Introduction, Stacey Ray, VP KOL Relations, IH Biomedical
Decades ago the majority of dental equipment and supply companies were owned by dentists. Slowly this has changed and now the majority of dental companies, outside of the clinical practices themselves, are owned by private equity companies, are publicly traded, are owned by pension funds or larger dental conglomerates. This means that the collective billions of dollars of profits related to DSOs and large supply companies are going to non-dentist investors.
Nothing against this trend, in fact, I used to be a multi-national executive with Dentsply working with Implant Institutes and key opinion leaders for many years. This “corporatization” of dental companies has shown dentists that there is great opportunity outside of “chairside” wet-finger dentistry. The authors of this article have chosen to add vertical components to their clinical practices allowing for other, non-clinical, streams of income to their dental businesses. We would like to give credit to Dr. Brady Frank, as many of these concepts have been adopted, and modified, from his book, Transition Time. The future of dentistry bodes well for those dentists who are able to look beyond the dental chair at the 30,000 foot view of the changing landscape of business in dentistry.
Dr. An Le operates multiple locations in the Dallas Fort Worth area. Implants are one the keys to his multi-million dollar growth the last few years. Let’s overview some of the principle and strategies in the implant market that have helped forge his success. Mastering the efficiency of the procedures in dentistry translates into maximum productivity and profitability, especially in implant dentistry. We can translate these favorable efficiencies and economics to the patient, which leads to a more affordable service and more implant patients.
Together, Implant Institutes around the nation have formed the Implant Alliance to help the general practitioner perform predictable, affordable and profitable implant dentistry – the fastest growing segment in the industry. The Implant Alliance is treated as one, big DSO from an implant-pricing perspective. We also share information related to many of the other important facets of implant dentistry. My private group has multiple locations with a business structure modeled after the “DDSO Concept” originally engineered by Brady Frank. As we have added these implant concepts to our DDSO we have exceeded our growth goals and wish the same for your practice.
Economically driven excellence in implant dentistry involves the following: Proper planning, a fairly priced and simple to use implant system, clinical efficiency/proficiency, a great but fairly priced implant, and the right dental lab.
A CBCT image is vital in answering some of these questions when it comes to planning. Once it’s determined that the bone is adequate….we need to decide whether we want to use a surgical guide for the case. Surgical guides can be outsourced now to an outside lab or a simple pilot-hole guide can be made in office from a study cast and Essix plastic and a vacuum forming machine. We also have a module in our Implant Mastery Course on how to print your own guide for less than $20 using a 3D printer which is economically priced right at $300. The printer accepts any software and any resin. All that is needed is an STL file from the CBCT image.
A Simple to Use Implant System – The iHex1 and 2 Implant Systems through IH Biomedical is compatible with all of the existing Zimmer-compatible internal hex implant systems. The iHex 1 implant also comes with everything you need out of the box to complete the procedure from surgical placement to restoration. The implant is packaged with the implant and the final stock abutment.
The final stock abutment and attached mount is used to drive the implant into the osteotomy. This can also be used as the final impression coping, used at the day of placement, or at the time of the implant uncovering 2-3 month later. There’s no need for having the extra cost of impression copings or stock abutments. A cover screw is also provided. Here is a screenshot of a recent webinar demonstrating the economics to include an Implant Alliance negotiated-fee lab (Figure 1). (iHeximplant.com)
In addition, the IH Biomedical’s 4 systems are compatible with the majority of the world’s surgical kits allowing for a very easy transition into any of the 4 systems. IH Biomedical has a suite of “conversion tools” to simplify and minimize expense in the transition. (MorsTorq.com)
At the DFWImplantInstitute.com, we offer didactic and surgical training to help you plan simple, as well as complex cases, and optional over-the-shoulder surgical training in your own practice. Through our Implant Alliance, we will also connect you with affordable CBCT manufacturers as well as dental implant labs providing DSO-like savings. Cheers to the Titanium Age of Dentistry!
Dr. David Prince has a bread and butter dental practice in the heart of the Rocky Mountains in Utah and has some great advice for dentists just getting into implantology: I have found over the last several years that Implants can be easily integrated into a busy general dental practice. It doesn’t happen overnight, however with proper training and mentorship it can happen relatively quickly.
Having a great mentor will help gain confidence quickly as well as provide valuable insights as to patient selection and management. I would suggest taking a beginner course to learn the basics, followed by careful case selection. A CBCT is absolutely critical for pre-placement planning, as it allows the clinician to easily see bone height, width and critical structure such as the IA nerve. It will also allow the clinician to plan a flapped or flapless approach. New guidelines for insertion torque have also led to a greater ease in placing implants. A recent article in Clinical Implant Dentistry concluded, “Primary stability can be improved by using a tapered implant in a slightly underprepared implant site. The use of high insertion torques (up to 176 Ncm) did not prevent osseointegration.
