What was once considered experimental and feared by many dentists is now becoming the standard of care. Implants have come of age and are now part of most general dentists’ arsenals.
There was a common phrase used by dentists, “a dentist gets married to a patient when an implant is placed”. The phrase was a result of the restorative difficulties caused by screws or angulations problems. The use of screw-retained implant abutments caused many dentists to fear the eventual screw loosening and the need to re-torque. Several implant systems have done away with the screws and complex restorations, resulting in more simplistic treatments.
Implants have been in use in other countries for over 30 years and in “the United States since 1982, when the Nobelpharma implant was introduced into North America.”(1) Implants are now widely accepted and requested by patients when visiting their general dentists.
The percentage of general dentists using implants in America is 10% and the rates are expected to increase by 10 to 15% each year.(2)
As a general dentist searching to make implants affordable, I have finally selected one universal system, the Bicon implant system.
The Bicon implant system meets the requirement of cost effectiveness for a general dentist. The implant can be placed in one stage, two stages, and with immediate loading. It can be used in poor bone and quality bone. The implant abutment can be converted to a severely angled abutment, o-ring denture supporting abutment, implant supported bar denture abutment, bridge abutments, telescoping abutments, and integrated abutments.
There are two parts to the implant system; the implant and the abutment. A 1.5º Morse taper connects them creating a cold weld. This is the same principle used in orthopedic hip replacements. Abutment impressions are conventional with no retraction cords and using traditional crown and bridge methods. Restoratively, crowns and bridges can be cemented on the abutments extra-orally and then placed into the implants.
From the fixed restorative view, the implants can be restored with porcelain fused to metal crowns, all porcelain, precious metal, and diamond crown integrated abutments.
The Bicon implants are made from surgical grade titanium alloy (Ti6A14V). There are three surface types; a. hydroxyapatite (HA), b. titanium plasma spray (TPS) and c. uncoated. They come in varying sizes; 3.5 and 4.0mm diameter with a 2.0mm well and 8, 11, and 14mm lengths. More common is the 4.5, 5.0, and 6.0mm diameter implants with a 3.0mm well and lengths of 8, 11, and 14mm, and a special 6.0mm diameter 3.0mm well with a 5.7mm length.
How can the Bicon implants be financially productive for a dentist and also cost effective for the patient? This is what makes the Bicon implant so exciting to me as a general dentist. With cost effectiveness, we are able to bring implants to the masses.
The implant costs are $175 to $195 depending on the type of implant surface. The abutment costs $85 to $100 depending on the types of abutments used. There is a 5% discount in prices when ordering online or by fax. Average lab fees for an implant crown for Bicon cases are $100 to $250 depending on crown materials and lab. For a typical pre-molar or molar Bicon implant with a PFM crown, it costs approximately $350.
The time it takes to place a single implant is normally 3 visits, including the restorative appointments. The first visit is the placement of the implant (30 to 45 minutes), the second visit is the impression at about three months after placement (10 minutes), the third visit is the crown-seating visit (20 minutes). Total chair time for the implant case is 60 to 75 minutes. At my office, we generally charge $1700 for the total case. Subtract the single implant, abutment, and PFM cost and you have a net profit of $1350 for the 60 to 75 minutes of chair time.
The implant costs can be compared to a 3-unit bridge. 2 visits; 1st visit is the prep (1 to 2 hours including temporaries), 2nd visit is the seating appointment (30 minutes). Total 1 to 2.5 hours of time. Our bridge fee is $1900 with an average lab fee for a PFM bridge about $300. This gives the dentist a profit but for the patient not as much benefit as the implant.
The greatest cost savings to patients in the short and long term is, no more potential for endodontic treatments, no crown lengthening, no failed bridges, the elimination of a removable prosthesis, no embarrassments, and no damage to other teeth.
The key to the general dentist making a profit is to both place and restore the implants. If only restoring the implant, the fee would have to be higher due to the abutment costs if not provided by the placing dentist. Surgery is the most profitable part of the implant treatment.
A patient presented with a failed bridge (Figs. 1 and 2), resulting in the need to remove the bridge abutment tooth. The patient did not desire a removable appliance and she wanted a right side posterior bite. She could only afford one implant and asked for a molar size tooth. A Bicon 5.0 X 8.0mm with a 3mm well implant was placed with a molar size PFM crown in the former bridge pontic area allowing the patient a stable bite(Figs. 3 and 4). The time was 1.5 hours to finish the total procedures with a $300 bill in expenses. Her cost was $1700 and three months of time. This is one very happy patient!
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The best way to fully understand the simplicity of the Bicon system is to attend the 50-hour Bicon Institute training course. Information is available at (800) 882-4266 x 107 or www.bicon.com.
1. Shepard N. Affordable implant prosthetics using a screwless implant system. JADA 1998, 129:1733-1739
2. Daniels A. Meet the profitability challenge. Dental Economics October 2000
Mark Collins, DDS, has an active family practice with his wife Qun, also a DDS, in Ft. Mohave, AZ. Mark is the Founder and President of the American Board of Family Dentistry (www.theabfd.com), a free association for dentists to change the way family dentists are seen and do dentistry. To contact Mark visit the message boards at www.dentaltown.com or email him directly at firstname.lastname@example.org.