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Howard Speaks: Dental Implants and the Law of Unintended Consequences Howard Farran, DDS, MAGD, MBA, DICOI; Publisher, Dentaltown Magazine

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Dental Implants and the Law of Unintended Consequences
by Howard Farran, DDS, MAGD, MBA, DICOI, Publisher, Dentaltown Magazine
Ten years ago my oldest sister told me if you study all the major religions, they don’t share a common name of a person, city or place; there is nothing that overlaps all major religions except for one tenet, which we all familiarly know as “the Golden Rule” (See Figure 1 below). This single most pervasive rule in the history of religion, in its varying forms, has been a guide for thousands of years, and has even been applied to professional codes like the Hippocratic Oath. It’s the one rule upon which we all seem to agree.

As doctors we try to do the best for our patients. We’re supposed to. It’s our job, isn’t it?

Are you doing enough to encourage your patients to get implants rather than a bridge? Bridges are always the easy way out when patients want the “what-the-insurance-covers” option, but are you informing them of the long-term cost? Maybe you should think about it this way: remove the financial incentives. Is doing a bridge instead of a titanium implant the way you think this patient needs to be treated if insurance didn’t cover either? No. When you prepare the adjacent teeth for a crown, you know that in five years one of those two teeth might need a root canal. If you’re going to do a root canal, 10 years later that same tooth might need to be extracted. Your patient can’t brush or floss around a bridge very well – so she won’t.

You also know that if this patient goes to a nursing home some day, root surface decay will completely wipe out everything we’ve done to repair her teeth in about 18 months. She’s on medication that causes xerostomia, she eats a diet of sweet and soft food, and she might have terrible arthritis and/or dementia so she won’t be able to physically brush her own teeth. The luckiest people in nursing homes are those who have dental implants, removable dentures or partials. There’s virtually no oral health care in these nursing homes. The best you might get is a candy striper who has to brush the teeth of 25 unruly octogenarians from time to time.

Are you really doing to others as you would have done to yourself by placing a bridge? Sure your patient’s insurance will pay for half of the work, but in seven years it’s all going to be in a landfill. And instead of replacing one tooth, you’re sentencing its two adjacent teeth to death. It’s time to take a good look at yourself in the mirror, doc, and stop the madness. Unless the neighboring teeth are already slated for crowns, a bridge is nowhere near as good as an implant. You know this.

If you’re more concerned about your patient’s pocketbook, you’re not thinking about their longterm dental health. There are at least 10 other countries that place more implants per 10,000 people than the United States does. If you’re concerned that it takes too much training, think about this: there are more implants being placed in Brazil than here – and their economy is a scant fraction of ours!

When I graduated from dental school in 1987, I first learned how to place implants with Dr. Carl Misch – and placing implants more than 20 years ago was tough. All we had were 2D X-rays or panos. Compared to the technology we have at our disposal today, we were basically placing implants blind. You’d take a look at a pano and see that you had an inch of mandible, so you’d go ahead, numb up the area, reflect back the tissue and you’d find you had only a knife’s-edge worth. Today, 3D cone beam computed tomography (CBCT) has changed the game for implant placement. Anyone who has gone the CBCT route has never turned back. A 2D X-ray doesn’t find a periapical radioluncency until it’s about 3mm large, but on CBCT machines, they’re finding dead teeth with a 1mm radiolucency – so not only are docs better prepared to place an implant, their endodontic diagnoses have shot up an amazing 20 percent!

What’s more amazing is there are CBCT software programs that will actually tell you the precise implant that will fit. It will tell you that you can only go 4mm in diameter and 18mm deep. There’s no guesswork involved. Placing an implant in 2012 is three times easier than placing one in 1990.

It’s time to start telling your patients about the decisions you and they are going to make when you’re putting a treatment plan together. Do they want something that’s going to stay with them for a long time? Do they want something that is easier to maintain but costs more, or do they want something cheaper that they’ll have to throw away along with other teeth and end up spending more money repairing in a few years? It’s time to start educating your patients about the benefits of dental implants, and it’s time to take money out of the equation. Who cares if insurance pays for half of the bridge?! What if insurance paid half of a castration but nothing on a vasectomy? Would you recommend the castration to your patient because Delta covers half of it?



Right now many of you are in this state of mind where you’re trying to analyze whether or not you should place implants, and I’m here to say it will be one of the best professional decisions you could ever make, and not even just for the reasons you think. The law of unintended consequences comes into play when you make the decision to start placing implants and begin taking courses on Dentaltown.com. All of a sudden you start going to seminars at dental meetings, and then you start traveling and taking hands-on courses. And you start meeting people. And you start chitchatting with doctors you’ve seen at a couple of these seminars. And you start coordinating your travel schedule with your new implant buddies. You go out to lunch with them and you discuss implants and start motivating each other. You learn how they run their practices. You learn how their marketing plans are performing. Your new buddy tells you what he’s tracking with his practice management software, which you have and had no idea it could do that! And your whole professional life starts flourishing.

When I stepped out of my rut to learn about implants I ended up meeting Dr. Jerome Smith, who, when he places an implant today is like watching Beethoven compose a symphony. Through Jerome Smith, I got turned onto missionary dentistry and through missionary dentistry I’ve learned more about the meaning of life than through just about anything I’ve ever done.

We’re all creatures of habit, and it’s your habits that can get you into a rut. The easiest way to break a habit is to force yourself out and try something new. Stop hanging out with the same friends in the same town you’ve been in since you were born. Get out of the practice and get on Dentaltown.com, too. Learn something you’ve never learned and implement it into your practice. Get out of your daily grind. Take implant courses and become proficient. Get a little mojo going!
Dentaltown Magazine
September 2025
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