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Case Presentation for Implants, Part 2: The First Words to Come Out of Your Mouth

This is the second part of my series “Case Presentation for Implants.”  In the Part One we discussed how the very words we use can make or break our consultation.  Use positive, gentle words that help the patient realize that you are on the same team.  Remember: Chilean Sea Bass, not Patagonian Toothfish!

In this section, we will explore the initial encounter with a patient who is a candidate for implant therapy.

Part Two: The First Words to Come Out of Your Mouth

So you walk into your hygiene room to greet Mr. Elfman, a new patient who is missing # 13.  Or perhaps you see good old Mr. Bartek on an emergency visit who has failed apicoectomy # 30 and the prognosis is hopeless.  Or maybe you are doing a root canal on Mr. Vatos and you discover the decay is through the furcation.  What do you say at the initial encounter when an implant is an option?

The goal is to help your patient understand their dilemma and show how an implant is the best option for their care.  That’s it.  No fees, no discussions of lab materials, no lengthy speeches.  The initial encounter is dedicated to sharing your vision for the patient’s ultimate well-being and scheduling them for a consultation visit.

You know the reasons why an implant is better than a bridge!  Find a way to communicate that.

COMMON MISTAKE: When we begin to formulate a treatment plan with a patient in the chair, we start thinking of the details.  To whom should I refer the surgery?  What system should I use?  Will I need a custom abutment?

Forget all that right now!  You need to share your vision of an implant solution with the patient.  Tell them you want them to come back for a consultation.  Let them know that you never charge for discussing their health care with them.  Now you have time to work out the details and present them with something more concrete next time.  Just get them excited about the concept.

So here’s what I say: “Mrs. Jones, I’d like to set aside some time to discuss how we can replace that missing tooth (or tooth that is slated for extraction, as the case may be).  Missing teeth can have terrible consequences to your oral health.  Fortunately we have a few options to get you healthy again.  Let’s meet again for a half hour in about a week.  That will give me time to review your records and investigate some options.  By the way, there will not be a charge for this consultation visit; I never charge a patient to discuss their well-being.”

I have never had a patient refuse that offer.

Now your homework begins.  Draft a few treatment options and investigate a rough idea of fees.  You don’t have to get exact numbers at this point.  This will also give you time to review the patient’s records.  Diagnostic casts, radiographs, and clinical photos should all be studied to see if you’re missing anything.  Esthetic considerations like smile line and gingival contours and functional considerations like occlusion are frequently missed without proper time to diagnose them.

So don’t rush to present a plan while the patient is still waiting in the chair.  Take your time and prepare accordingly.

PRO TIP: When you get very comfortable presenting single implants, you may decide to delve into your treatment plan while the patient is in the chair.  If you’re good at reading vibes, you may be able to effectively share your vision  and seal the deal right then and there.  I routinely do this for single implants but I will revert to the separate consultation if I sense resistance or if the case is more complex.

Speaking of more complex cases,  the full arch implant restoration is a very special scenario.  Now we’re talking big dollars and many modalities of treatment.  Should it be a hybrid, PFM bridge, or an overdenture?  An overdenture with a bar or Locator attachments?  What about the lab bill?

Relax.  It’s not time yet.  Don’t go into the history of dentistry complete with a review of material science and physics while the patient is in the chair.  Just say this: “Mrs. Jones, there are many ways we can solve your dilemma.  We can talk about them next time at the consultation.  Right now I just want to know this: Do you want teeth that are fixed in your mouth, or do you want teeth that you have to take out at night?”

You will save yourself a lot of time when you pay attention to your patient’s response to this question.  They will say one of three things:

(1)    “I never want to take my teeth out at night.”

(2)    “I don’t care.  Whatever is less expensive.”

(3)    “I know it’s less expensive to have a denture.  That’s all I can afford.”

The first two responses have opened a dialogue about the possibility of fixed implant restorations.  The third response is a bit more close ended, but implants may still be a part of the solution.

In Part Three of this series we will examine the Who, Where and When the consultation visit.


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