If you have been placing or restoring implants for a long enough period of time, you have no doubt been asked the question: “How long do you guarantee your dental implants for?” This question can be a tough balancing act for the dentist being that you do not want to give patients false expectations, but at the same time, you do not want to have your patients forgo treatment they need or go to another dental office.
Studies have continuously shown that implants enjoy a high survival rate. However, implants are a medical device; we have to remember that just as no medical implant has a 100% success rate, dental implants should not be expected to perform any differently. In addition, there are many different risk factors that can have adverse effects on implant survival rate, such as the patient’s medical history, smoking status, history of periodontal disease, iatrogenic factors, and oral hygiene practices. In fact, studies suggest that one type of implant complication, peri-implant disease, can occur in the range of 8%–82% of the time.
What is the correct answer when a patient presents you with the question above? I posed this question to 100 different dentists of varying years in practice, in various locations throughout the United States, of those who place dental implants. As one may expect, the answers were of a wide range. Here is a sample of responses from some of the leaders in the dental implant industry. They may help you formulate your own answer the next time your patient asks you if you guarantee your dental implants.
According to Master Clinician recipient, Dr. Dennis Tarnow, a periodontist and prosthodontist in New York:
I will replace any failed implant that does not integrate or withstand the loading phase initially.
However, when patients ask how long implants will last, I basically tell them that their own teeth did not last for a lifetime, and it will depend on how well they take care of the implants and maintain their periodontal health and recalls. I also give them the general statistics that more than 90% of the implants will still be functional at 10 years and that they may need replacement. Nothing is guaranteed for life.
According to Dr. Stuart Froum, a periodontist in New York and author of the textbook Dental Implant Complications:
I never give a guarantee or warranty. There are too many factors that can go wrong (i.e., overload from a poor crown, peri-implantitis—which I warn about and tell them that if they come in regularly, then they can minimize risks, osteoporosis, cancer, autoimmune disease, etc. If all is normal, I say if the implant has to be replaced because of anything related to my part of treatment, I will replace for the cost of the new implant. However, I warn patients (see my Dental Implant Complications textbook) that complication occurs in 40% of implants in the first five years and 50% of implants in the first 10 years. I give them an analogy to buying a car; they must maintain them and come in for professional monitoring and maintenance.
According to Dr. Donald Clem, a periodontist in California:
Our consent form is very general in this area. We simply say ". . . no guarantee or warranty regarding success of treatment can be made and that failure can occur." We tell patients that we expect the implant to function with a high degree of success for a minimum of five years but have certainly seen implants fail as other medical devices can within that time frame. While we cannot guarantee the success of a medical device, the vast majority of patients can expect a minimum of five to 10 years of function or longer with a high rate of success. We do not employ any type of "warranty" program as I prefer to take it on a case-by-case basis.
According to Dr. Jeanne Salcetti, a periodontist in Colorado:
So this is a multivariable answer. Yes . . . I guarantee my implants for one year after placement, which means I'll pick up any replacement costs associated with a failure. BUT . . . if they smoke . . . no guarantee, and this is in writing. If they fail to present for all of their follow-up appointments, no guarantee. If I see poor oral hygiene at any one of their follow-up appointments and upon reexamination, they still aren't performing the necessary proper hygiene, no guarantee.
I let patients know that this implant is a medical device and medical devices have been known to fail. If after a year and there is no reason for the failure—and depending on the patient—I'll replace the implant at 50% of the cost. This is truly a subjective decision and I can't give my logic, but most of the time I'll charge for removing the implant, doing a ridge augmentation to rebuild the bone, and then charge again for the implant.
According to Dr. E. Todd Schyer, a periodontist in Texas:
In our consent it says no warranty, other than the manufacturer’s. So patients would get the cost of the implant discounted. In reality, Mike (Dr. Schyer’s partner, Dr. Michael McGuire) and I replace implants at no cost in the first three years or so . . . unless the failure was an obvious failure from occlusal overload or smoking/health status, and those patients are documented as such way up-front if these factors are present during treatment planning. Odd failures we always replace those implants on our dime to keep the patient and referral happy.
Those are the responses from some of the biggest leaders in implant dentistry, with a range of practice and opinion when it comes to guaranteeing dental implants. One current theme is that replacement of failed implant parts is usually determined on a case-by-case basis with careful consideration given to patient-related factors.
MORE CLINICAL TIPS FROM DR. SCOTT FROUM . . .
'Help! My implant fell out!'
'How much do you charge for an implant? I just want to know the price!'
‘The implant you put in my mouth is now bleeding; what should I do?’
After a tooth extraction, are you guilty of chucking the tissue?
It's 10 p.m.; do you know where your patient's hemostasis is?
Scott Froum, DDS, is a periodontist in private practice in New York City. He is the editorial director of Perio-Implant Advisory e-newsletter, as well as a contributing author for DentistryIQ and Dental Economics. Dr. Froum is a clinical associate professor at the New York University Dental School in the Department of Periodontology and Implantology, and a diplomate of the American Board of Periodontology. Contact him through his website at www.drscottfroum.com.