Preparing for winter

Immediate-load FP3 full-arch implant therapy is one of the more gratifying aspects of dentistry. We completely revitalize masticatory function and restore their livelihood through their appearance — in 24 hours or less. It’s one of the few procedures in all of medicine and dentistry that tackles both form and function simultaneously. What more could you ask for?

Years ago, there was one major player on the market, and the rest were small operations and sole practitioner offices doing full arches on the side at premium cost to the patient. Today, the prevalence of implant-focused offices and groups is increasing fast and has gained the attraction of institutional financiers.

The number of ancillary products and services focused on full arch are also increasing, including marketing companies, labs, and implant companies. With respect to supply and demand, the increase in competition leads to a rush to the market and dwindling rates to attract patients and customers. Some of these organizations very respectably hold a strong stance on maintaining quality and integrity; however, this isn’t always the case.

Some marketing firms boast experience and results alongside competitive rates but fall short in several, if not most measurable, metrics. Some labs attract customers with competitive rates but have an overworked design team that lacks competency and fails to achieve clinically reasonable completion times. CE ventures are no different. My colleagues and I came across recent graduates offering CE courses in full arch implants only months after having taken one of their courses themselves. Unfortunately, a dentist only has the benefit of word-of-mouth to vet new companies in this space, and if they don’t, are forced to “try them out” often at the patients’ expense. Sadly for patients, most can only afford to have this done once. The use of dentist-only social media groups for this reason are invaluable.

What’s alarming are malpractice firms with more interest in dental implants. This may be a sign that failures are increasing, perhaps indicating a decreased priority for proper training. If this trend persists, I fear more trouble for my colleagues despite proper clinical protocols, as well as regulation by governing bodies, dental as well as medical. I recently read an article showing all the documented extraocular muscle injuries secondary to malpositioned zygomatic implants, some of which were documented in ophthalmology journals.

In the context of dental practices, with more clinicians performing full arches, many feel the need to lower their rates to gain market share, which has gained the sentiment of many as a “race to the bottom.” Is this warranted? Considering that the rate of edentulism in America is to 1 in 10 Americans (roughly 33M), making the total addressable market more than that figure with consideration to the terminal dentition population, I don’t believe we are near saturation.

There is no question the number of full arches in the U.S. is increasing quickly. Couple this with the natural failure rate of implants over time and a paradigm shift away from conventional dental treatment planning which drives the average All-on-X patient age down, and we will soon have an epidemic of revision cases on our hands. What does this mean for the future? An increase in interest in the remote anchorage approach as well as future novel approaches not just by dental professionals, but also vendors. More revisions mean more mess for patients and for doctors. Hence, in the words of Jon Snow of Game of Thrones, “Winter is coming.”