implants - international magazine of oral implantology

I research Table 3_Fixed costs relating to implant placement in a private practice. 16 I implants4_2012 scientific literature? We should not forget that the intervention of implantation entails placing a for- eignobject,evenifthisismadeoftitanium,intothe mouth of a patient, hopefully for life, and with un- deniable biological effects. In order to do this in a verified and ethically correct way, I believe that the 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).Fixedcostsaredefinedcoststhatarenotde- rived 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, sterili- sation, 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 isevidentthatthecostsofthestoreroomandofthe implant components are significant. If an implant system entails many surgical steps, requires the use of many drills, has different plat- forms depending on the diameter of the neck, re- quires a surgical screwdriver and a prosthetic screwdriverorifdifferenthealingabutmentsarere- quired 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 dif- ferent transfer and a different analogue, the amount of material to be kept in stock will be much higher,consideringtheprostheticsolutionforevery case.Intermsofthehealingabutment,stockingdif- ferentheightsanddiametersaccordingtoeachsize available (at least four for the major implant sys- tems) requires dozens of healing abutments even if only a few implants are placed. All this also in- evitably leads to mistakes, organisational miscom- munication, etc. If the cover screw and the healing abutment came together with the implant, and therefore al- ready included in the package (and price), things would be much more ergonomic. There would no longerbeaneedtostockothermaterialortore-use titanium healing abutments with the inevitable as- sociatedriskofinducingperi-implantitisduringun- covering. _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.) [PICTURE: ©LIGHTHUNTER]