I have been talking about the use of short implants to various groups over the past 15 years. In articles, advertorials, lectures, study groups and roadshows, I have discussed subjects such as simplicity, surgical ease, restorative completxity and I have even talked about money.
The money, the business and profit from treatment is the lifeblood of your practice. Time and again, when questioning the brave souls prepared to listen to our musings, we are amazed and saddened to hear of those who are paying massive amounts for their components and lab bills but still charging low fees because 'that's all the patients can afford,' or 'I want to do implant dentistry but I don't do much because I can't charge enough to make money'.
I don't know how you figure out patient fees. Is it by time, degree of difficulty, overhead? Dentists seem to be terrible business people compared to others but that's maybe understandable because of the intangibility of the treatment process and unpredictability of outcome.
So let's take a look at one simple treatment – the provision of a crown. In the early part of my career, working in private practice in central London we'd charge three and a half times the lab fee. At £100 for a nicely made crown, that would be £350 to the patient. A decent fee, the lab fee was well covered, the practice overhead was dealt with and left a tidy profit. The benefit of this was, if there was an early failure (a breakage, an enforced endo after the crown was cemented, an open contact developing or the patient simply didn't like the colour) you could remake the crown without taking a financial pounding. Charge a decent fee and you can easily cover the occasional failure.
Failure is inevitable, there are always going to be some but the percentages are low. With the simple crown, maybe two per cent of the time I'd be remaking the crown. Of course there would be late failures but they would be years and years away – 10 years plus – and well after the crown had done a satisfactory job.
So could you apply the same method to the implant and crown? A multiple of the implant component fee? How much is that? If you were using the Bicon Implant System the overhead would be £360 (that's implant, healing abutment, impression post, abutment, drills and drapes) plus £90 for a well-made crown from a decent laboratory. So let's apply the multiple for the simple crown treatment: Overhead (£450) x 3.5 = £1,575. On that basis you could provide implant treatment for £1,575 all in and make a decent profit.
What about the failure rate? Implants can suffer from early failure, late failure and periimplantitis, component fracture, crown fracture and aesthetic compromise and dissatisfaction. What percentage would that add up to? Four per cent? Seven per cent?
On the basis that you may charge a multiple of the overhead to provide a profit and that profit is definitely affected by failure rate, aren't you obliged to find reliability at lower cost (like drivers do with a Volkswagen Golf)? The alternative is to use a 'fancy' implant (a Bentley or Ferrari) that is high cost. If you do that your failure rate doesn't change but your overhead does.
Let's say the inevitable failure rate changes the fee to five times the cost. Five times the Bicon overhead is £2,250 but five times the Ferrari or Bentley overhead is around £3,700. There aren't many practices where the patients will bear a fee of £3,700 for each restored implant.
Actually the Ferrari overhead can often be as much as £900 and the mutiple may even be six or seven times. That takes the correct fee, taking in the failure rate to well over £5k.
We make a big thing of the business aspect of implants when we speak and that's really uncommon. What is quite common is practices where they make no money placing and restoring implants, they just feel they should be doing it and have been seduced into thinking they should be using Ferraris and Bentleys. Choose a reliable simple implant at a moderate fee. You know it makes sense.