Implant Consults

This is the initial implant consult.

It can be done entirely by the dental assistant or treatment coordinator, and should take about 15 minutes.

1. Set the agenda

2. Identify pain points

3. Urgency

4. Identify goals for the future

5. Intro to solutions

6. Records

7. Doc exam

STEP 1: Set the agenda

After making some friendly chit chat...

YOU: So Mr. Jones, there are LOTS of ways to fix your smile. In fact, there are probably a dozen ways to go from where you are now to a smile that looks and feels really comfortable and natural. And if we were to show your mouth to a dozen different dentists, we would probably get a dozen different plans. So I can tell you right now, without even looking in your mouth, that there IS a solution out there for you. That's the good news. But the bad news is that having so many options can be really confusing.

That's why my responsibility is to help create a treatment plan that is customized to YOU. Basically, I'm here to simplify things and to make sure you get everything that you want, ok?

PATIENT: Yes, sounds like exactly what I'm looking for.

YOU: Great - so in order to do that, I'd like to get a better understanding of 2 things today. The first is your current situation, I'd like to learn more about where you are now, how you got to this point, and what you like and don't like about your current situation.

And then second, we'll talk about what you want your new smile to look and feel like when everything is finished. I need to know which features are the most important to you, what your priorities are, and which ones are not that important to you.

Once we know all that info, that will really help us customize your treatment to make sure that you're going to be really happy with it, and it checks all the boxes that are most important to YOU. Sound good?

PATIENT: Yup.

STEP 2: Identify pain points

YOU: Ok - to help me understand what's going on in your mouth and what you're looking for, I'm going to ask you a lot of question. So let's start with your current situation. I understand that you've been having some problems eating/smiling/ in pain/etc because you have some broken/worn down/missing teeth/etc - is that right?

PATIENT: (They tell their story)

YOU: (Dig deeper to encourage them to tell the real truth of their story. Remember - at this point in the consult we are much more interested in building an emotional connection, and not as interested in their clinical diagnosis.)

Examples of phrases that help to show empathy, patience, and understanding:

- How long has this been bothering you?

- Have you talked to someone about this before?

- What kinds of solutions have you tried in the past?

- Why do you think those solutions haven't quite worked for you?

- I'm sorry you've had to go through all that. How did you manage?

- How has this been affecting your social life? Your family life? Your work life?

- What's the biggest difference it would make in your life if you managed to fix this problem?

YOU: I totally understand. We're here to help you, and this is what we do every day. I'm just glad that you decided to take action and do something about it. There are a lot of people who struggle with the same problems every day and never take action until it's too late.

STEP 3: Urgency

YOU: After hearing everything you've been through, I have to ask you something. This is something that's been bothering you for years, right? So I'm just curious - what was holding you back from seeking help all those years? Was there something specific that happened recently that made you want to come in today?

STEP 4: Identify goals for the future

YOU: Well, no matter how bad you might think your mouth is, I can assure you that there IS a solution to every single problem you mentioned. In fact, like I said at the beginning of our chat today, there are probably a dozen different solutions, and they all differ in their features. I don't want to waste your time talking about the pros and cons of a dozen different solutions, and then try to compare pricing of a dozen solutions, so what I'd like to do now is to start narrowing down your options, based on your preferences.

So if I were to ask you - what's the most important thing for you? Is it esthetics? Making your smile look nicer?

Or chewing power? Teeth that feel solid and you can eat whatever you want?

Or comfort? Teeth that are pain free and feel as natural as possible?

Or all of the above?

PATIENT: (They answer)

YOU: Got it. And what are your thoughts about a long-term vs a short-term solution? Some patients are looking for a quick fix to buy some time. And other patients feel like if they are going through all this time and anxiety and expense, they want something that's built to last.

What are your thoughts on this?

STEP 5: Intro to solutions

YOU: So based on what you've told me, it sounds like you'll most likely be a good candidate for an implant (or some implants, or full arch implants, etc).

Have you done any research about some of the different options?

PATIENT: ......

YOU: Great, so let me give you an overview of __________ and some of the common options. That way you'll have a good starting point and then can ask more specific questions when you meet the doctor, ok?

*Warm the patient up and prep them to make a decision by saying something like:

I'm going to go through 3 or 4 different options and explain the difference between them. They all work, but it's up to you to decide which features are important to you.

I will tell you though that when I explain these options to patients, almost always people know exactly which one sounds the best to them. They know right away that these other options don't sound very good, and this one option sounds ideal based on what's most important to them.

