#AskT-Bone – Ep26 – Which Comes First – CBCT or Implant System


Hello! And welcome to another episode of ask T-Bone on the T-bone speaks podcast.


So today we have a question submitted by Anthony, and the question is:


T-Bone thank you for your podcast and how it has real immediate relevance to my practice. I have started a payment plan which the team and the patients have appreciated very much. My question is related to expanding my practice by adding a service. I want to incorporate implants into my practice. Diagnostics are important to treatment planning, so what comes first?

Purchasing a CBCT to get better treatment plans?

Or an implant system to start placing implants?


Anthony thank you for saying that my podcast is real and has immediate relevance. it’s unbelievably important for me to have that. I know I’m not going to have that for everybody, but my goal is to have that for at least 2/3 to 3/4 of the listeners. I am a general practice, just like everybody else I take insurance I have the same struggles that everybody has and I’m glad to also hear that you’re having success with the payment plan system. So make sure that you keep an eye on that, make sure that they’re following that through. And have a good success with that, and keep tweaking that system along the way as you find what works well within your practice.


Adding a service


I’m so glad to hear that you are wanting to add a service to your practice and in my opinion implants are a great place to add services to your practice. I think it’s one of the fastest-growing areas within dentistry, and I think there’s so much opportunity there. So this is a classic question: “The cart before the horse, the horse before the cart”. And here is what I would say to you. Unfortunately we are comparing apples and oranges here. A Cone beam system is going to be in the $80,000 to $100,000 Ballpark, and an implant system to start placing implants honestly should be in the $5,000 to $10,000 ballpark. So it’s quite a bit of difference. So it’s hard to compare apples and apples there, because there are simply not. But here’s what I would tell you: I went the route initially of taking training, buying the system and then presenting treatment and doing implants as they came in. And here’s what I found: I found that I lack the guts to do with the implants, I lack the confidence to know which implants were right for me, and I was scared of not knowing what to see. In other words a PA and a Pano simply wasn’t enough for me to be able to comfortably tell my patients what was possible. So I would tell you that looking back, that there is, in my opinion, a greater value of being able to diagnose and get your patients to say yes than to have the tool. And I go back to an analogy my dad told me when I was starting out in a practice, and I was taking all kinds of CE for a complicated procedure, and what he said to me was, he said -Great, you have clinical skills for something that you can’t get patients to say yes to.- And that hit a chord with me. What that said to me was: I learned all the technical aspects, but I didn’t learn how to visually present the treatment and how to get the patient to say yes. And I would say that really, I know it goes hand-in-hand, but really it should go backward. It should be that we need to have the tools to be able to present the treatment, and to be able to gain case acceptance. And then we will learn along the way. Now, what gets people in trouble is they present things they don’t know how to do, they present things that are way above their head, and so that’s the challenge. Just because you by technology doesn’t mean that you can suddenly do something that you’re not capable of doing. In all honesty, I think premolar, molar implants are relatively straightforward, certainly with cone beam and guided surgery that become very straightforward, so I would say those things are in the wheelhouse of something that you can do without a significant amount of training. Now when you get into anterior implant to a certain degree immediate implant and then when you get into multiple implants, certainly that’s not something that you should be doing until you really get a firm foundation underneath you. And I think that’s what gets people in trouble. They get this pressure. And often times what I believe is when people buy technology and they need to get an immediate return on it, they get this pressure and then they start doing dumb things. Technology should be bought when it’s not creating a burden into your life or to your practice. So I believe in buying technology that you can take six to nine months, just pretend, I’m not going to get any money out of this for six to nine months, it’s going to be a wait. And then that’s the time period to learn how to use it. That’s the time period to build up your pool of patient on your case acceptance.


So, looking back, I would without question do this:


I would buy the cone beam first I would learn how to use it, I would get case acceptance I would know my limitations, and I would start learning Implant Dentistry along the way and then quite honestly, how easy is it to buy your implant kit when you already got your patient to say yes? And you already have a lot of patience saying yes, or two or three patients lined up ready to go. And quite honestly in the beginning you don’t even know which implant system you want. So in the beginning I would encourage you to contact your reps and say “Hey listen I’m going to try out two or three systems and as I get cases on, I want to buy the implant, but I’d like you to provide me the use of your kit for one or two times max -I don’t think it’s fair to ask him to do more than that-, and then that way I can make a decision”. So there’s nothing wrong in going for a test drive, you know you’re not going to go buy a Mercedes without test-driving, you’re not going to hopefully buy a car without test driving that and a few other car is to go along with it, so the same thing with implant systems. So don’t be afraid to make the plunge into Cone Beam, but make sure it’s not a financial burden for you and make sure that you have the practice and everything else in place for it and you will certainly succeed with this. And looking back and telling from current experience, once you have Cone Beam, you will see and diagnose with greater confidence, you have a greater level of case Acceptance and purchasing a kit and the guidance system and all of that will be a relative non-issue for you.


So again Anthony thank you so much for asking such a great question, such a relevant question to some of the choices that we have to make and I would say that to me, in conclusion, the tools to gain case acceptance is more important than the actual physical tool itself, because that can be borrowed, that can be bought on a one-time basis. and that, you know, is easier to accomplish than trying to figure out if you can do something or not. So, thank you again.


Again if you have questions we now have the ability to leave written questions or voice questions simply visit www.tbonespeaks.com
Thank you!

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