With graduation getting closer and closer I have become curious. How important is it for today’s general dentist to learn to place implants? Is it a complete game changer and worth the CE time/money as well as liability?
How important is it to learn to place implants?
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The answer is: it depends.
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I think it's important, but not as important as rctbucrown. Focus on single tooth or implant bridges (up to 5 units) and you'll be fine. Implants are an important tool, and it's the end game of a lost tooth. As I've mentioned before, if you can be the master of the single tooth, you'll be able to make easy, low liability money. If you can capture most of the entire spectrum of single tooth restorations, from fills > crown > rctbucrownCL > retreatment > apico > ext/implant > explant/implant, you can fix most single tooth problems. I personally think it's not the end all (see spectrum), because if it fails, you don't have as many options and you can only explant/implant so many times. I know that implants are a big help for dentures (especially lower dentures) and you might want to get into that as well, if you have the time/patience for it.
Liability is low as long as you stick to easy cases. CE courses can be expensive for live patient implant courses, but it really depends if you need live patients or if you're good to go with weekend courses. If you're good with weekend courses, there's a lot of cheap (sometimes free) company sponsored CE courses on surgical and restorative aspects of implant placement.
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Its important to learn placement and to restore. Specially nowadays...implants are supercheap $20 per implant. If you know how to place a post, then you know how to place implants. Stick to easy cases, easy patients, good bone, dont overcharge. Its something to keep you interested, not to build your practice around. Molar RCT is the moneymaker!
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What implant is $20? Is it made of titanium, or junk car bumpers?
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Think you left a few 0’s off there, bud.
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I used DSI Implants (Dental Solutions Israel), for 5 years, I visited their factory, and no they are not re-used. They have an amazing catalog with everything you could think of. Now I use implants from Belgium, I like them better, and seem to have better construction and faster shipping. They are made from Titanium ofcourse, internal hex. They all osseo-integrate. I placed and restored over 600, not a lot, but enough to feel confident. Less than 5 failures...I removed and re did the implant for free.
Its easy to criticize something you dont know or understand.
I do stand corrected though, it was $19 USD in cluding the abutment.
Its easy to criticize something you dont know or understand.
I do stand corrected though, it was $19 USD in cluding the abutment.
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You have said this a couple times on these forums and it’s ridiculous. I’m not talking about your philosophy overall but a GP’s approach to a “failed RCT”. If a GP does a RCT and it doesn’t respond to the tx they refer it out. Why the hell would they go back in and try to do something different if they couldn’t do it right the first time? And a GP doing a root end surgery? What? We’re talking CBCT, proper diagnosis of why the previous RCT failed, proper management of the anatomy, requiring the right surgical armamentarium, magnification, etc... You obviously have good experience, not doubting that, but suggesting GP’s should be trying to do retreatments or apicos is silly, man. And unless it’s an 8 or 9, I don’t see how it’s even financially advantageous for you guys.
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If you're a GP that does root canals, you need to understand WHY your root canal failed, not just pawn it off to the specialist. The best way to know why it failed it to see it inside and out. If you retreat your own lesion, you will go back in there and see what you might have missed the first time. You're right, you need the right armamentarium and seeing it is only half the battle. Why can't a GP take a CBCT, take a peek of what's going on, why it failed, and retreat it the second time? What prevents me from opening a flap having taken a preop cbct to determine length and position, removing 3mm root, hemostasis, stain, retroprep, and retrofill? I have failed root canals and I want to know why it failed so I can improve my endodontic treatment in the future. When you retreat other people's root canals, you learn from that too. You won't learn much if you don't accept your own failures or other people's failures. When you learn to disassemble and think critically from why these failures occur and what you can do to prevent them next time, then you will be able to improve your care with your patients.
There's a reason I take notes, there's a reason why I would want to dissect the treatment that failed... I want to know what happened in the past, what I see now (at the state of failure), and how I can improve and do better each time. If you're referring every failure out, you might be missing out on a learning opportunity to improve your own practice.
Edit: Anyone who says that their treatment doesn't ever fail is full of ****.
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What you are saying is all true, I just think it’s just unrealistic for 99% of GP’s. Taking a CBCT, reading and diagnosing the issues, drilling through a ceramic crown and composite core, getting to a pulpal floor, tracing the floor for canals most likely also filled with resin, find a canal that either you, another GP or even an endodontist missed, properly navigating the exiting canals/ removing GP, etc. It’s all easy to write about, but dealing with it efficiently and effectively is a whole different story. You’re a GP, you know how valuable your chair time is. A 1.5- 2 hr retreatment or potential multiple visit tx just isn’t smart. And since most GP’s are not skilled at retreatments, what are you going to say to the patient after it fails a second time. Or if you get in there and can’t get patency on that root with a lesion or can’t find that MB2 that you know is there. Much easier conversation to have if it’s an endodontists work that fails than your own retreatment. At what point does that patient lose trust in you.
