Are placing implants worth it as a GP?

[Mauricio45]

I'm considering taking an implant training course. Specifically, the Maxicourse. I've been out 5 years now and would like to expand on my skillset.

Just curious if any GPs here place them? Is it worth the investment? Thanks.

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[oralcare123]

There are less expensive options out there

 

[maruprime]

I’m a surgeon. I spent $12,000 to get an implant kit. I already had a bien air electric handpiece for $15,000 with 2 straight nose and 1 implant angled drill. I order each implant after I do my consults. I don’t have a stock of 20-100 implants sitting in my cabinets. Each implant is $375. I also pay for the cover screw, and I buy the analogue and coping to give to the dentist. This makes it over $550 for all the parts. I use Nobel, straumann, zimmer. I don’t use the cheap $90 implants. I’ve taken many of those out due to failure. The dentist next door charges $2000 for implant and crown and he has a big advertisement painted on his window so I have to charge less than $2000 to place an implant. I also already have a Kodak cbct that cost me $75,000.

It’s a big investment.

 

[Mauricio45]

I’m a surgeon. I spent $12,000 to get an implant kit. I already had a bien air electric handpiece for $15,000 with 2 straight nose and 1 implant angled drill. I order each implant after I do my consults. I don’t have a stock of 20-100 implants sitting in my cabinets. Each implant is $375. I also pay for the cover screw, and I buy the analogue and coping to give to the dentist. This makes it over $550 for all the parts. I use Nobel, straumann, zimmer. I don’t use the cheap $90 implants. I’ve taken many of those out due to failure. The dentist next door charges $2000 for implant and crown and he has a big advertisement painted on his window so I have to charge less than $2000 to place an implant. I also already have a Kodak cbct that cost me $75,000.

It’s a big investment.

Yeah, that's quite an investment. I still want to place em though. It gets "boring" to just do fillings, RCTs and exos all day. So, I want to expand.

I only just want to do "straightforward" cases though such as single, posterior implants. I would avoid complicated procedures such as anterior implants, sinus lifts lateral windows, overdentures, etc.

For CBCT, can GP's not refer patients to another office that has one for the scan? Or refer to OS for the scan? Rather than spend $75,000 for the machine.

 

[ncide]

Yeah you can refer out your CBCT scans. Also don't cross off overdentures. They're not that difficult.

 

[Lemillion]

Have you looked into the course at Birmingham?

CIRP in Alabama - Comprehensive Implant Residency Program

Alabama Implant Education provides Comprehensive Implant Residency program (CIRP) which will help you to take your dental surgical training to the next level.

www.dentalimplanttrainingce.com

I have a handful of friends that went through that program and loved it. Sounded like it was a great investment when chatting with them.

 

[ElCubanito]

I took Implant Direct Hands On course maybe a couple years out of school. I only do single unit, some bridge and overdenture cases. I dont use CBCT. I have been placing DSI Implants for almost 10 years, they are inexpensive and impressive component options. I typically prep the abutment in the mouth and take an impressions. Few failures that I can remember, but I typically replace for free because the implants are so inexpensive. I wouldn't do them as an associate in someone elses practice though. Implant kits and drills are dirt cheap. So yes, totally worth the investment.

 

[ElCubanito]

I’m a surgeon. I spent $12,000 to get an implant kit. I already had a bien air electric handpiece for $15,000 with 2 straight nose and 1 implant angled drill. I order each implant after I do my consults. I don’t have a stock of 20-100 implants sitting in my cabinets. Each implant is $375. I also pay for the cover screw, and I buy the analogue and coping to give to the dentist. This makes it over $550 for all the parts. I use Nobel, straumann, zimmer. I don’t use the cheap $90 implants. I’ve taken many of those out due to failure. The dentist next door charges $2000 for implant and crown and he has a big advertisement painted on his window so I have to charge less than $2000 to place an implant. I also already have a Kodak cbct that cost me $75,000.

It’s a big investment.

A lot of people get into implants at a more affordable bracket. I find that $20 implants integrate the same as $375 implants. Also, you dont need a CBCT to place a straight forward implant. Lets be honest here.

 

[ncide]

A lot of people get into implants at a more affordable bracket. I find that $20 implants integrate the same as $375 implants. Also, you dont need a CBCT to place a straight forward implant. Lets be honest here.

They all use the same source for titanium blocks.

Metallurgy more important than implant surface treatment and shape? Hmmm...

