Friday, May 27, 2011

Immediate Load

Friday, and I can just taste the beer waiting for me when I get home. My son Luke finished school today. Well, he really finished on Monday, but they party for 4 days just to fill the days. My hard-earned money, well-spent.

Anyway, we were talking about implants. I was telling you about this case that was putting implants at the forefront of my mind. A prosthodontist showed us a case where he removed this patient's lower teeth and put implants in on the same day, and then put on a screw-retained denture. While he was showing up pictures of this I was thinking to myself, "My surgeon would never do something like this."

So I gave him a call. Which reminds me, I think you guys (guys means male and female dentists) need to have a very good relationship with your specialists. If you don't, and they are not easy to talk, to then maybe you need to get another one. I think you need to be able to call your specialist up and ask him questions. Now, my periodontist and I don't like to talk much during work because we talk too long and we both get behind, but that is a good problem to have.

This prosthodontist and I talked for about 10-15 minutes on philosophy. He doesn't mind doing immediate placement that much (but I can tell you he doesn't do it very often). It is the immediate load he has a real problem with.

Let's talk about this a second. This prosthodontist made everyone in the room believe that this was the only way. Whether he meant to do that or not, he still did it. If there was another way and he thought about doing it that way, he didn't mention it.

I was talking to my periodontist and he told me that failure is something that will drive him crazy. And immediate load raises the failure rate 5-7%. To him, that means 5-7% more of his patients are going to be ticked. That means 5-7% more of his work is going to have to be redone.

Like me, he is a perfectionist. He doesn't sleep at night when something doesn't go right. That means 5-7% more sleepless nights. And the cases that fail? They just don't fail; they fail epically. To him, it isn't worth it. He wouldn't have done it that way.

I asked him why he thought this guy would do it this way. He said his surgeon probably told him it was fine. You know who is telling the surgeon it is going to be okay? The implant rep. "Sure doc, we do this all the time. It is no problem."

It also cuts down on chair time. Think about it. In this case it is one surgery and one follow up appointment. If you don't do immediate stuff, you are looking at a lot of surgeries and a lot of time. Extractions and bone grafting. Then 6 months later, you place the implants. Then 4 months later, you might be ready. Then add in all the checks and "this hurts" and "I have a question appointments."

Do you realize how much money the surgeon is saving by doing one visit? Listen, I am not bashing surgeons; I am just making an observation. I have tried to put pressure on my surgeon to do immediate stuff and he just won't do it.

A 5-7% failure increase is too risky for him. Do you know what failure means? You have to bring a patient back in who is just starting to realize things are failing. You have to tell them that you have to redo the whole thing. The patient gets angry. You try to soften the blow by telling them you will do it at no charge, so now the surgeon is angry. And you're angry because you're doing this a no cost, too. The surgeon loses the patient and maybe even a referral source.

By the time you're done removing the implant, doing a bone graft, waiting (this time), placing the implant, waiting (this time,) and then putting the crown on, you have a ticked off a patient and you have lost tons of money. So, he is saying it isn't worth it? As I write this, I am leaning toward agreeing with him. Is all that worth 6 months of waiting?

I think it is definitely worth discussing. Do you give the patient the option? If they want to go with the immediate, do you tell them they are going to be responsible to pay for the whole thing again?

I would like to know what you think. Are you and your surgeon doing any immediate stuff? Have you had any implant failures, immediate or not?

Have a great Memorial Day weekend. Do me a favor and do a little remembering what this weekend is about: people putting their lives on the line for their country and what it stands for. I am humbled when I think about that. I hope you are too.

Man, it is noon. I can smell the beer now!

1 comment:

Anonymous said...

The surgeons in my area will not do immediate placement of an implant after an extraction let alone immediate loading. I refer to a general dentist that will do immediate placement after the extraction. He will immediate load an anterior tooth with a temp crown. The patients really like this this vs wearing a "flipper" He give his patients an option of immediate placement as long as they accept the slightly higher risk of failure. If it would fail the imolant is removed grafted and wait 3 months to place the new implant at no Charge. They understand this going into the first surgery.

He has also done some "All on four" Complete extractions place four implants and set the screw retained denture on them like the case you saw. He will place two extra in and not load them at no charge in case one or more fail. If they all take the patient gets two more for free.


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