What’s the real cost of one dental implant? (Part 2)

What are the individual procedures in dental implant treatment?

The examination, diagnosis, and treatment plan options

An examination can run the gamut from “free” to over $150. Although I rarely charged for this service with an existing patient – in large part because I knew the patient would incur hefty expenses soon – I understood that I probably should have. Dentists undergo years of training to provide competent care to their patients and deserve to be compensated for their knowledge. Yet from the patient’s perspective, they may be wondering, “Duh…why do I have to pay to find out I need an implant? I already knew I needed an implant!”

Let’s consider a hypothetical. Your dentist informs you that due to the challenges of your case, he concludes that you would be better served being treated by specialists, including a prosthodontist, a specialist who will oversee the crown. He spent half an hour reviewing the details, educating you on the options, and patiently answering your questions. He charges $100 for the exam. Alternatively, even though he realizes this particular crown may be beyond the scope of his expertise, he decides to tackle it himself and waives the exam fee.

Which scenario would you prefer?

My point is that the exam should be a completely separate entity and the dentist should be compensated. If he chooses to waive the fee, that’s his choice. You, as the patient, are paying for his expertise and guidance.

X-rays

An examination for an implant would be inadequate without a diagnostic x-ray. This could be in the form of a simple, two-dimensional x-ray of the area, costing around $40.

Or to accurately depict the location of strong bone into which the implant will be anchored, you may need a three-dimensional CT scan of the area. The cost can range from $250 to $400. Increasingly, these 3D scans have become the standard of care as they provide the most accurate data.

The Extraction

Sometimes the implant will be placed into an empty gap, once occupied by a tooth gone bad. In this case, unless your dentist will be placing the implant, the examination will occur at the surgeon’s office. More often, an unsalvageable tooth needs to be removed and an implant placed. The extraction can range from $200 to over $600 and, again, cheaper at your general dentist’s office.

 Under certain conditions, an implant can be placed immediately after the extraction. In addition to saving several months of treatment time, it’s also less invasive for the patient by combining two procedures into one appointment. Whenever I anticipate this can be done, I’ll ask the surgeon to extract the tooth despite the incremental cost. In the long run, the patient benefits

Implant placement

The actual implant placement usually ranges from $2,000 to $3,000, bearing in mind that cost varies depending on multiple factors, such as whether one or six implants will be placed on the same day. Be wary if the cost is well below this range and find out exactly what you’re committing to.

Anesthesia

Local anesthesia is included as part of the procedure. However, if you require an adjunct such as nitrous oxide – commonly known as laughing gas – be prepared to pay extra. Nitrous oxide is usually charged according to the amount of time used.

Implant, abutment, and crown

Certain patients need to be sedated with some form of intravenous sedation. Although anesthesia would be covered by your medical insurance in a hospital procedure, this doesn’t apply to sedation in a dental office. Plan on paying out of pocket. Sedation can be a few hundred dollars as part of the surgeon’s services or over $1,000 if a separate dental anesthesiologist must be brought in.

Bone grafting

Sufficient bone is one of the keys to success in implant therapy. Bone grafting runs the gamut from simple and one-time to complex over multiple surgeries. An example of simple bone grafting is adding bone chips to fill the voids in the old root space after an immediate implant placement. This can cost $200 to $400.

Bone chips

An implant placed in the upper back molar region will often have to contend with the caverns of the maxillary sinuses. In a procedure called sinus augmentation, or sinus lift, bone is added into the sinus to secure the implant. The approximate cost can be from $1,500 on up.

 When a tooth has been missing for long periods of time, the bone also shrinks leaving a defect. If years later the patient wishes to have an implant, significant bone grafting must be done first. This process, though, is unpredictable and may require more than one grafting procedure. When all is completed, the patient may have spent several thousand dollars before the implant is even placed.

Gum grafting

Similar to bone grafting, gum grafting is used to create a more pleasing cosmetic appearance around the implant. Think of the gum like a glove, a layer of material that drapes over the bone and skin of the hand. Natural looking gum tissue requires the support of adequate bone. Gum grafting and bone grafting are related and the two procedures may overla

The temporary tooth

Three to four months of healing follow the placement of an implant, during which time the bone grows around the implant, allowing it to “integrate” with the bone. Do you walk around toothless during that time? You might – and probably will – if the gap is in the back of the mouth. But in a highly visible area, chances are you’ll want a temporary. The approximate cost is $250 to $750.