 

[Mauricio45]

Have you looked into the course at Birmingham?

CIRP in Alabama - Comprehensive Implant Residency Program

Alabama Implant Education provides Comprehensive Implant Residency program (CIRP) which will help you to take your dental surgical training to the next level.

www.dentalimplanttrainingce.com

I have a handful of friends that went through that program and loved it. Sounded like it was a great investment when chatting with them.

Thanks. However, I'm in Canada so it would tough to take that course especially with COVID. I'm planning on taking Maxicourse.

 

[laundry]

Implant dentistry is a great addition to your revenue stream if you plan to do it regularly.

Firstly, implants kits and motors/CBCT are what we refer to in business as sunk costs - something that you spend money on once, can amortize over time, and thus is not considered in the cost of doing business.
Second, most implant companies will give you the kit for free and significantly cut the price of the motor if you buy 30+ implants from the get go. You can, of course, then exchange the implants for the exact sizes you need, case by case.
Third, I use Straumann exclusively (I'm a GP) and I manage to get a great discount, with even BLX costing less than $300 with free cover screws and healing abutments because I bulk order. I place about an average of 30 implants / month (range of 10-50). I charge $ 325 for CBCT (have it in house together w/ Trios), $700 for surgical guide and $1700-2500 per implant (depends on in-network vs UCR). Guides run about $300. So, my total revenue per implant placement is $2725 at it's lowest. Guided implant placement into an edentulous site takes about 15 min. We can safely book 30 min appointments for most cases.
Four, single implant placement can lead to more advanced cases, like all-on-$$$.

So, as you can see, if done correctly, implants are pretty awesome.

 

[PerioDont]

Implant dentistry is a great addition to your revenue stream if you plan to do it regularly.

Firstly, implants kits and motors/CBCT are what we refer to in business as sunk costs - something that you spend money on once, can amortize over time, and thus is not considered in the cost of doing business.
Second, most implant companies will give you the kit for free and significantly cut the price of the motor if you buy 30+ implants from the get go. You can, of course, then exchange the implants for the exact sizes you need, case by case.
Third, I use Straumann exclusively (I'm a GP) and I manage to get a great discount, with even BLX costing less than $300 with free cover screws and healing abutments because I bulk order. I place about an average of 30 implants / month (range of 10-50). I charge $ 325 for CBCT (have it in house together w/ Trios), $700 for surgical guide and $1700-2500 per implant (depends on in-network vs UCR). Guides run about $300. So, my total revenue per implant placement is $2725 at it's lowest. Guided implant placement into an edentulous site takes about 15 min. We can safely book 30 min appointments for most cases.
Four, single implant placement can lead to more advanced cases, like all-on-$$$.

So, as you can see, if done correctly, implants are pretty awesome.

Are you guys having a lab made guide?

Getting into 3D printing with software like Blue Sky could save you tons on surgical guides.

 

[PerioDont]

I'm considering taking an implant training course. Specifically, the Maxicourse. I've been out 5 years now and would like to expand on my skillset.

Just curious if any GPs here place them? Is it worth the investment? Thanks.

As a perio resident, my only thoughts are make sure you do the straightforward cases and when you know what you are doing.

We get **** implants that we have to explant or do other things with as they were not done properly everyday. very difficult not to throw some of those people under the bus

 

[laundry]

Are you guys having a lab made guide?

Getting into 3D printing with software like Blue Sky could save you tons on surgical guides.

Yes - exploring this now. Although it would only save about $100-150 per guide.

 

[Mauricio45]

As a perio resident, my only thoughts are make sure you do the straightforward cases and when you know what you are doing.

We get **** implants that we have to explant or do other things with as they were not done properly everyday. very difficult not to throw some of those people under the bus

That's why I like the Maxicourse. I'm taking it at UBC in Vancouver. It's a 10 month long course with a good amount of clinical experience with mix of didactic. It seems comprehensive too at 300 CE hours too. I don't want to just take a weekend course and then start placing implants. You can't possibly know everything after 1 weekend.

I plan on taking more courses too.

 

[LaughingGas]

Clinical survival of implant is not same as success rate. Straightforward cases may look " straightforward" but I can tell you CBCT will definitely make you humble..

 

[JackyTreehorn]

Do not do implants as a GP without CBCT. Invest in good quality CE. You'll need the kits, bone grafting materials, membranes, PTFE sutures, Implants, guides, CBCT scans, ect.

