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The removables market continues to thrive thanks to a growing demand from an aging population, increasing consumer awareness of esthetic dentistry, and product and technological developments. Two of the market's key growth areas are implant-retained overdentures and high-end esthetics, and here LMT profiles two laboratory owners who are riding the wave of these trends.
Implant-retained overdentures a niche for veteran technician
Joel Cash, owner, Beehive Dental Lab, St. George, Utah
Joel Cash began fabricating implant-retained overdentures over two decades ago with the guidance of one of the industry's most celebrated clinicians: Dr. Gordon Christensen. "He taught me how to anchor a denture with an implant and he's probably influenced my career more than any other person," says Cash, who today operates Beehive Dental Lab in St. George, Utah, his independently owned, in-office laboratory that serves Dr. Phillip Hall, as well as his own mail-order dentist-clients.
Since his initial training with Dr. Christensen, Cash began specializing in implant-retained overdentures and he's watched the steady growth of this restoration. For instance, when Cash joined Dr. Hall's practice nearly a decade ago, it wasn't doing any implant-retained dentures; today Cash fabricates about three per week. And for his own accounts, he's seen about a 30% boost over the same time frame and doesn't see the demand slowing down anytime soon. "I'm turning away work and I haven't marketed my services in 15 years. I just sit here and work and the cases keep coming in."
Cash credits the demand to a variety of factors including the fact that people are living longer and want a better quality of life in their later years and, most importantly, the success and predictability of implants over the last decade. "Everyone practicing dentistry knows how hard it is to retain a lower denture. In the past, dentists weren't comfortable with implants so they wouldn't even suggest them as an option," he says. "But today implants are a standard of care and they successfully anchor the lower denture to the mandible. I believe it's the most life-changing procedure done in dentistry today."
Another recent advance in implantology--mini implants--is also fueling patient interest. Cash and Dr. Hall are using these small diameter (less than 2mm) implants exclusively for implant-retained overdentures. "With traditional wide body implants the surgery is more complicated, there's more healing and you have to go back and attach a bar," says Cash. "Minis require less bone and the surgery is simpler and less invasive because they don't require a tissue flap. They're also immediate load and less expensive for the patient."
And although restorations retained with mini implants command a lower lab fee than an attachment- or bar-retained one, Cash's profitability remains about the same thanks to fewer required parts and significantly less labor. "Minis are one piece so they don't require an abutment, and you don't have to fabricate a metal bar so there are no metal costs," he says. And since he uses the indirect technique with analogs as opposed to picking up the attachment chairside, they also offer an easier learning curve: the fabrication process is not that different from making a denture that's retained with denture adhesive.
Working in the dental office gives Cash a leg up when fabricating an implant case. "I can discuss the patient's expectations and actually see the implant and its angulation firsthand. Although I am able to see this in the model, when I'm looking directly in the mouth I have a whole different viewpoint."
Being chairside also allows Cash to charge a premium for his services: his in-office client pays approximately 50% more than his other clients, whether it's an implant case or not. "Being chairside means these cases take me twice as long so I have to be sure I get paid for that extra time," he says. "In the first evaluation alone, I spend half an hour with the patient and I also do all the try-ins. When patients know they're with the guy who actually makes the denture, they start asking for a lot more things like twisting a tooth one way or showing more or less of a tooth, and I work to get it just right."
Lab owner targets esthetic denture market
Jim Collis, owner, Collis Prosthodontic Laboratory, Elmhurst, Illinois
When Jim Collis, CDT, first started out in 1978, he had a laboratory in his parents' basement and used to boil and cure dentures on the kitchen stove. He's come a long way since then: today his most esthetic denture commands $680 per arch, nearly three times higher than the national average.
Although Collis had always strived to fabricate a good product, he decided to take his work to the next level about six years ago by seeking out educational courses, networking with peers and experimenting with products. Today, high-end esthetic work makes up about 30% of his laboratory's caseload and he's seen a recent rise in demand.
The main factor driving patients, he says, is a trickle down effect from the highly esthetic C&B work consumers are seeing on reality makeover shows. "TV is showing people what can be done with crowns and bridges, and now even the edentulous patient wants a Hollywood smile," says Collis. "Today people want to be confident that their dentures look so natural you can't tell they're dentures. The worst compliment a denture wearer can get is, 'Hey, Joe, your new teeth look great!' What they want to hear is, 'You look great, what did you do differently?'"
Collis is able to charge a premium for his work by using techniques like setting up denture teeth in balanced occlusion, naturalizing the denture base and custom staining teeth to add translucency. He also requires his dentist-clients to provide the tools he needs to fabricate the best product possible, such as final impressions with a bordered mold which results in fewer adjustments. He also points out that manufacturers are making it easier to provide an esthetic product thanks to improvements like layered acrylic denture teeth, tooth colored composites, burs that don't "grab" denture teeth and injection systems.
While Collis is meeting the demand of one segment of the market with his high-end work, he knows that not every patient can afford it, so he offers a range of services in his laboratory. For instance, he provides a standard denture for $425 which includes everything the $680 denture has except tooth and denture base colorizing and a lingualized tooth setup. "My $425 denture is still a very good restoration, it just doesn't have all of the bells and whistles. Just because a patient can't afford the best, doesn't mean he shouldn't have access to an esthetic appliance."
However, Collis does have a strategy to "upsell" his clients and their patients. When a dentist asks for the standard denture, he includes a postcard with photographs of a custom characterized denture along with the anatomical try-in. "Two out of 10 clients will upgrade the denture right away and even if they don't opt to use my added services now, some will take me up on it months later," he says. Collis also sends out a simple two-page newsletter once a year with tips and information, as well as frequent follow-up postcards. "The key is to let them know what services you offer and then consistently promote those services."
Collis doesn't expect the demand in his esthetic niche to die down anytime soon. "In C&B, the big thing right now is to outsource overseas, but because dentures are so difficult to outsource, this trend isn't affecting removables in the same way," he says. "There's always going to be a demand for a technician who fabricates high-end dentures and I don't see a lack of business anytime soon."
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