Narrow-Diameter Overdenture Implants: A Sensible Option for Growing a Practice

The number of patients wearing removable, complete dentures is growing and will reach 60-61 million arches by the year 2020.¹ Although the rate of edentulism has been declining throughout the past few decades, the increase in the US population has resulted in an increase in the number of edentulous persons.² This growth is due to the “baby-boom” population shift, an older populace that tends to have an increased reliance on complete dentures. Approximately 10% of persons in the US have one edentulous arch or more. Moreover, only 6% of this population has had implants placed to retain their denture, leaving some 30 million people wearing at least one arch of a denture without implants.

Additionally, the older population, especially those over 65 years old, are increasingly aware of oral health, and, as a result, many actively seek dental treatment. As this population and dental awareness increases, dentists would be wise to incorporate ways to attract more of these patients to their practice and consider providing an implant treatment that other dentists may not be offering.

Getting new patients in the door asking about implant dentistry is crucial to the sustenance of a dental practice; without new patients, dentists are only maintaining their existing patients’ health. While this may be an effective strategy for routine general maintenance practices, being able to offer comprehensive full-arch implant treatment to new patients can significantly contribute to the lifeblood of a practice. Internet marketing is rapidly growing to become a principal marketing strategy. Two simple tactics can help grow a dentist’s implant practice. First, the best marketing is and always will be existing patients and their endorsement of the practice. The key is to tap into existing patients and ask them for referrals. Happy denture patients will refer other denture patients. While there may be many “mechanical” reasons for seeking treatment, it often boils down to an emotional bond between clinician and patient. Do the patients think the practitioner is compassionate and/or trustworthy? Every practice has denture patients in its existing pool. Seek them out and provide excellent implant treatment to them. The organic referrals from satisfied patients will help fill the practice. In this author’s experience, when patients are sent by another patient (or another dentist), they are much more likely to accept treatment. They have been referred for your expertise and have, in essence, already partially committed to being treated by you. Now, it’s just a matter of being able to offer them treatment that fits within their budget and they can afford. Second, the practice’s direct marketing and Internet marketing strategies will further solidify its presence as a trusted expert in implant dentistry. In today’s society, when people want to know more information about someone, they “Google it.” Having the practice/practitioner appear on the first page of Google results should be a top priority. The clinician’s name should be linked to the practice’s website. Also, in search results, be sure there are multiple five-star Google reviews touting the clinician and practice as a leader in implant dentistry.

Many patients can be treated with two to four traditional-diameter implants (> 3 mm), a treatment that has been considered the first option for the edentulous mandible. However, some patients, due to a lack of sufficient bone to accommodate an implant greater than 3 mm, may be excluded from this treatment without additional therapy. Extensive bone grafting, osteotomy enlargement, or ridge splitting can heighten the potential for surgical risks and postoperative sequelae. Additionally, patients may refuse this treatment due to the actual or perceived invasiveness of these procedures.

Primary barriers to patients accepting implant treatment are cost, surgical anxiety, and lack of awareness of such therapy. During treatment discussion, this author typically presents three main options to the patient: 1) fixed; 2) an overdenture with two standard-diameter implants; or 3) an overdenture with four to six narrow-diameter implants. The average costs of fixed treatment range between $20,000-$30,000, putting this option beyond the budgets of many patients. Removable overdentures with either standard- or narrow-diameter implants typically range between $4,000-$8,000, making this a substantially more affordable option.

While narrow-diameter implants have been historically advocated for use in patients with inadequate bone volume and/or those who desire minimally invasive therapy, they can also be utilized with most patients seeking denture retention.³ Offering implant treatment with an implant that offers a less invasive surgical procedure can be an effective strategy for increasing patient acceptance of treatment.

Many narrow-diameter implants offer an all-in-one price point, including the implant, abutment, and retentive housings. Most standard-diameter implant systems include only the implant and a cover screw, requiring the clinician to purchase the abutment and retentive housings separately. Compared to standard-diameter implant systems, the clinician’s implant costs are often less because of this inclusive concept. As a result, while this author charges the same fee for two standard-diameter implants as for four to six narrow-diameter implants, the price point of the narrow-diameter implant system actually makes it more profitable since the implant and abutment costs are lower with narrow-diameter implant systems compared to that of standard-diameter implant systems.

Offering narrow-diameter implants to patients provides the practice a tremendous amount of fee flexibility, allowing for reduced fees when a more competitive fee offering is needed. In this author’s experience, treatment acceptance is high because a lower-cost, minimally invasive solution is available. Ultimately, this strategy can benefit both the patient and the practice’s bottom line.

The author serves as a clinical consultant/lecturer for ZEST Anchors, LLC.

Michael David Scherer, DMD, MS Assistant Clinical Professor, School of Dentistry, Loma Linda University, Loma Linda, California; Clinical Instructor, School of Dental Medicine, University of Nevada–Las Vegas, Las Vegas, Nevada; Private Practice limited to prosthodontics and implant dentistry, Sonora, California