CD0412

I special _ cost management Table 1_Cost analysis for various procedures. Table 2_Average price of a cheap implant system in the market, showing variable costs. 20 I cosmeticdentistry 4_2012 the one to decide for his patient. So be sure that the quality of his performance becomes a must of his action. When professionals begin to question the quality of their performance, then you are facing a true and profound cultural change. To these considerations, one might add: why would a patient choose to seek treatment in a dental centre? “The dentist? A mechanic who changed parts of your car but, not being technical, you never know if you’re rubbing or not.” This in how one interviewee responded to the request by the well-known psychologist and professor of marketing and communication Alberto Crescentini to describe the figure ofthedentist.5 Theaveragepatientfindsit difficult to evaluate the quality of a med- icalservicefromatechnicalpointofview because he simply does not have the skills. It is our duty not to betray him, and act ac- cording to the science and our knowledge. Bearing this all in mind, we should determine the possible savings in the management of implants and whether buying an implant at a lower cost will re- sult in cost effectiveness. To quote Charles Darwin: “It is not the strongest species that survive, nor the most intelligent, but the ones most respon- sive to change.”6 In the literature, there are various articles about implant placement techniques, biomaterials and loading protocols, but there is only very little in- formation about cost analysis in relation to im- plant-prosthetic procedures. Questions regarding the cost of implant place- ment and the amount a dentist can earn by placing fixtures tend not to be discussed at congresses, as if in fact the one and only important aspect is the finalisationofthecase.InacountrylikeItaly,where dentistry is largely private, the economic aspects are fundamental for the acceptance of the treat- ment plan by the patient. Even in ethical terms, if the dentist believes that his implant is really the most appropriate solution for that particular case, prohibitive costs could deprive the patient of that possible solution or push him towards other choices, both operational (other restorative solu- tions) and logistic (low-cost dentist or travel to a dentist abroad). As observed earlier, there are over 300 different types of implants in Italy. Conventionally, these are divided into classes based on various aspects, one of which is purchase price. We could argue, how- ever, that all implants are osseointegrated in the end and that implants that are more expensive are simply more advertised, but in essence they are the same as others. In Italy, many “homemade” and low-costimplantsystemsareavailableonthemar- ket whose traceability is practically absent in the literatureandwhosemanufacturersarenotableto guarantee long-term reliability.7 If we evaluate the sales data of the leading implant-producing com- panies,eighttotenleadingcompanieshold90%of theexistingmarketshare.Asalogicalconsequence, the remaining 10%, amounting to approximately 100,000/150,000 units, can be divided among the remaining 300 or more companies on the market. What can the average number of implants sold by each of these be (despite what their dealers tell dentists)? Are they supported by case studies or Procedure 1 fixture + 1 crown in porcelain Protocol Delayed-load cemented solution Implant system xxx Cost of the practice 1 h surgery € 130 Cost of the practice 1 h prosthetic € 80 Cost of 1 h other activities (consultation,check …) € 70 Item Cost Fixture € 95 Insertion 225:10 (Drills/Number of uses) Cover screw € 28 Surgical screwdriver € 54 Transfer € 45 Analogue € 27 Titanium abutment € 55 Prosthetic screwdriver € 31 + € 181 (DIN Raquet) Individual impression tray € 30 Prosthesis (single ceramic crown) € 250 Total € 568