Marginal bone levels in the control and experimental groups were similar both at the time of loading and 1 year later.”(1)
This means that high primary stability, associated with high success rates is very successful with higher than average torque values making implant placement easy and predictable. I feel that following these steps, the clinician can easily place a single implant in under an hour without feeling rushed. Believe me, if I can do it, YOU can do it!
Brady Frank DDS: What Dr. Le and Dr. Prince are doing with their institutes is truly advancing implant dentistry and the profession. Teaming up with either of them is a great opportunity for any dentist who enjoys implant dentistry with a desire to help others learn. I call the model Over-The-Shoulder Mentorship which I, personally, have done over the last 15 years. In this situation you travel from your location to the location of another dentist who is a couple steps behind you on their implant journey.
You spend the day with the mentee dentist as they place implant cases that they would prefer to have a more experienced clinician’s guidance and support. For the mentee, this experience is similar to what they might experience going to the Dominican Republic or another international location and paying $10,000 or more for the course. The Over-The-Shoulder Mentorship day is funded by the patient fees allowing for the mentee to not only receive the CE, but actually earn income in the process.
The more experienced mentor is able help another clinician receive another stream of income outside of the clinical practice. Over the last 10 years I have flown all over the US mentoring others in the placement of implants. The recommended compensation to the mentor is between $10,000-$20,000 per day, funded through patient fees.
Generally, the mentee still NETs over $10,000 for the day, as opposed to paying over $10,000 to fly elsewhere for the teaching. These mentorship days are usually scheduled through an Implant Institute. If you have interest in being a mentor, or being mentored, InstituteFaculty.com has a more detailed video explanation.
Many of these practices and DDSOs have strengthened their positions by adding a clinical teaching facility, or Implant Institute to their operation. An Implant Institute creates synergy by adding an incredible new implant patient source, a regional CE opportunity for other dentists, aids in recruiting new dentists to the practice or group and creates a foundation of clinical excellence.
The largest DSO in the US leveraged their CE Institute into multi-fold growth while creating a CE centerpiece for their expansion. Collectively, of the 58 DDSOs that I currently work with have dozens of practices, and dental buildings, under contract right now and 12 have opened Implant Institutes. It is these practices that are changing the dynamics of dentistry’s current environment with individual strategies and stories at DDSOlive.com.
Figure 2: External root resorption of #9 necessitating extraction (Calvin Bessonet, DDS).
Figure 3: Recently extracted site tooth #9 (Calvin Bessonet, DDS)
Figure 4: Self-tapping implant placed sub-crestal to maximize esthetics with a morse taper connection (MorsTorq [IH Biomedical])
Figure 5: Immediate placement of implant with sharp, OsseoCompatible threads allowing for a high degree of primary stability (MorsTorq [IH Biomedical])
Figure 6: Vertical root fracture tooth #4 requiring extraction (David Prince, DDS)
Figure 7: Immediate implant with aggressive, osseo-condensing threading used with a high torque value and primary stability (iHex 1 [IH Biomedical])
(1) Clin Implant Dent Relat Res. 2013 Apr;15(2):227-33. doi: 10.1111/j.1708-8208.2011.00351.x. Epub 2011 May 20. Clinical outcome of dental implants placed with high insertion torques (up to 176 Ncm). Khayat PG1, Arnal HM, Tourbah BI, Sennerby L.
Brady Frank, DDS has been a private group practice owner for over 15 years. Through his own experience of employing over 28 associates in the mid-2000s, he created several business models that have allowed hundreds of dentists over the last 12 years Transition to Freedom. In his book, TransitionTime (available FREE – just pay shipping and handling – at www.transitiontimebook.com), he provides 14 modules for practice transition and expansion. Dr. Frank also details the most common vertical companies related to multiple streams of income as one Transitions to Freedom.
An Q. Le, DDS, AAID graduated from Baylor College of Dentistry in 2005. He has been a faculty member for Hiossen and currently operates the DFW Implant Institute (DFWImplantInstitute.com) teaching dentists from around the country on both moderate and advanced implant procedures. He is also on the clinical board of Advisors and a faculty member of IH Biomedical.
David Prince, DDS operates the Rocky Mountain Implant Institute (RockyMountainImplantInstitute.com). He has a passion for helping dentists develop their skills in implant dentistry through a study club environment.