Try to get a reputable brand contract 20-30k that includes discounts on components, guides, implants, copings, kits, ect. You can finance these contracts, but make sure you have some case load to make it worth it.

CBCT if you don't have a scanner then use a mobile unit that comes to your office. Make the patient pay for the guides, scans, grafts, ect. It's expensive and a big investment. I would not invest in a CBCT machine right away unless you have the cash backing or you already have a big case load. If you are a beginner, get scans from the mobile unit or use someone else's scans. If you are a beginner, don't skimp on anything and do it by the book. Pick your poison in terms of cases, pick the RIGHT cases. Don't do sketchy cases to start with bad bone or limitations. Single unit posterior cases. Be damn careful working around the mental foramen or lingual cortical plate. Don't do 2nd molars to start with, bone is crap back there especially maxillary arch.

 

[DavesNotHere]

Implant dentistry is a great addition to your revenue stream if you plan to do it regularly.

Firstly, implants kits and motors/CBCT are what we refer to in business as sunk costs - something that you spend money on once, can amortize over time, and thus is not considered in the cost of doing business.
Second, most implant companies will give you the kit for free and significantly cut the price of the motor if you buy 30+ implants from the get go. You can, of course, then exchange the implants for the exact sizes you need, case by case.
Third, I use Straumann exclusively (I'm a GP) and I manage to get a great discount, with even BLX costing less than $300 with free cover screws and healing abutments because I bulk order. I place about an average of 30 implants / month (range of 10-50). I charge $ 325 for CBCT (have it in house together w/ Trios), $700 for surgical guide and $1700-2500 per implant (depends on in-network vs UCR). Guides run about $300. So, my total revenue per implant placement is $2725 at it's lowest. Guided implant placement into an edentulous site takes about 15 min. We can safely book 30 min appointments for most cases.
Four, single implant placement can lead to more advanced cases, like all-on-$$$.

So, as you can see, if done correctly, implants are pretty awesome.

can i ask what state and type of city are you in? I’m curious only because you’re charging up to $3500 for cbct+guide+implant and then patient will owe additionally for a crown and that’s a lot more than surgeons around me charge. You seem to be placing a lot if you’re getting 30/month though.

Patients are okay paying $700 for a $300 guide?

thanks

 

[laundry]

can i ask what state and type of city are you in? I’m curious only because you’re charging up to $3500 for cbct+guide+implant and then patient will owe additionally for a crown and that’s a lot more than surgeons around me charge. You seem to be placing a lot if you’re getting 30/month though.

Patients are okay paying $700 for a $300 guide?

thanks

SF Bay Area. Implants have fairly inelastic demand curves, so if you explain their value to patients correctly, they have no problem with higher fees.

 

[DavesNotHere]

SF Bay Area. Implants have fairly inelastic demand curves, so if you explain their value to patients correctly, they have no problem with higher fees.

Ah okay, yeah that’s the type of region i was expecting. Cool.

 

[Alpha Centauri]

If you need surgical guides for single unit implant cases you are not skilled enough to place implants without supervision / training

 

[allDAT]

You should learn to place them. Local specialists should support your development. If they don’t, find new ones to refer to.

 

[bergus95]

You should learn to place them. Local specialists should support your development. If they don’t, find new ones to refer to.

How does that work? Curious here, how can a specialist support development and what are you referring them in exchange? Never really got an understanding of these dynamics. Thank you

 

[Mauricio45]

Local specialists should support your development. If they don’t, find new ones to refer to.

Probably hard to find. Especially in a cut-throat business like dentistry.

 

[allDAT]

How does that work? Curious here, how can a specialist support development and what are you referring them in exchange? Never really got an understanding of these dynamics. Thank you

Sorry for the delayed reply, I haven’t signed into SDN for a few weeks.

A specialist can offer to make their CBCT accessible to the GP to start. Then the specialist can review cases with the GP quarterly or biannually over lunch or dinner. The specialist can invite the GP to be present during implant placement on his or her own patients. For example, if I have an interest in learning to place implants or improve my placement, I would refer a patient to my OS and accompany the patient to the office during surgery. Watch, learn, ask questions.

Works well for both parties if the GP decides to no longer EXT any wisdom teeth and refers all of them to the the helpful OS. Also works well if the GP learns to place implants and decides to only deal with single units and refers all patients who need multiple implants to the OS, etc.

