Editor's note: Guest post by Teresa Yang, DDS, author of Nothing But the Tooth: An Insider's Guide to Dental Health
What’s inside
- Implant basics
- Costs of individual procedures
- Contributing factors
- So what can you expect to pay?
- The bottom line
My mother-in-law was so easy in her transparency and self-sufficiency. The only part of her that wasn’t easy was her mouth. Like the ping of broken tennis racket strings, her teeth would break randomly, one by one until she had less than a handful left. Each time would entail repairing, redoing, and adding another fake tooth to her dentures. Sometimes she spent weeks at our house, “dental wellness retreats,” she called them.
Enough teeth had broken that I proposed a more permanent, and radical, solution: we would take out her remaining teeth and make her false teeth anchored onto a bar and implants. Right away she said, “Sure!”
She was an intrepid early adopter, instant messaging her grandchildren in garbled English, knowing next season’s colors, ziplining at age 80. Although I agonized over this decision, thinking she might be too old to undergo such a procedure, she appeared to have no qualms. Two titanium posts would be drilled into her jawbone. This technology, although not new, wasn’t yet commonplace. Maybe she figured that anything would be an improvement—her lower denture floated like a toy duck in the bathtub.
The implants provided her with eating pleasure for the next 10 years and dramatically improved her quality of life.
Also by Teresa Yang, DDS
Manual vs. electric toothbrush: What's the best choice?
When is a cavity really a cavity?
Dental implant basics
If you’re missing teeth, you no longer have to make do with an uncomfortable and obviously artificial partial denture. Ask any dentist and they’ll tell you that implants have made a huge impact on their patients’ lives. They can feel as natural as one’s own teeth.
An implant is a titanium or zirconia screw post that is embedded into your jawbone to replace what is in essence the root of a natural tooth.
An abutment, either custom made or from a manufacturer’s prefabricated assortment, represents the nub of natural tooth onto which the crown is attached. An abutment is held in place with a small screw.
An implant crown replaces the natural tooth. The implant crown is cemented onto the abutment. Sometimes the abutment and crown are combined into one piece and secured onto the implant with a screw.
The challenge is paying for treatment. It can be misleading to see an implant advertised for an unusually low amount. Often that number doesn’t include all the necessary procedures.
Costs of individual procedures
Examination, diagnosis, and treatment plan options
An examination can run the gamut from free to over $150. At their discretion, some dentists may apply the cost of the exam toward treatment.
X-rays
An examination for an implant would be inadequate without a diagnostic x-ray. This could be a simple, two-dimensional x-ray, costing around $40-65. Or to accurately depict the location of strong bone into which the implant will be anchored, you may need a three-dimensional CT scan, which costs $250 to $400. These 3D scans have become the standard of care as they provide the most accurate data.
Extraction
Sometimes the implant will be placed into an empty gap, once occupied by a tooth gone bad. More often, an unsalvageable tooth needs to be removed prior to implant placement. The extraction, ranging from $200 to over $600, may be cheaper at your general dentist’s office.
Under certain conditions, an implant can be placed immediately after the extraction. In addition to saving several months of treatment time, it’s also less invasive for the patient since it combines two procedures in one appointment. In this case, despite the incremental cost, the extraction should be done at the surgeon’s office.
Implant placement
The actual implant placement usually ranges from $2,000 to $3,500, with cost varying depending on multiple factors such as whether one or six implants will be placed on the same day. Be wary if the cost is well below this range, and find out exactly what you’re committing to.
Anesthesia
Local anesthetic is included as part of the procedure. However, if you require an adjunct such as nitrous oxide, commonly known as laughing gas, be prepared to pay extra. Nitrous oxide is usually charged according to the amount of time used.
Certain patients need to be intravenously sedated. Although anesthesia would likely be covered by your medical insurance in a hospital procedure, it doesn’t apply to sedation in a dental office. Plan on paying out of pocket. Sedation can be a few hundred dollars as part of the surgeon’s services or over $1,000 if a separate dental anesthesiologist is brought in.
Bone grafting
Sufficient bone is one of the keys to success in implant therapy. Bone grafting runs the gamut from simple and one-time to complex over multiple surgeries. An example of simple bone grafting is adding bone chips to fill the voids in the old root space after an immediate implant placement. This can cost $200 to $400.
An implant placed in the upper back molar region will often have to contend with the caverns of the maxillary sinuses. In a procedure called sinus augmentation, or sinus lift, bone is added into the sinus to secure the implant. The approximate cost can be from $1,500 on up.
When a tooth has been missing for long periods of time, the bone also shrinks, leaving a defect. If years later the patient wishes to have an implant, significant bone grafting must be done first. This process, though, is unpredictable and may require more than one grafting procedure. When all is completed, the patient may have spent several thousand dollars before the implant is even placed.
Gum grafting
Similar to bone grafting, gum grafting is used to create a more pleasing cosmetic appearance around the implant. Think of the gum like a glove, a layer of material that drapes over the underlying bone. Natural-looking gum tissue requires the support of adequate bone. Gum grafting and bone grafting are related, and the two procedures may overlap.