And I am not talking to you. If you feel like you can do all this well, then you are 1/1000. I’m just saying while it all sounds ideal, a lot of GP’s would find themselves in a ****ty situation if they took this approach.
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Curious. When a GP's RCT fails and the patient is sent to the specialist. How is the fee handled for the failed RCT. I mean the pt will be paying again for the RCT.
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Last year, I did maybe 10 root canals.
This year I have done 0.
When root canals fail prematurely from a GP, it is the easiest way to lose a patient. I still open/broach when a patient is in pain or an emergency- but I leave the root canals for the specialist. It simply is not a good practice builder when you are build your practice...on patient recalls and word of mouth.
Plus .001% of collections for more liability and loss of patients? Count me out.
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Definitely, it's stressful to be able to manage the retreatment well. Sometimes you cannot bypass or remove broken instruments. That's why you need the comfort, training, and surgical armamentarium to perform surgical endodontics. That's your absolute last resort besides intentional replantation. Intentional replantation is pretty easy if the roots are not too divergent and slightly mobile. If you can't fix the problem, then you either refer or extract. If they lose confidence in you (and they shouldn't if you know how to talk to them), then so be it. You tried your best and there will be many more patients in your care. I can do it well, although it takes more time. I take it as a learning experience. If you have more time than money, I encourage dentists to do their own retreatments. How else will you learn how to improve your NSRCT to begin with, if you don't know the problems that arise from your NSRCT. Learning how to identify perfs, PARL's, etc... even from the smell, I can sometimes tell why it failed. VRF's have a certain smell (smells like fungus), chronic inflammation has a certain look and viscosity (thick red bleeding), recurrent caries smell like asparagus, etc...
If you couldn't find MB2 or negotiate it, amputate the root and retrofill. Sometimes, the surgical approach is the less invasive approach.
Yea, if your practice is based on recalls and word of mouth, taking a hit from a patient hurts more. When your patient pool is derived from mass media marketing, it's not as bad.
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The real world is not dental school. Of course we all make unintentional mistakes and we learn from our mistakes. A patient (regardless if you have an endless supply from Mass marketing or word of mouth) trusts their doctor to treat them with near 100% success. If your skill set is not able to deliver a successful treatment outcome ... Then you have no business treating that patient.
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Yes, if you don't know the basics and cannot apply the basic principles of treatment to more advanced treatment, then I would agree that you shouldn't be treating the patient at all. However, if you have the basics, the foundation, and the problem solving capabilities of treating the patient through any stage of treatment (initial, recurring, and complications), then there should be no problem treating the patient at all. That's why I don't do braces (from a clinical and financial standpoint). I really wouldn't know how to bail myself out if teeth didn't move the way I wanted nor can I monetize it the way I want to make it financially worth pursuing. As dentists, we're too hard on ourselves to expect 100% success rate on all procedures. Nothing in life is 100% successful, nor close to it. Look at it from a business aspect: Failures require redos, we don't want things to fail because it consumes additional time and money to redo something for success. If you can get as close to 100% without spending too much time/money where yields drop significantly, that is the ultimate goal with delivering a good service. Please as many people as possible by delivering successful treatment while using as little resources as possible (time/money). As a doctor, time is more valuable than money in most instances. On average, I would value doctor time to be at least 25USD/minute.
Now, from a business perspective, the more diversified/expanded your patient portfolio is and less dependent on subjective variables, the more resilient your patient base becomes from attrition or bad reputation. In the age of Yelp and review sites, this is something that the corps have right that I have implemented. Word of mouth is a slow means of growth and can go both ways depending on the types of patients you keep in your practice. It only takes a few sour apples to ruin a word of mouth reputation. With mass advertising, you gather patients based on specific demographics, personalities, consumer behaviors, etc... that are deemed to be keepers in the practice. With a new flow of patients, independent of reviews and word of mouth, you are free from the shackles of reputation. Now, that doesn't mean you should be the worst dentist in the world and do whatever you want just because you have a free flow of patients, but if you had the reputation and mass advertising, that's the best way to bring and retain a ton of good patients. Even if one or two patients didn't have a good experience, it doesn't affect your patient flow or your bottom line too much.
I've seen too many doctors that are so reliant on reviews and word of mouth that they try and please everyone, regardless of the massive time consumption that some low yield patients bring. Taking reputation management out of the equation allows me to please the patients I want to keep.
I kinda went on a tangent, but this is my perspective on the business of clinical success and patient attraction/retention models.
