What's the absolute fastest you would agree to...?

Jason D

Jason D

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We have been getting increased pressure about full arch immediate load scheduling. Usually we do pmma with temp cylinders post surgery, but lately several clients have been asking to go to final restorations (agree or disagree with the concept...but this is what they are asking.)

So :from a fixture level impresssion today, they want titanium bar and pmma prosthesis returned for insertion ASAP. What is the earliest return date you would agree to?
 
TheLabGuy

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I disagree with it personally...osseointegration, or the lack of, I believe is the greatest failure of implants. With that in mind, ClearChoice does it everyday (although usually with the existing denture, or an immediate denture for loading purposes). Going to final at placement is crazy...tissue/bone recession, lose an implant, etc...
For Part 2 of your question...Usually 6-8 weeks. is what we tell them from fixture level impression...but I fish a lot, then again, maybe not enough :p
 
JMN

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We have been getting increased pressure about full arch immediate load scheduling. Usually we do pmma with temp cylinders post surgery, but lately several clients have been asking to go to final restorations (agree or disagree with the concept...but this is what they are asking.)

So :from a fixture level impresssion today, they want titanium bar and pmma prosthesis returned for insertion ASAP. What is the earliest return date you would agree to?
If they are willing to pay enough to monopolize a tech and equipment... 1.5x as long as it would really take if a tech did nothing but that until it was out the door at every step jump to it when it is ready to proceed.

Really doubt they want to pay that much.
 
Jason D

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This one we received last night around 4 pm, bars milled this morning, pmma designed and milled this afternoon, veneering and luting will be done tomorrow morning, patient appointment at 1pm 40 miles away....

If we are going to do this kind of thing regularly (we have 4 docs asking for these currently) I need to establish pricing that makes sense for all of us....
 
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This one we received last night around 4 pm, bars milled this morning, pmma designed and milled this afternoon, veneering and luting will be done tomorrow morning, patient appointment at 1pm 40 miles away....

If we are going to do this kind of thing regularly (we have 4 docs asking for these currently) I need to establish pricing that makes sense for all of us....
Is anyone else comfortable discussing pricing? There is lots of time involved doing these. Cutting any corners greatly increases risk; risk is money lost. The reasons Drs are asking for these quick are over confidence or not caring or understanding everything involved.

For what its worth, 7500 per arch.
 
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PDC

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We have been getting increased pressure about full arch immediate load scheduling. Usually we do pmma with temp cylinders post surgery, but lately several clients have been asking to go to final restorations (agree or disagree with the concept...but this is what they are asking.)

So :from a fixture level impresssion today, they want titanium bar and pmma prosthesis returned for insertion ASAP. What is the earliest return date you would agree to?

Hi Jason,

I think I would offer a few different options for a service like this. I would probably do something of a tiered pricing based on turnaround time. After all, FedEx and UPS do this.

Next day: $$$
2nd day: $$
3rd day+: $

You would definitely want the “Next Day” price to give them a little “pause”. Lot of stress and labor costs involved with that one.

My 2 cents.
 
Chalky

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I believe that Dr's tend to make unrealistic promises to patients... 'you can spend 10's of $1000's and get a complete makeover in a few days!' its unrealistic I believe, too much can go wrong if corners are cut. Honestly, I am a bit out of touch these days with this stuff because of the lab I am in, but in the past it is an awful lot of pressure on the lab to get sh!t done in a hurry (usually all nighter type of work to meet the Dr's promise to the patient),and it all fall back on us (lab techs) to fix... more after hours work to recover. And as also previously mentioned - is it the best long term option to immediately load?? everything usually goes really good if you have a Dr that plans the crap out of the case, is also willing to work closely with you to ensure that you BOTH work towards the best result. Some Dr's I have found are out of their depth in even attempting these cases!
This is a really difficult area for labs I think, it is high end work, the money can be great, but there is also a range of issues and problems that are attached...
 
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Holly93

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Hi Jason,

I think I would offer a few different options for a service like this. I would probably do something of a tiered pricing based on turnaround time. After all, FedEx and UPS do this.

Next day: $$$
2nd day: $$
3rd day+: $

You would definitely want the “Next Day” price to give them a little “pause”. Lot of stress and labor costs involved with that one.

My 2 cents.
1000x this. Aren’t we all tired of dentists beating us up on price and wanting everything to be a rush. I’ll tell my clients to use glidewell if they don’t pay late fees or rush fees.
 
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nickate

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Patient don't know how long it takes to do ANYTHING. Heck-- they don't even know how many teeth they have. I say 10k for a single arch. 25k for both rushed.
NO WARRANTY. I am against tier pricing here. When I pick it up I'm going for the goal line asap so I charge like it.
 
sidesh0wb0b

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We have been getting increased pressure about full arch immediate load scheduling. Usually we do pmma with temp cylinders post surgery, but lately several clients have been asking to go to final restorations (agree or disagree with the concept...but this is what they are asking.)

So :from a fixture level impresssion today, they want titanium bar and pmma prosthesis returned for insertion ASAP. What is the earliest return date you would agree to?
as long as youre note left holding the bag if/when failures arise...whats your normal turn around?
i mean, doing our best to educate the clientele and advise against it only goes so far. if all that is done and they still want to proceed....they are the ones with that fancy title. we just fulfill the prescriptions. no?

*edit* after reading more i guess i didnt realize that time/cost was the big question..... i really dislike rushing something that takes soooo much time and has to be "just right". but then again im forced to do it often. bill accordingly! i rarely feel like i bill enough on these super rush cases. (working on changing that....i do find it a challenge because if i say no or throw a large number out there, the clients tend to dislike that). @user name has a good mentality for it. $7500 an arch seems reasonable. plus parts. but to do them in less than 24hr? shoot. im too small to make that happen i guess. we still need to touch base on the phone to sort that out LOL
 
2thm8kr

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What is the surgeon's word on this?

Placed in native bone or immediate placed in extraction sites? I get that it's just a general question, but I could think of a long list of variables that aren't being considered.

If the GP is dictating when the final will be placed ALL of the risk is on them. Doesn't matter which implant god is placing them Sh!t happens. Failures and changes to the plan occur before you get to the end at times.
Typically it's 3 months on the lower and 4 on the upper arch for full integration. Taking healing caps or cover screws off a day or two later and or swapping out an immediate temp for a final prosthetic before the implants are fully cooked is not a wise move.

All that being said, if the patient is aware of and consents to the risks and extra money that may be involved they can have whatever the clinician and specialist deem appropriate for their situation.

Everyone wants instant gratification these days, but I say just let them live in the PMMA and temp cylinders. It's definitely an improvement over what most of them present with.
 
2thm8kr

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I dont understand how anything can be close to torqued if its not integrated with the bone. (?)
The guy I work with likes to see 50+ncm on an implant at placement. Most abuts torque to 30ncm.
 
JMN

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The guy I work with likes to see 50+ncm on an implant at placement. Most abuts torque to 30ncm.
Add to that that a torqued implant 30 minutes later will be looser enough that I know one who has the pt wait and re-measures taking it deeper/tighter before impressions.
 
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AnAppleaDay

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Most Nobel implants, when placed following protocol, will achieve over 35Ncm torque, often more around 50-75Ncm.
This is called primary stability (before osseointegration).
You can immediate load as long as your primary stability is over 35Ncm.
 
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