Make it pay: Implants

Implants continue to gain momentum as the treatment of choice for a range of dental situations, so being ready to efficiently and cost effectively handle those cases grows ever more important to a lab’s financial success. While those cases can be complex, there are many simple steps that can be taken to make implants a key profit center for a lab.

It starts with organization

With more than 20 years of implant experience, Stephen Killian, CDT, co-owner of Killian Dental Ceramics in Irvine, Calif., has found one of the biggest keys to success with implants is being organized about everything right from the start. He starts each case with a worksheet containing more than 30 details he needs to review before any work gets started.

This worksheet helps him track what the costs will be to his lab in both time and supplies so he can quote the right price to the dentist and eliminate accidentally undercharging by forgetting to factor in some expense at his lab. It also helps him obtain all the technical and clinical details he needs to complete the case to meet the doctor’s needs. A new addition to his work order sheet is a set of abutment emergence profile schematics the doctors use to communicate their plans. Killian said those little drawing have reduced calls back and forth to doctors and more importantly reduced the number of cases being sent back to his lab.

“That’s a huge loser for both the doctor and the laboratory to have a case go back and forth,” he said.

Another huge loser for a lab when it comes to implants is sitting on a stockpile of implant parts waiting for the right case. Since most implants are not rush cases, it is possible and actually more cost efficient to purchase the supplies needed for each case individually. Of course to do that efficiently you need to know everything you might need right from the start of a case. It is in this area that Killian said his worksheet is most helpful, but it’s also critical to have a good knowledge of all the implant systems that a dentist might be using.

“You need complete visualization before you get started. Part of complete visualization is being expert on all systems. The clients depend on us to be an excellent technical resource,” he said.

Being the expert

That technical expertise can come in the form of keeping manuals or websites from the major companies at your fingertips so you’re ready to talk with a dentist about any implant system. But it also means being knowledgeable enough to work with the dentist on planning that implant case.

Killian said making successful implant restorations still comes down to the basics of understanding the tooth that will be replaced and replicating it both above and below the gumline. This means knowing root formations and the way a tooth emerges are important when fabricating custom abutments. Killian said he uses Typodont models from Viade which allow him to pull the teeth from a rubberized base to provide a better understanding of the emergence shape of root formations.

Approaching implant cases as the expert resource his dentist clients can count on means Killian tries to answer any questions as quickly as he can, and when he doesn’t know something, he tracks down the answer for the dentist rather than sending the dentist off to find someone else with an answer to his question.

“I’m their one stop shop, and I want to be in that position,” he said.

To be ready to find those answers, Killian said he maintains a good relationship with pretty much all the major implant manufacturers. Those relationships make it easy for him to help his clients and to order the parts he needs for each case.

The implant companies certainly welcome these relationships and try to be resources for information and assistance as well as parts suppliers. Martin Dymek, CEO of Straumann USA, said his company has a sales team dedicated to working with the lab side of the industry that tries to develop a unique approach to meet the specific needs of each lab they work with.

“Our goal is to recognize the skill, the emphasis, the positioning and the activity of our partners and put together the appropriate relationship,” he said. “We’re always interested in partnering with laboratories, surgeons and general practitioners to help them promote their services to a new audience.”

Finding and passing on savings

The major manufacturers can also help labs find cost efficiencies through their outsourcing services. Killian said when it is more cost effective for his lab to outsource custom abutments they are happy to send cases to a wide range of the custom abutment suppliers including Atlantis, Astra Tech, Biomet 3i and Nobel Biocare.

Knowing when to send part of a case out can be helpful, but for implant cases to be a profitable part of a lab’s business there needs to be implant cases coming in. Killian said he always looks for ways he can drop prices on implants just a bit and when he can pass a bit of his savings on to his clients he’s sure to let them know.

One area in which he recently cut his prices was for implant cases with solid abutment crowns. Those cases require less work at the lab, and so Killian decided to price them accordingly. He also dropped all extra implant charges for cases where the clinician orders and places the abutment without involving the lab.

If a clinician is experienced enough and comfortable with handling that aspect of planning the case and wants to send the lab an impression of the abutment as if it were a standard preparation, then the case is just like a normal crown, and Killian said he bills it that way. For his dentist clients who are looking to save money on their implant cases, Killian said he is happy to help them find the resources they need to take their skills to the necessary level to handle implant cases to that point.

“In order to stay profitable you have to assume you are getting new business and retaining it. You have to offer money-saving solutions to your clients,” he said. “If they want to get educated, we’ll help them.”