Ask Marty: What do you do when a patient has an implant placed by a dentist you did not refer the patient to?

2014 02 13 13 44 51 873 Ask Marty200x200

Q: What do you do when a patient has an implant placed by a dentist you did not refer the patient to, without contact from the surgeon prior to the implant placement, and it is from an implant company that you don't like to restore?

A: That is an excellent question that almost every dentist who restores implants has confronted. This scenario is one of the reasons that I eventually hired a periodontist to treat and place implants in my office.

We would all like to have great communication with both the patient and the doctor who placed the implant, but alas this is not always the case. The first thing I do is ask the patient why they went to a dentist I did not send them to. There may be legitimate reasons that the patient did not accept your referral. Some reasons expressed to me have been that the patient moved after the implant was placed or there were insurance issues. If the reasons are acceptable to me, then I just let the episode pass, as it is in the best interest of retaining the patient in the practice.

The problem in most cases is that the implant surgeon does not care about the restorative process and prefers to just place the fixture. At that point, if I have to order special parts, I add these additional expenses to the cost of the restorative treatment and explain to the patient the reason why it may be costing more.

I understand that every implant surgeon cannot have every implant system available just to place the implant of my choice. That would be an unrealistic expectation. I have parts for three different implant systems. All it takes is for the implant surgeon to call my office and tell me what implant systems he or she prefers to place and why. In most cases we can reach an agreement on an implant system that satisfies us both.

The problem arises when there is no communication at all prior to implant placement and all you get is a letter stating that the implant was placed. Now you are put in the situation of possibly following a treatment plan that is different than your own, or restoring an implant that you may not be comfortable with. A phone call to the surgeon may be necessary at this point to diplomatically express your displeasure in the lack of communication prior to implant placement.

If the restoring dentist is not comfortable restoring the implant, then my recommendation is to refer the patient back to the implant surgeon and request that they find a dentist to restore the implant. In the end, it is up to the restoring dentist to decide how they want to handle these situations. Make sure you take into account all aspects of the treatment, including patient relations and cost to the practice.

Marty Jablow, DMD, lectures and consults extensively about integrating technologies into the modern dental practice ( If you have a technology question for Dr. Jablow, send it to [email protected].

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, product, or organization.

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