‘If all you have is a hammer, everything looks like a nail!’
Recently, I met with several patients after they had been to ClearChoice, a well known chain of dental implant centers. They all had a similar issue: several teeth with deep caries that required extractions, along with remaining teeth that seemed to be quite healthy, well positioned and appropriate to keep. Their story was the same: at their consultations at the chain centers, each of them was advised to have ALL of their teeth extracted and replaced with implants using the ‘all-on-4’ approach. Providing a second opinion, I saw no good rationale for extracting their healthy teeth. All these patients needed to restore their bites were extraction of several badly decayed teeth and replacement with implants — a treatment option much less invasive and costly than the full extraction recommended by the implant center.
It’s a common report by patients who have visited dental implant centers: no matter what their dental conditions or needs, they are advised to extract all of their teeth and replace them using the ‘all-on-4’ implant option.
But why recommend extraction of perfectly healthy teeth?
And why is it that only one treatment option seems to be offered regardless of the individual patient’s dental conditions and needs?
The fact is that there are other less aggressive treatment options that preserve healthy and restorable teeth and are more relevant to individual needs and dental conditions. But implant centers don’t seem to be offering any alternatives.
Why? Well, it helps to understand the business model driving such dental implant centers. To attract patients, these centers must compete on price, offering discounted services. If they are discounting services, then to keep profits up, they need more patients. One way to accommodate a high volume of patients is to create an assembly line, one-product only, 1-2-3 approach that saves time and resources. So it appears that these centers primarily offer one product: extraction of all teeth and replacement with the ‘all-on-4’ implant concept. It’s what they do as reflected in their advertisements and presentations; and these centers have created an efficient system for providing this service in fewer visits and less time. While driving the center’s product sales, the treatment approach may not be in the best interest of the patient. Further, such a system does not support effective, multi-disciplinary, and optimally designed patient-oriented treatments that require time, thorough diagnostics, and close collaboration between the treating dentists. This is why implant center patients do not seem to be referred to endodontists, orthodontists, or periodontists for relevant evaluations. I have talked to a number of dental specialists who say they have never seen patients for consultation from an implant center; an unlikely scenario in real world dentistry.
I must respect ClearChoice and other implant centers like it for increasing public awareness about dental implants. They create an environment in which people can enjoy total dental rehabilitation in a relatively short time and with lower cost (although the quality of care has been under much scrutiny). Additionally, their clinicians appear to be qualified oral surgeons and prosthodontists who work in a team approach.
However, their business model supports a one-product-suits-all mentality, and, I believe, their clinicians may find their hands tied in making the most appropriate recommendations as they have to follow company rules and business practices. With over a million dollars spent annually on marketing alone, implant centers like ClearChoice have to maintain certain business practices in order to remain profitable. Such business practices are not always aligned with the best and most comprehensive dental treatment options.
In reality, patients who are true candidates for complete extractions, ‘all-on-4,’ and the same-day-teeth approach are the exceptions rather than the rule. In most patients, predictable and successful outcomes require preservation of healthy teeth when possible, choosing the appropriate prosthetic design to meet their specific patient goals, staging the treatment over a longer period, and collaborating between skilled surgeons, restorative dentists, and other dental specialties. Yes, it sometimes takes longer and may be more costly, but it is more often the right course of treatment to achieve lifetime results.