The implant crown

There are two basic designs of implant crowns: a one-piece screw retained crown or a two-piece version consisting of the abutment and the crown. An abutment can run between $350 to $650. An implant crown usually costs in the range of $1,500 to $2,500. A screw retained crown will be higher.

While it’s beyond the scope of this article to discuss the pros and cons of the two designs, many determinants factor into the decision. Foremost is your dentist’s preference. Practical considerations involving insurance dictated fee schedules also influence the choice.

A mouthguard

When the work is finished, your dentist may recommend a mouthguard to protect your expensive investment, particularly if you are a grinder or clencher. A custom-made mouthguard can cost anywhere from $500 to over $1,000.

By now you must be reeling…

Over the years I have seen patients break down in tears when they learn how much it will cost to replace one tooth. From start to finish, getting an implant can easily run over $5,000. High cost notwithstanding, most patients still prefer the function and feel of a “natural” tooth versus the alternative, a partial denture that rests on your other teeth and must be removed at night. Still, there are some things you can do to manage the costs.

Get specific costs up front

Ask for a line-item breakdown of the costs. Discuss the possibility of bone grafting or a temporary. Even if you end up not needing those, it’s best to anticipate and plan for any hidden costs.

When dealing with multiple doctors

If your general dentist refers you to a specialist for the extraction and implant placement, ask about the history of their working relationship. How do they communicate with one another? At any single time, both should know exactly where you are in the course of treatment.

If you are part of a PPO insurance network, is the specialist a provider on the list? If not, what are the compelling reasons for choosing this doctor? Unlike your medical insurance, going out of network can be a realistic option with dental insurance. It may cost you more, but it won’t bankrupt you.  

Some specialists expect to be paid up front even if you have dental insurance. They may assist you with filing the claim though. Find this out beforehand to prevent surprises.

Staging treatment

Regardless of whether you have dental insurance, the nature of implant treatment allows it to be staged. Once the implant is placed, depending on its location in the mouth, there is a minimum mandatory healing period of three to six months. However, waiting longer than the prescribed period of time doesn’t create undue harm. In certain instances, the surrounding teeth may shift in position. If that’s the case, an affordable temporary may be installed until you have the funds for the implant crown.

You may be tempted to simply extract the offending tooth and wait until you’ve saved enough money for the entire procedure. Please don’t do that. Once the tooth is gone, the surrounding bone will begin to atrophy. That precious bone is critical to the success of the implant.  

Get the most out of your insurance policy 

More and more dental insurance policies cover implant treatment. Even if they don’t, they may give an allowance toward treatment by paying for a cheaper alternative. For example, the policy may not cover an implant and crown, but they will cover a bridge which is 25 to 40 percent less.

The best way to determine this is to have your dentist file a pre-authorization. While this doesn’t guarantee payment, it’s the closest way to find out where your insurance stands.

Almost all policies have an annual maximum, after which no dental expenses are covered. Usually this is based on a calendar year rather than a fiscal year. Time your treatment so that the implant placement and the implant crown are done under two separate insurance years.

There are very rare instances where your medical insurance will cover your dental implant. This usually occurs when an accident causes you to lose a tooth, such as an automobile accident or one that happens in the workplace.

Financing options

Many dental offices partner with financing companies such as Care Credit. Care Credit offers a range of repayment plans, some with zero interest for several months. While this route may provide a way to get your implant, be careful and read the fine print. Some plans stipulate that if you miss a single payment, the entire amount comes due.

If your employer offers a Health Savings Account (HSA), use it. HSA offers you a way to pay for your medical expenses with pre-tax dollars. The caveat is that you must specify the exact amount to be allocated months in advance. With implant treatment, though, you will have an accurate idea of your future health expenditures.

What if you need more than one implant?

When multiple implants are unrelated, they can be planned sequentially. Work with your dentist to create a master five-year plan. Prioritize the most important ones first.

If multiple implants are part of a full mouth, or full upper or lower jaw, reconstruction, then usually this must all be done together. Such treatment requires planning and coordination with multiple doctors. The costs can be significant. 

The bottom line

In the foreseeable future, I don’t expect implant costs to drop. Nor do I anticipate the woefully inadequate insurance maximums, averaging around $1,500 per year, to rise. As for the much talked about incorporation of a dental component to Medicare for the over 65 population, this option is now off the table. Even if future legislation is successful, the chances of implant coverage are virtually nil.

But getting an implant remains the closest substitute to a natural tooth. One of the first steps is knowing the costs so you can begin planning.