagnosis, treatment planning, surgery, and prosthetics. They provide a firm fee quote with financing options prior to initiating treatment. Although they do not provide maintenance care, their initial rates of success and patient satisfaction are high. Over the next few years, as they continue to expand farther north, you and we will lose patients to them.


So we all have a decision to make. We can choose not to definitively treat the segment of our practices who are candidates for full-arch implant prosthetics. We can nurse them along as they need perpetual intervention for recurrent caries, periodontal disease, and/or fractured teeth. At some point, some of them will pursue another course, either at Clear Choice or at a local practice that offers a similar approach. Or we can help them move forward.


Providing full-arch implant prosthetics, including same-day provisional hybrid insertion, requires a high level of energy and commitment. Many doctors are happy without including this modality in their practices. Others find it highly rewarding, and so do their patients. You can see their reactions on the Clear Choice website (just google Clear Choice Woburn). If you view full-arch implant prosthetics as a source of unwanted stress, and if you are satisfied with your present mix of treatment, read no further. If you prefer a challenge that offers a way to change patients’ lives, and that can be very profitable, then read on. Or perhaps yours is one of the few local practices routinely implementing this type of care, in which case you already know what follows.


There are multiple requirements for successfully incorporating or increasing the number of full-arch implant prosthetic cases in your practice. First – and perhaps the biggest hurdle – is to present the option. This requires knowledge of, and comfort with, the fee. We suggest a global case fee for the surgeon (which includes all imaging, surgical guides, extractions, implants, surgical components, and bone grafting) and the restorative doctor (which includes the provisional and final hybrid, prosthetic components, and lab fees, which usually totals $5000-7000) comprising a total case fee of $30,000 to $32,000. We advocate offering financing from Care Credit or a similar lending source.


Second is a referral to a surgeon with whom you have a close relationship and a high level of trust. Their consultation will include Cone Beam imaging, which will be included in the fee if the patient proceeds with treatment. Along with the restorative doctor’s scans and/or models, it will form the basis for planning the number and location of implants, bone reduction or grafting as needed, and fabrication of surgical guides and the interim prosthesis. Less experienced restorative doctors should count on their surgeons for guidance through the process. On the day of surgery, you will probably see your patient in the specialist’s office for insertion of the interim prosthesis. Some specialists (including us) offer a free initial consultation for curious but undecided patients.


Third is integration with a reliable laboratory. Failure to rigorously adhere to this requirement is the most common cause of frustration and failure in these cases. The laboratory is essential for planning all aspects of the case using its planning software. For all but the most highly experienced restorative doctors, the lab technician should be in the office on the day of surgery and initial prosthesis placement, and should have an inventory of all potentially necessary components. The lab technician with whom we work relieves the restorative doctor of most of the difficult work, since he prepares the prosthesis for picking up all abutments and adjusts and polishes it prior to insertion.


Fourth is a supportive implant representative. He or she should also be in the office on the day of surgery (at least for your first several cases), and should provide implant and surgical supplies for any contingency (and allow return of all unused parts). Most of the well-respected implant manufacturers have local representatives who are eager to provide this support.


Fifth is the right patient. There are several possible reasons for loss of a dentition, and sometimes these reasons make the patient a poor choice. Most problematic is poor compliance, whether with keeping appointments or with hygiene. Other red flags include a history of severe periodontal disease, smoking, young age, and bruxism. Some of the best candidates are older patients with failed prosthetics and/or extensive caries (especially root caries). Others are phobic patients who avoid routine dental treatment but who are willing to undergo one day of sedation, surgery, and prosthetics (and who will return for the final prosthesis and subsequent maintenance).

We estimate that most practices see at least one patient per week who would benefit from considering full-arch implant-based prosthetic treatment (if your practice sees 100 patients per week, this represents 1%). If one of these patients proceeded each month, the financial impact on the practice would be striking. The impact on the restorative doctor’s engagement and advancement in his or her career would be more striking. But most of all, the impact on these patients’ lives would be a revelation. For us, the choice is clear.