Guarantee for Dental Implants: Discussion Topic

How long is a piece of string? Implant treatment is no different from any other commercial transactions and should only be guaranteed for ONE year. You don't expect a car company giving you a life-time guarantee for your new car, do you? Dental implant is not fit and forget and is affected by the home care, the health of the surrounding tissue and the prognosis of the remaining dentition. Yearly inspection is necessary. For the peace of mind, patients can take out private dental insurance cover for the implant treatment for the first few years. After 5 years, the chance of failure is very remote. My own implant has been in function for 20 years ! Dentists are not likely to do something which are going to fail! I can only tell my patients that the implant treatment will be carried out with my best ability, using the current knowledge and technology. But with the biologic and science, we are always dealing with probability and there is always a chance of failure, no matter how small. A well written treatment plan (and costing) would help to resolve any problems later.

I think this guarantee issue started because of what we used to say about implants ( Some of us still do ). We called it " permanent solution ". Some specialists blame GPs jumping in doing implants has caused higher failures but I've seen failures from both ends. I try to tell my patients this is long term treatment option, single most durable option in dentistry once the case is success but I never tell them it's going to be permanent, especially after dealing with some of those failures. I give my patients a warranty for 1 year but that's it.

No warranty for medically compromised patients with diabetes, osteoporosis, smokers etc. Patients have to be properly advised and counselled to manage their expectations and matched to the appropriate reconstruction. I would recommend 100% guarrantee against component failure. That liability rests with my selection of manufacturer.

All I can say is that in the few failures I have had over the years I replaced each implant without additional cost. It is when patients don't show up for their yearly followups after complete treatment that I would charge them for a new one if it fails. Certainly if they aren't using their night guards and destroying their implant, I would also charge them for a replacement

We tell our patients that 3 to 5 out of 100 implants will not take and we do not know why. Dental implants much like artificial knees and hips are foreign objects to our body. All of these wonderful technologies improve the quality of life like nothing else before them. If the implants requires "revision surgery" (note we do not use the term failure) in the first year we take care of this at no cost to the patient.

The suggestion of offering a guarantee, is setting an awful precedent . Is the hip replacement or cabg, refundable ? There are no " guarantees in medicine ". This is why it is up to the consumer , to find out who the most experienced doctors are . Many implant companies replace lost implants and I will tell patients, that if the implant fails , I will refund them the cost of that, assuming they are a good candidate and were compliant. We are not in the retail arena. I will never promise anyone, anything , that I can't fully control. No one wants the implant to be successful, more than myself, but I can't promise that a cancer is not going to recurr or a fracture is going to heal or if a patient is going to wake up from the anesthetic. There are a lot of things that I can do,to improve our odds. What a silly notion. Bv

Since when are we in the used car business? The idea of giving patients a guarantee on implants originated from some manufacturers trying to convince the dentist to buy their implants ( over the competition)....and the guarantee was originally for 5-10 years, and that involved strictly fixture replacement....no surgical, or prosthetic considerations, which the patient was responsible to pay; and the dentist had to send in the failed implant to the manufacturer so they could analyse the reason for the failure....... The idea of lifetime guarantee should make the consumer sceptical because nothing comes with a lifetime guarantee......just read the many restrictions written in fine print when something is fully guaranteed. It is good business sense and courtesy to the patient to redo or replace a failed implant if the failure occurs in the first couple of years for any reason....but should not be written or considered as a guarantee. In my area, offering a guarantee in reference to any dental procedure is frowned upon, and may lead to disciplinary action by the licensing body........ about 18 years ago, the Quebec Order of Dentists viciously and stupidly attacked Dr. Hershel Bernstein because he was quoted in the newspaper when asked by the reporter what would happen if an implant failed.....and he said he would replace the implant if it failed in the first year...this is not a guarantee, it is being decent and respectful to the patient..... after a very expensive legal battle, Dr. Bernstein beat the Quebec Order of Dentists in the court of appeal . It is illegal for a doctor, dentist, lawyer,etc to give a guarantee of any kind in relation to the work they have done.. One must take into consideration exactly who the majority of our implant patients are...these are people who have totally neglected the dentition they were born with and hence ended up in a mess.......implants are giving them another lease at life....but are they going to change their habits......wishful thinking!!! In situations where there are two different professionals doing the treatment, when there is a failure...the surgical team usually tries to blame the restoring dentist or vice versa. Any dentist who is considering being involved in implant dentistry, should be capable of doing both the surgery and the prosthetics, and this includes the periodontists and oral surgeons......but the problem here becomes sticky, as the referring general dentist does not want to get taken out of the equation. Gerald Rudick dds Montreal, Canada Providing surgical and prosthodontic implant treatment

