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I special _ cost management Table 3_Fixed costs relating to implant placement in a private practice. 22 I cosmeticdentistry 4_2012 otherscientificliterature?Weshouldnotforgetthat the intervention of implantation entails placing a foreign object, even if this is made of titanium, into the mouth of a patient, hopefully for life, and with undeniable biological effects. In order to do this in averifiedandethicallycorrectway,Ibelievethatthe operator should ask questions and go beyond just checkingtheCEmarking,muchashewoulddointhe caseofadrugprescription.Whowouldrecommend taking an antibiotic available on the market a few years ago and tested on an insufficient number of patients? _Cost considerations After these considerations, procedural and ethi- cal, I turn to what may be the cost items for the re- alisation of an implant-prosthetic restoration. This assessment does not come from the perspective of a marketing expert or an economic expert, but from the pure and simple perspective of a daily operator who must evaluate which elements actually affect daily clinical practice. It takes into consideration the variable costs and fixed costs. Variable costs change more or less in proportion to changes in the production volume (theinsertionoftwoimplantsandtwocrownscosts more than that of only one; paying an assistant for two hours costs less than paying him for eight hours). Fixed costs are defined costs that are not derived from the production volume. Fixed costs in dentistry are all the costs linked with the activity of the practice, such as those related to radiation pro- tection, verification of the electrical system, steril- isation, waste disposal, insurance policy, building rental/payments and utilities in general. The fixed costs are taken into account for any type of service rendered by the practice (Table 1). It is generally believed that a cheaper implant system is needed to save costs (Table 2) regarding implant treatment. From an analysis of the variable costs, it is evident that the costs of the storeroom and of the implant components are significant. If an implant system entails many surgical steps, requires the use of many drills, has different platforms depending on the diameter of the neck, requires a surgical screwdriver and a prosthetic screwdriver or if different healing abutments are required for each implant placed, the final cost will changesignificantly,togetherwithanincreasedrisk of errors and inaccuracies (Tables 3 & 4). In particu- lar, if the implant system offers different diameters, each requiring a different healing abutment, a different transfer and a different analogue, the amount of material to be kept in stock will be much higher,consideringtheprostheticsolutionforevery case. In terms of the healing abutment, stocking different heights and diameters according to each size available (at least four for the major implant systems) requires dozens of healing abutments even if only a few implants are placed. All this also inevitably leads to mistakes, organisational mis- communication, etc. If the cover screw and the healing abutment came together with the implant, and therefore already included in the package (and price), things would be much more ergonomic. There would no longerbeaneedtostockothermaterialortore-use titanium healing abutments with the inevitable associated risk of inducing peri-implantitis during uncovering. _Costs related to sterile conditions In a study on the success rates of osseointegra- tion for implants placed under sterile versus clean conditions, Scharf and Tarnow found that the dif- ferenceinthesuccessrateswasnotstatisticallysig- nificant.8 Sterile surgery took place in an operating room setting and followed a strict sterile protocol. Radiation Protection Verification of the electrical system Waste disposal Insurance Additional fees (phone,electricity,etc.)