This works for Ortho, OS, and Perio. Not really applicable to pedo or endo.
For perio, it helps them to teach GPs to place posterior implants in exchange for all the anterior ones because perio is competing with OS for posterior implants. The perio would then be in a better position to gain the referrals for the tough posterior implants from this GP.

For ortho - it seems that the orthos I know who do the best, are very open to teaching GPs how to do simple ortho because they know that it’s not really profitable if the GP is just dabbling and will result in even more referrals When the GP learns what to look for.

 

[allDAT]

Probably hard to find. Especially in a cut-throat business like dentistry.

Easier to find in competitive markets where specialists are abundant. Hard to find in small towns where there’s a long wait to see OS and there’s no Perio, pedo, and only 1 ortho.

 

[rippedbx]

How does that work? Curious here, how can a specialist support development and what are you referring them in exchange? Never really got an understanding of these dynamics. Thank you

I had an OS that came into our office for 2 days/month. I asked for some feedback on Sinus lifts and 3rd molar extractions (I feel comfortable with most 3rds but haven't done any sinus lifts). The OS was bugged that GPs were doing so many difficult surgeries and said, "The world doesn't need more dentists thinking they're superdentists. "

I decided to let him go and I now have an OS that is very helpful.

 

[rotichawal]

I had an OS that came into our office for 2 days/month. I asked for some feedback on Sinus lifts and 3rd molar extractions (I feel comfortable with most 3rds but haven't done any sinus lifts). The OS was bugged that GPs were doing so many difficult surgeries and said, "The world doesn't need more dentists thinking they're superdentists. "

I decided to let him go and I now have an OS that is very helpful.

Dude was being a dick, but I'm not sure how appropriate it is to learn sinus lifts from a visiting oral surgeon

 

[rippedbx]

Dude was being a dick, but I'm not sure how appropriate it is to learn sinus lifts from a visiting oral surgeon

I figure asking about procedures is appropriate. I'm not going to perform a lateral lift based on 60 seconds of what an OS tells me. I'm just asking to see if it's something I would want to do in the future,

 

[schmoob]

How does that work? Curious here, how can a specialist support development and what are you referring them in exchange? Never really got an understanding of these dynamics. Thank you

My specialists have no problems working with and teaching me. They show me techniques and procedures, in return I keep their schedules full. If the Perio is teaching me how to safely place an implant in 30 with abundant bone, I’m more than happy to scratch their back by sending dual arch anterior case with atrophied ridges and tissue graft, a case I know is way above my level. Same thing if for some reason I run into some trouble and need OS or endo to bail me out.
If the specialist wants to nickel and dime with procedures, I would gladly find another specialist who would be more than happy to take my referrals.

 

[gtrdds]

Have you looked into the course at Birmingham?

CIRP in Alabama - Comprehensive Implant Residency Program

Alabama Implant Education provides Comprehensive Implant Residency program (CIRP) which will help you to take your dental surgical training to the next level.

www.dentalimplanttrainingce.com

I have a handful of friends that went through that program and loved it. Sounded like it was a great investment when chatting with them.

Is this a year long course or a week long course. The website says year long but I've been reading that it's a week long course?

 

[Lemillion]

Is this a year long course or a week long course. The website says year long but I've been reading that it's a week long course?

Not sure! Never did the course myself to know. There's a CE course route and then there's the AEGD one year residency route. That may be the difference?

 

[yappy]

Dude was being a dick, but I'm not sure how appropriate it is to learn sinus lifts from a visiting oral surgeon

It was an unreasonable request. Either pay for CE or do a residency.

 

[Yuqiao Liu]

I’m a surgeon. I spent $12,000 to get an implant kit. I already had a bien air electric handpiece for $15,000 with 2 straight nose and 1 implant angled drill. I order each implant after I do my consults. I don’t have a stock of 20-100 implants sitting in my cabinets. Each implant is $375. I also pay for the cover screw, and I buy the analogue and coping to give to the dentist. This makes it over $550 for all the parts. I use Nobel, straumann, zimmer. I don’t use the cheap $90 implants. I’ve taken many of those out due to failure. The dentist next door charges $2000 for implant and crown and he has a big advertisement painted on his window so I have to charge less than $2000 to place an implant. I also already have a Kodak cbct that cost me $75,000.

It’s a big investment.

Really ? 2000 dollars for an implant and a crown???
I thought even a single crown would cost at least 1000 dollars?

