4Nov

Your Biggest Risk in Dental Implantation

As any other surgical intervention, dental implants come with risks too. In this post I will tell you about the biggest risk you surely want to avoid at any cost. You are now a few minutes away of gaining the skill to identify and avoid this risk for you.

Lately we have entered into many online arguments with quite a few people claiming other clinics (most often we hear Turkey in particular) as being much “cheaper” (thus perceived better) disregarding the risks which this may bring. With this article I want to clear one thing – there can rarely exist a huge bargain in dental implantation unless it compromises your long term health benefits.

Don’t get me wrong – not all clinics in Turkey/ Bulgaria/ Hungary/ Germany/ UK/ …wherever follow bad protocols and not all follow good ones – there are “bad guys” everywhere: in Bulgaria, in Turkey and in the UK, etc. And the opposite – there are “good guys” everywhere. The trick to avoid the risk of being scammed is to learn how to recognize them.

The temptation to say “YES”

Imagine(!) you run a new dental clinic with all its investments and expenses. Today you have an inquiry from a potential patient from the UK, called Ann in this imaginary story, for dental implants. Ann wants a price quote. Of course you want to look professional and you request back Ann’s X-ray (although it means almost nothing in the implantation protocol!) and she sends you one which proves her bad teeth condition. Now, here is the tricky moment for you, your moral dilemma – will you go for honesty and human moral or you’d go for the cash! This is so, sorry I must repeat it, because an X-ray MEANS CLOSE-TO-NOTHING in proving enough jawbone for implantation, and no bone means no implant. At least it should in an ideal world…

Of course you know Ann inquired with at least 5 other clinics and you need to hurry. Let’s imagine you are pressed by your business expenses and you decide to disregard what you learned in the dental university. You need Ann and her potential 5000+ Euro/GBP. You must win Ann – you send her an incredibly low ALL-ON-6 price offer for both jaws, an offer that can rarely be outpriced by others. In the back of your mind you only hope Ann is good for implants…

And now comes Ann’s risk! She falls for your nice voice and agrees to your offer with free flight, free hotels, free transfers, free food, free tour, free whatever. Ann comes to the clinic with her purely natural trust in doctors being genuine in their Hippocratic Oath. Ann knows nothing about dental implantation protocols (her mistake!). She arrives and meets the nicest version of You, who in the process discovers (by the means of a 3D CBCT scan) that Ann has not enough stable jaw bone (in about 50% of the cases) – so she is no good for implants! Wow, bad luck… what do you decide?

– to tell Ann the truth and greatly disappoint her and pay for her the free flight, free hotel, free whatever and make her very disappointed and possibly angry??

– or to hide the fact and go ahead and take the unjustified risk of placing the implants, likely leading to infections and big future complications??

Remember, you knew well before Ann came to your clinic that she may not be good for implants and still you sent her that “great” ALL-ON-4/6 offer. You knew what you are going into… and now you have to finish what was started and you decide to place these implants. After a few hours Ann is happily implanted and after a day or two Ann sees her new teeth. You smile on the photos and only hope that the complications and problems would not come back soon enough… Believe me you don’t want to be Ann’s shoes.

A real-life case!

Now let’s get back to real life… For the purpose of this article I made a random approach to a few clinics that advertised on Facebook. Nice, ads by the way… some were really CHEAP too. Three out of four said that bloody “YES”! Here is how my conversation went (see screenshot below):

Do you notice the “YES”??!! They offered me an ALL-ON-6 (a fixed structure on 6 implants) for both jaws. No, if’s, warrants or hesitations! Wow, great, my father will finally have fixed teeth again… or maybe not for long… Unless this clinic discovered a real breakthrough in dentistry…

During a phone call, the nice lady on the other side of the line told me that they do not offer zirconium crowns over implants which in fact “should never be done and if other clinics are offering me this are scamming me”. (What?!!) Also, my second stay should be 10 days, which lead me to think that they had no internal laboratory and had to rely on a third-party which is never good. But all this is secondary. The important thing is they decided to go after the money not caring about my health.Here is another example (click here to see the screenshot). Funny enough this time the same X-ray returned a different “diagnosis” that teeth need to be removed and 8 implants will be placed right after extraction (wow!), which usually is a no-go in the implantation protocol. This only proves what I mentioned previously – the X-ray is not a good base for implantation planning and clinics will likely fall for the cash.

Additionally, quite often clinics tend to talk about the make of implants rather than the make of zirconium (the most common material in dental restorations). Cheap zirconium can be 10X cheaper than quality zirconium (click here to see details). A titanium bar is sometimes required, which adds even more to the price. On the other hand, zirconium, although popular, is not always the best material for All-on-4/6 because it is heavier and not as flexible as G-CAM for example. What I mean is that there is a lot more to consider than just “All-on-4” but many clinics prefer to keep silent about this. Unfortunately, quite often the regular client-patient is unaware of all this and becomes an easy victim.

The business fact is that the clinics working at low profit margins will have bigger difficulty saying “NO” (giving bad news) to patients. Not all do that, do not get me wrong, just the “YES” chance is higher! Such clinics are pressed by lower revenues and every patient in the pipeline is important to keep a steady revenue stream. The medical business requires heavy investment, expensive labour force, big marketing budgets and agile sales teams. Finding a balance between all this is the key to survive in business.

Please do not have any doubt that a careful analysis of a 3D scan the one and only required test to prove your implant case. A 3D scan is very objective – you either have enough bone or not. Of course in some cases bone grafting can be done, but this rarely comes with any guarantees (Click here to read more). In 2012 the American Academy of Oral and Maxillofacial Radiology (AAOMR) issued an original position statement “that CBCT is the imaging method of choice for gaining the assessment of all dental implant sites” after evaluating all radiology methods used in dental treatment (here is the original reference).

In our case, at Sofia Implant Centre you’d hear our consultant say that we will need a 3D scan before we confirm your case. We are always in the search for a good balance between price and what we offer. We are neither the cheapest, nor want, nor need to be. Price for us is a side effect of our efforts to provide good value. Our message to the patient is always one – your long-term health benefit is leading in all our decisions and actions. Sometimes this creates friction – giving bad news is never easy. We will continue to say “NO” in cases without medical justification. Our promise is that we will never, never, NEVER!, place an implant in case of lack of enough bone. For us this is the right way to go.

Your takeaway
The important thing to remember is that no clinic/doctor can honestly tell you they can place implants until they analyse your 3d CBCT scan. If they do – stay away no matter how cheap their offer is. Going simply for “cheap” will likely cost you a lot more in the future, not only in terms of cold cash but also in time and suffering. Not following the right implantation protocol is the biggest risk you take and you need to know how to recognize it. “Cheap” only raises the risks.