Did the patient get a lifetime guarantee on their natural dentition ?

Sterioss, now Nobel has replaced the lost implant since, inception . I thinks it's quite generous. I'm pretty certain strauman and Biohorizons does as well. Nobel has replaced two that we have dropped on the floor. Do all companies, provide this service? Bv

Robert , can I use that same criteria, with regards to failures ? Of the ones I have called "failures", they have almost all occured in the first year and I have bailed myself out in all but a couple of those. I'm going to quit stating the number , primarily, because I don't believe some think I'm being honest about that data and secondly , I'm afraid I'm going to jinx myself. I'm not being sarcastic , this time. I have often considered calling those that I have replaced at second stage , that went on to succeed as non-failures. What do the other guys think? Let's do the industry a favor and concur!!! Bv

Dear Doctors: I have a patient using 3 implants in the upper left side since 2004. He`s loosing them because of bone problems (migration) and I called Nobel Biocare company to ask if the implants are guaranteed. They are replacing all of them at no charge. Of course, the patient is going to pay for the new prosthesis. I am not charging for the implant placement. Isn`t this a follow up for the patient and a good background for the company?

Why are you doing the surgery for free? Are you obtaining a scan? You should be prepared for a bony defect, especially if the implants have moved. It is likely, that the area is harboring virulent strains of bacteria and if so ,will you proceed? By doing the case, pro bono, some could misconstrue that as a suggestion, that you are taking blame for the failure. Obviously, I have no more information, than what you have provided. There is nothing wrong with providing charitable services, but if this patient was able to afford three Nobel implants and the restoration before, then they are obviously not destitute . Just don't understand the premise of your entry, other than Nobel stands by their promise. Bv

I'm sorry to keep " hammering away" at this last entry, but if you truely think that the patient is having some sort of " bone problem", I would advise you to find out what that problem, might be, before you throw three more fixtures in there. Maybe this is just a translation issue and what you are calling a bone problem, is just, peri-implantitis, which is, in itself a problem that should be corrected, as well. Just trying to be helpful! Remember, when you are doing something, " for free ", you are actually, paying for it. Bv

Dr. Rudick, I'm sure you have been made privy to this and may already utilize this stuff, but we are in the works of cojoining our ct scanner product with digital(powderless, sans any impression material) impressions, thus taking a significant portion of the lab work out of the restorative doctors hands. This ,is what I'm afraid this industry is coming to. My only real gripe, with this is, some of these restorative doctors have never taken the, "over the bridge and far away" route, which leaves them with a less informed mentality. "got a fall, before you fly", in my opinion. But it is pretty exciting stuff! Bv

Giving a guaranteenis a bad idea! Implants do fail, teeth fail. Any thing put in control of the patient has a possibility of failure. In the Commonwealth of Virginia, we cannot give a guarantee on any dental treatment. Baker made some good points: the bone can have bacteria lie dormant for up to 20 years, going into a site of a prior endo can be like rolling the dice, then the pure business side of the issue. When a patient dies in the hospital, the family gets a bill. We have to wake up and realise that there is bad boilogy and we are not Clark Kent!