 

[schmoob]

Really ? 2000 dollars for an implant and a crown???
I thought even a single crown would cost at least 1000 dollars?

I wonder if this includes the custom abutment?

 

[gowgates]

Mauricio.

Go for it! You spent a lot of money to get the skills to do fills, crowns....what is another $25k for implant surgical knowledge. Even if u choose not to place them, you will diagnose more and this is beneficial to you and the patient.

As for the comment about $20 implants being the "same" as $3-500 implants, I respectful disagree. My ONE PRACTiCE RULE: Just DO same txt option on pts as you would have done to yourself knowing what you know!...

And I refuse $20 implants anywhere near me ..... let alone my dog!.....LOL!

 

[P7898]

If you have the patient base and numbers make sense to do it. AND if the procedure takes you 1 hour or less then I say yes it is worth it.

 

[P7898]

If it takes more than 1 hour then maybe do it on a day where hygiene is limited.

 

[ShortShortsDad]

Sorry for the delayed reply, I haven’t signed into SDN for a few weeks.

A specialist can offer to make their CBCT accessible to the GP to start. Then the specialist can review cases with the GP quarterly or biannually over lunch or dinner. The specialist can invite the GP to be present during implant placement on his or her own patients. For example, if I have an interest in learning to place implants or improve my placement, I would refer a patient to my OS and accompany the patient to the office during surgery. Watch, learn, ask questions.

Works well for both parties if the GP decides to no longer EXT any wisdom teeth and refers all of them to the the helpful OS. Also works well if the GP learns to place implants and decides to only deal with single units and refers all patients who need multiple implants to the OS, etc.

This works for Ortho, OS, and Perio. Not really applicable to pedo or endo.
For perio, it helps them to teach GPs to place posterior implants in exchange for all the anterior ones because perio is competing with OS for posterior implants. The perio would then be in a better position to gain the referrals for the tough posterior implants from this GP.

For ortho - it seems that the orthos I know who do the best, are very open to teaching GPs how to do simple ortho because they know that it’s not really profitable if the GP is just dabbling and will result in even more referrals When the GP learns what to look for.

There’s a lot of good in this reply.

All my “good” referrals - those that I personally like or even semi regularly send me things - have my personal cell and can and do call/text at anytime about anything. That’s pretty much all local dentists except the guy that creates multiple MRONJ cases for me by not taking a good med history and the guy who sends all his thirds far away and expects me to see only the old super sick single exts right away and is a dick to my front desk.

I’m happy to mentor anyone on cases and manage or advise them on how to manage their complications. Most GPs prefer to text but I’m fine if they want to come watch. Implants are fun and while lucrative, a patient that I see for an eval/treat thirds sedation spends maybe a half hour total in my office for quicker easier money - I don’t see it as a loss at all if the GP sends me those and keeps the easy implants.

What I don’t like to see is them do crappy work placing cheap products. Implants are just carpentry, the art is in the planning - conical vs int hex, how sub crestal, grafting techniques, and even prosth considerations like material selection for the final, splinting, engaging/non-engaging abutments must be considered by who is placing the fixture (should being the operative word, Im OMS and I know many of my colleagues don’t consider restorative options as much as myself).

There really is only an “easy” implant if you have knowledge over all those other variables. If you have something go wrong as a GP and god forbid someone makes a complaint (rare but implants are one of the bigger topics) you’ll have to be able to defend all those choices/variables even if you didn’t consciously make a decision. To the dude who said you don’t need a CBCT that’s bad advice, while I don’t always use one a GP will fry if something goes wrong that could in anyway be blamed on lack of imaging. Don’t let that scare you off but also don’t go into this thinking that you can get an accelerated education to just do the easy cases, that’s where most of my middle of the night phone calls from stressed GPs come.

The point about the CBCT though, I will not take scans for anyone else. It’s just too complicated, they have to fill out all the HIPAA stuff and intake paperwork, I’ll have to put a read note in and to do that I really should take a look in the mouth and then I’m doing a consult. I’ll take on the medicolegal liability for the scan and should anything go wrong and the patient sue I’ll be named even though I didn’t touch the patient. For those reasons my malpractice strongly advises against doing this routinely. If a GP has an issue I’ll see the patient and handle it myself, scan and treat if that’s what they want but it’s really not worth it to operate as an imaging center without their setup and safeguards.