For replacing a few teeth:

1. Explain implants requiring major grafting

2. Explain regular implant

3. Explain bridges

4. Explain removable dentures

*Note the order we explain things "walking down the stairs".

EXAMPLE:

So when you're missing a tooth like yours, there's a few different ways to replace it.

Implants are usually the first choice, because they are the strongest for chewing, look the nicest, last the longest, and have the fewest complications. The downside is that they take the longest time - about 4 months or so - and they cost the most. And if you don't have enough bone, you might need major bone grafting, which pretty much doubles your time and increases your cost by thousands. It might cost you $7,000 to $8,000, and you will probably have to go to the specialist.

If you're lucky and have enough bone as is, or if you only need minor grafting, then you can save a few thousand dollars and it costs around $5,000.

Another way to do it is with a bridge instead of an implant. They are a little less expensive - not half the price of an implant but maybe a few hundred dollars. Bridges are also faster to complete. The downside is that they don't last as long as implants, so they have to be redone more often. And you sometimes get side effects on the anchor teeth like sensitivity or even root canal problems.

And then the cheapest, fastest way to replace that tooth is with a removable denture. The downside to this option is that it's removable - so it's the last comfortable and stable. It feels pretty bulky in your mouth, and moves around and rubs when you talk and eat.

So Mrs. Patient - based on what we've gone through so far, which of these sounds closest to what you had in mind?

For replacing full arch of teeth:

1. Explain fixed full arch implants the old way

2. Explain AOX

3. Explain snap-in overdentures

4. Explain removable dentures

EXAMPLE:

So when you're looking to replace a full set of teeth, there's a few different ways to do it.

One way to do it is a full set of porcelain crowns and bridges attached to 8-10 implants. This is the very best solution available and it works really really well. The problem is that it's very complicated to do because most people don't have enough bone for that many implants. So we have to do multiple rounds of surgeries, grafting, and trips to specialists. And that's why it's also the most expensive option - you can easily spend in the $60,000 range for just one jaw.

There's another way to do something very similar and gets you an end result that's almost the same as the first option, but costs only $20,000 to $40,000. Using modern techniques and our special process, we can do it with half the number of implants, just one surgery, and all in our office. And the best part is you walk out with a brand new set of teeth that are attached to implants in just one day.

Another option is to do something removable. The first 2 options are fixed in your mouth - they are screwed in and permanent - so they are rock solid for chewing. This option is removable, but supported by implants, so it snaps in and out. You save some money doing it this way, but it's not nearly as comfortable or solid or natural feeling. You can send anywhere from $8,000 to $25,000 on this type of solution, so a lot of times it makes more sense to just to the fixed option because it's way more comfortable and similar price.

And then the cheapest, fastest solution is a regular denture with no implants. The downside of dentures it that they aren't attached to anything - they just float over your gums and are held in by suction or gravity, so they aren't very good for chewing and aren't very comfortable. People chose dentures when they want the absolute cheapest solution.

So Mrs. Jones, based on how far we've gotten so far, which of these solutions sounds closest to what you had in mind?

If you can give us some feedback about which of these options sounds crazy, and which ones are kinda interesting, then Dr. Ling and I can focus on the interesting options and help you narrow it down from there.

YOU: Can I give you my opinion? Based on what you've told me so far, and based on the results I've seen from other patients in similar situations, the solution I think will make you happiest is _________. I think that's the one we should ask the doctor about first, and then he can tell us if that's a good idea or not, of if there's something even better.

STEP 6: Records

Here are the records we require for an implant or complex case:

1. 8 x 8 cm CBCT

2. Full arch upper and lower tier scans. These scans should capture:

• as much tooth structure with as few holes in the scan as possible

• as deep into the buccal and lingual vestibules as possible

• the entire palate

• beyond the maxillary tuberosity, which is distal to the most distal upper molar

• beyond the retromolar pad, which is distal to the most distal lower molar
  

3. Full face, smiling portrait

• use the ring light to ensure good lighting

• patient standing against plain background

• patient should be showing a full smile with lots of teeth, but not a forced or painful looking smile

• patient head should be level with the floor, or with their chin pointed slightly downward (definitely don't take the photo looking up their nostrils)

• camera held at the same level as their face

• we want to see their entire face, from the top of their hair to their shoulders

STEP 7: Doc exam

Introduce the doc to the patient, giving the doc an overview of who the patient is, what they're struggling with, and what they're hoping for.