Dr. Baker Vinci, of course this is peri-implantitis and it`s going to be corrected. The implants are going to be moved from the original placement because there is a bone defect in the site. The patient is going to wear provisional teeth until bone recovers. As for the pro bono work, I usually give the patient peace of mind that someone is going to be behind the work. As for the phrase "when you are doing something for free, you are paying for it, the answer is "It is only time and surgery. Thanks anyway.

I tell my patients that nothing man made can approach natural teeth, and unfortunately for various reasons natural teeth are lost or break down. There certainly should be a high enough fee charged which will allow you to redo any short term failure gratis-this builds good will and avoids litigation.For those who are adamant about a longer guarantee, I offer them a "lifetime guarantee"-when the implant fails they die!

I wish that was legal in our country. Sometimes , I want to shake the failed implant patient, because maintenance is pretty simple, but to "snuff them", might be a bit harsh . I bet your success vs failure rates, are better, this way. Do you use succ./ k+/propofol? I am all about, good clinical data. Bv

Baker I would not be that extreme, but I share your frustration! In most cases failure on in implant(s) is not malpractice.

Richard Hughes, i agree with you

This is a tricky one in private practice . First we should distinguish between guarantee and warranty. The guarantee is a commitment to make good on defects of a product or a service in a fixed period. A warranty looks after the repairing of a new article within the validity period.In the retail world you pay for warranties. Guarantee implies that money is refunded ...warranty implies repair if defective. I can never tell anybody anything lasts for ever . However you usually need to state that point as the initial expectation from most, is that it does last for ever. Failed components should always be replaced at no cost...screws ..porcelain etc assuming normal function.Different companies have different philosophies..in other words the expensive systems can easily replace an implant...but so what... it is the cheapest part of the problem! Considering the array of treatment plans and possibilities and different views and protocols on this subject, we all know very well that this stuff does not last forever. Semantics plays a big role ...so I am very careful how I speak. Telling a 25 year old that the single tooth implant is "permanent" vs telling the 70 year old something is permanent are 2 very different types of conversations. I have good dentistry in my mouth,some of which is 15 years old...Im ok with it if it has to be replaced today ,I have had great value 24hrs a day 7 days a week for 15 years! That is usually exactly the type of conversations I have with my patients. It is very subjective depending on the operator and patient and on many uncontrollable and unpredictable situations. I am yet to learn an absolutely right way to do anything in a patient of any biologically condition with implant dentistry. For example we all have seen molars replaced with long and short implants ...one and two implants...immediate and delayed placement ...with or without grafting....narrow and wide implants..osteotomies with or without full set of drills...different insertion torques etc etc ..not to mention systemic issues...I have done all the above depending on numerous factors. .Im not really seeing a big difference in success rates between many of the above well documented protocols and techniques in terms of success. Further to this... do every single one of your patients allow you to do exactly what you see as your version of "ideal" every time ? The mere existence of this website answers that question very clearly! Do you ever compromise? One less implant in a bridge ? A slightly longer span? etc etc .However when you get a failure we can all easily say retrospectively why this case has gone wrong and should never have been done" like that" So how do we talk about long term promises to our patients? In 99% of cases of dispute with patients is down to your ability to communicate with them.(the assumption is that you know what you are doing) I will replace implants and/or prosthetics that fail in a very short period of time ,simply because I believe it is the decent thing to do. Sometimes I lose on this ...that is a fact of life in practice.How much time is "short" ...well certainly the first couple of years...it also varies with all the factors mentioned in the posts so far. My fees and volume are high enough, and my experience is sufficient over 20 years that this continues to work for the patient and for me. You need to cost out these issues according to your circumstances and clearly according to the litigation of your region. At the end of the day your rapport, explanations and practice philosophies will determine the outcomes much more than one might expect. Having said all of the above ...if you are placing implants regularly in 2012 and you are seeing more than 5-6% failure rates...you have a different problem.