I have done implant cases and lost money.
Your fee for restoring implants shouldn’t be a mystery. It shouldn’t be a crude calculation, like multiplying your lab cost by three. It shouldn’t be whatever the PPO pays.
Your fee should be a reflection of your expertise, material costs, and the difficulty of the case.
We may have a fee in our minds for a single unit restoration. One abutment plus one crown equals $1500, or whatever. But even the “simple” single unit can become more costly for us. And that’s fine. My fee for other services, like class two composites and molar endo, is the same regardless of the complexity of the case. Some dentists who are not in-network with insurance plans may inflate their fees for tougher cases (and tougher patients) and that’s their prerogative. Those of us who do participate with plans may feel locked into a fee schedule. But I do think that our fee for a “simple” case, meaning one to three units, should be the same regardless of difficulty. If I have to use angled, screw-retained abutments then I won’t charge more for that.
But what I’m really driving at are the are occasions when we can potentially lose money or barely break even. I believe this occurs most often with a patient who requires four implants or more, including a full arch.
First of all, I have found that not many dentists are comfortable restoring these types of cases. If there is a scarcity of something, then its price goes up. Most restorative dentists can handle a 1-3 unit case, but replacing a quadrant, sextant, or full arch is beyond their abilities. So if you’re the one out of twenty dentists who can tackle these cases then you deserve to be well-compensated for your uniqueness.
Second, complex cases are genuinely more difficult. Longer restorative spans have additional clinical considerations that don’t exist with single units, such as passive fit, occlusal harmony, and hygienic design. There are more opportunities for something to go wrong, be it a cosmetic, functional, or hygienic complication.
Third, with greater difficulty comes greater risk. The above mentioned complications are expensive to fix. Remaking a single crown on a natural tooth is costly, but sending a metal framework back can take your profits from black to red.
If dentists are financially intimidated from treating complex cases then our patients will have a more difficult time getting the care they deserve. So let’s find responsible fees for these difficult cases that compensate us for our time, education, materials, and risk. I like to use a formula based on procedure cost, which is a term I’ve been playing with for a little while now. Take your total costs, including lab, and divide it by your fee, then multiply by 100. If your fee for a full arch case is running at 50% procedure cost, then that is way too high. we need to find ways to get that closer to 20-30%. There are two ways to do this:
(1) Raise fees. This is difficult to do if you are in-network.
(2) Lower costs. Use a less expensive lab and/or implant company.
(3) Add legitimate procedures. Note that I say “legitimate.” This is not up-selling unnecessary treatments; rather we are adding procedures with low overhead that enhance clinical outcomes and lower the overall procedure cost. For example, I am a firm believer in provisionals that aren’t flippers and ultimately using implant-supported provisionals. These procedures significantly improve the patients experience and the clinical outcome, no doubt. But they also are opportunities to improve the procedure cost of the overall case. Provisionals are not covered by insurance, so we have more flexibility to make sure that we are being compensated fairly and, most importantly, not losing money to do the case.