It was July of 2017 when a 43-year-old male patient came to my office complaining of pain in #27. Much to my surprise he was missing all lower molars and bicuspids, with an RPD anchoring on both mandibular canines. He also had a full maxillary denture that flopped around like a fish out of water. The remaining lower mandibular teeth, 22 through 27, were not in the best condition and would need removal. Sounds like the typical story “my hygiene was never the greatest,” right?
After further examination, it was obvious his alveolar ridges were atrophied, resorbed, nearly non-existent, and all this in just under three years. So, I gave him a treatment plan to remove the remaining teeth and place bone in the socket sites to preserve the remaining alveolar ridge on the mandible. Here it comes…. He said to me that he was never offered such a procedure when they removed his teeth nearly three years back. NO, I did not slam his previous dentist, because maybe that person didn’t know how to do a ridge preservation procedure. Not one of us are perfect and we would do well to teach each other instead of “one-up” our colleagues. And yes, this patient had money to pay for his needed oral health care.
I referred him to two oral surgeons and one periodontist. Not one of them wanted to touch this case for implant placement in the maxillary arch, nor the mandibular posterior. This was one of the most severe cases I think I’ve seen. What would have been the likely outcome for this patient had the previous dentist placed bone in each of those sockets, with a collagen membrane and suture over the top?
The outcomes and options for implant placement increase significantly when we maintain optimal dimensions of the alveolar ridge by placing bone in the sockets following tooth removal. Without bone placement, the buccolingual and apicocoronal aspects of the alveolar ridge quickly become compromised. It has been shown that the alveolar ridge can lose up to 50% of its original width and height (Schropp et al’).
I implemented this procedure back in 1992 after attending an update course from Clinical Research, and can honestly say I have had less than a dozen patients opt out of alveolar ridge preservation and just go with the extraction since that time.
There are four key points we use when presenting this treatment to our patient:
1. It maintains the periodontal integrity of the adjacent teeth
2. It preserves the right for future implant placement
3. It maintains the ridge integrity for better implant options
4. It improves the fit for fixed and removable prosthetic options (should the patients choose to do so)
This past year in our Clinical Business of Dentistry Introductory Training Courses, I have asked nearly 100 offices if they routinely offer socket preservation to every patient they do an extraction on, especially second molars forward. Less than 10% of our attendees said they do. Being a private investigator in the State of Utah, I naturally push the question, searching for the reasons why my colleagues would not offer this procedure to every patient with an extraction procedure. The answer most commonly uttered was not what I was anticipating. The most common answer given was… FEAR!
What? We are dentists! We tackle challenges head-on: insurance nonsense, patients who hate us but continue to keep coming back, children screaming in our ears, bitten fingers, insatiable employees, and meeting payroll twice a month. What in this world does fear have to do with alveolar ridge preservation? So, I asked. The number one reason was the potential of rejection by the patient due to the cost of the procedure. And not just rejection, but the fear they will go elsewhere for their dental care.
Well, everyone who has attended one of our courses knows exactly what I think of that nonsense. It’s just fine to charge for what you do, to make a profit, to provide for you, your family, your team. This is one of the most beneficial procedures you can provide your patient. When your patients understand “why” you are recommending it, believe me, they will be happy to pay for it. Patients will almost always choose oral health care over other expenditures when they become emotionally attached to the treatment you have recommended them. As our clients will tell you, few things teach the “why” better than the My Dental Docs treatment documents. Bottom line, you absolutely need to give your patients the choice, because it absolutely should be their choice.
The four main billing codes associated with Alveolar Ridge Preservation are:
-D7210 Extraction-surgical/erupted tooth
-D7953 Bone replacement graft ridge preservation/site
-D4266 Guided tissue regeneration/resorbable membrane
-D7911 Complicated suture up to 5cm
The combined billing total of these codes places the value of this procedure at or above $1,000 in most states. There are four additional codes which can be used that increase the billing total by $500 in most regions. These additional codes are for value-added procedures we teach in the Clinical Business of Dentistry Team Training Program at My Practice My Business. When coupled with our recommended explanation to the patient, and informational documents from My Dental Docs, our patients rarely say no to this critically beneficial procedure.
Fear not my friends and colleagues, when you provide your patients with valuable products and services, which you do every day, you should never feel guilty for being paid for them. If you want to learn more about the “Clinical Business of Dentistry”, and how to provide value-added services that you can offer your patients with need-based dentistry – services that insurance companies cannot regulate or control because of the doctor-patient relationship, please attend our introductory seminar. And if that business light turns on in your head, our Team and Office Manager Training will take you the rest of the way in your dental practice. It will be one of the best business decision you can make in your practicing career.
Rob Thorup, DDS
My Practice My Business