CD0412

special _ cost management I Clean surgery took place in a clinic setting with the critical factor that nothing touched the surface of the implant until it contacted the prepared bone site. The results indicate that implant surgery per- formed under both sterile and clean conditions can achieve the same high rate of clinical osseointegra- tion. This means that, while it is therefore not es- sential to incur the costs related to absolute sterile conditions (Table 5), dentists should not undertake surgerywithouttakingadequateprecautionsinthis regard. The modest savings achieved with regard to the total cost of the intervention could lead to a significant increase in the risk of failure. We have to consider that an insufficiently tested implant system may lead to trivial errors (difficulty in taking an accurate impression, tightening the components,rotationorlooseningoftheprosthetic components),resultinginaninevitablelossoftime, which in turn affects the cost and delivery. What sense does it make to save € 50 on the cost of the implant system when you have to spend as much or more in buying components separately or in see- ing the patient several times owing to these trivial errors (considering the hourly rate given above)? Also, if failure is always a factor to be taken into consideration, it follows that dentists must seek to eliminate predictable and avoidable failures, which arethoseforwhichthedentistispartlyresponsible (theaforementionedpoormanagementofsterility, impropersurgicalplanning,andanincorrectorad- equate surgical sequence). Predictable and avoid- able failure may not only result in easily quantifi- able economic damage, but also lead to important and less easily quantifiable damage in terms of the reputation and credibility of the practice, which could affect the patient’s confidence in the dentist and his willingness to promote the practice. _Conclusion In conclusion, we should consider the following withregardtocostmanagementinimplantsurgery: _paying particular attention to the significant costs; _simplification and streamlining of clinical and extra-clinical procedures; _identification of alternative treatments with a different cost–benefit analysis; and _a schedule for reduction or elimination of errors and significant associated costs. All this will contribute towards a better under- standing,andinamoreresponsibleandethicalway, of when it is really necessary to try a new implant system and by what criteria its actual reliability can be evaluated. What is the true effect of the price of the implant on the total cost for the practice? We should not be misled in selecting an item that does not appear to be of primary importance in terms of absolute cost. A final consideration is the cost in termsofthepractice’sreputation,forexampleinthe case of an avoidable failure. In the light of these considerations, by selecting protocols and materials more rigorously and by giving greater consideration to ethics in our eval- uations, we will be able to achieve a real reduction incostinareasthatdonotinvolveinterferenceinthe final quality of our work output. We should attempt to save money in areas that affect the final result, withimportantconsequencesforus,forourprofes- sionalism and for patients who gave us their trust and confidence when entrusting their health to us. Do we have the right to betray their trust, or do we rather have the duty to preserve and respect it?_ Editorial note: A complete list of references is available fromthepublisher. Table 4_Fixed costs of the fixture. Table 5_Cost of sterility. I 23cosmeticdentistry 4_2012 Prof.Mauro Labanca Consultant Professor Corso Magenta 32 20123 Milano,Italy maurolab@tin.it _contact cosmeticdentistry Cost of fixture Cover screw Surgical kit Drills Surgical screwdriver Transfer Analogue Titanium abutment Prosthetic screwdriver (if required) Individual impression tray Prosthesis (crown,bridge,etc.) Sterility kit Cost High-sterility kit (mod.Brånemark) € 80 Medium-sterility kit € 40 Minimal-sterility kit € 25