Temporary tooth
Three to four months of healing follow the placement of an implant, during which time the bone grows around the implant, allowing it to “integrate” with the bone. Do you walk around toothless during that time? You might, and probably will, if the gap is in the back of the mouth. But in a highly visible area, chances are you’ll want a temporary. The approximate cost is $250 to $750.
Implant crown
There are two basic designs of implant crowns: a one-piece screw retained crown or a two-piece version consisting of the abutment and the crown. An abutment can run between $350 to $650. An implant crown usually costs in the range of $1,500 to $2,500. A screw-retained crown will be higher.
Mouthguard
When the work is finished, your dentist may recommend a mouthguard to protect your expensive investment, particularly if you’re a grinder or clencher. A custom-made mouthguard can cost anywhere from $500 to over $1,000.
Contributing factors to cost
Aside from the multiple procedures, there are other factors that can affect the overall cost of implant therapy.
Implant manufacturer
There are numerous dental implant manufacturers, but only a handful that are well-known and well-regarded. Even if ownership has changed or evolved, these companies have been around for decades. This means your chances of getting a spare part will be greater should you need it in the future. Some even warranty their product. All have research and development branches to explore improvements and innovations.
They also employ technical support teams to provide training for dentists and laboratory technicians. Some even go into the field to assist your dentist with an unfamiliar product or technique. When I replaced an implant crown on my mother atop her older-model implant, not only did the manufacturer representative provide the outdated tools, he was on site with me every step of the way.
Because of these manufacturers’ reputations, more dentists use them, which means that the pool of dentists familiar with the products will be larger. As well, the tools required are proprietary to each manufacturer, and most dentists can’t invest in the costly and necessary tools for multiple manufacturers. So the more well-known and highly regarded the implant company, the greater the likelihood that any dentist will be able to fix a problem with your implant.
Typically, an implant from one of these companies can run four to five times more than from a new or obscure manufacturer. Granted, the actual titanium may be the same, but the differences are significant. And well worth it.
The location in the mouth
An implant in the lower back of the mouth is, to borrow a sports term, a “slam dunk” for many reasons. The bone in the lower jaw is of higher quality and density than the upper. If the implant is placed too high or too low, any cosmetic deficiencies will be less visible and obvious. The color of the crown doesn’t have to match perfectly; in fact, it may even be metal.
Contrast that to an implant in the upper front tooth area. Our eyes are naturally drawn to that spot and, even if we’re not aware, we can detect differences in the appearance of the two upper front teeth.
A good match starts with the foundation: the implant placement. Even though the implant is buried under the gum and not visible, its position is crucial and strongly affects the esthetic outcome of the crown. The other determinant are the people making the crown, the lab technician and your dentist. Very few lab technicians can successfully match and recreate the color subtleties of a single front tooth. These skilled professionals command, and deserve, a higher fee. And what about your dentist? In addition to excellent clinical skills, do they look at your front tooth with an artist’s eye?
That front implant and crown are much harder to get right, and it may cost you more.
Geographic location
The cost of living varies greatly across the US. So, too, does dental care; even within the same state, urban and rural areas differ in terms of costs.
Which dental professional is doing the implant procedure
Your dentist will likely be doing the implant crown, but there’s also the possibility that they may be extracting the diseased tooth and placing the actual implant. Or they might refer you to a specialist such as an oral surgeon or a periodontist, whose fees will be higher.
Insurance plans
Fees may be lower with a preferred provider plan (PPO). However, you may be restricted to certain providers or treatment options.
So what can you expect to pay?
From start to finish, getting an implant can easily run over $5,000. High cost notwithstanding, most patients still prefer the function and feel of a “natural” tooth versus the alternative, a partial denture that rests on your other teeth and must be removed at night. Still, there are some things you can do to manage the costs.
Get specific costs up front
Ask for a line-item breakdown of the costs. Discuss the possibility of bone grafting or a temporary. Even if you end up not needing those, it’s best to anticipate and plan for any hidden costs.
Staging treatment
The nature of implant treatment makes staging (doing it in phases) ideal. Once the implant is placed, depending on its location in the mouth, there is a minimum mandatory healing period of three to six months. Waiting longer than the prescribed time, though, doesn’t create undue harm. In certain instances, the surrounding teeth may shift in position. If that’s the case, an affordable temporary may be installed until you have the funds for the implant crown.
Maximize your insurance benefits
More and more dental insurance policies cover implant treatment. Even if they don’t, they may give an allowance toward treatment by paying for a cheaper alternative.
Almost all policies have an annual calendar year maximum, after which no dental expenses are covered. Time your treatment so the implant placement and the implant crown are done under two separate insurance years.
Financing options
Many dental offices partner with financing companies that offer a range of repayment plans, some with zero interest for several months. Be sure to read the fine print.
The bottom line
An implant remains the closest substitute to a natural tooth. Plan ahead by understanding the costs involved so you can be prepared.
Teresa Yang, DDS, has practiced dentistry in the Los Angeles area for more than thirty years. She has taught clinical dentistry and patient management at UCLA School of Dentistry, has written extensively on dental topics, and is a member of the Forbes Health Advisory Panel. She is the author of Nothing But the Tooth/An Insider’s Guide to Dental Health (Rowman & Littlefield, August 23, 2023). Learn more at teresayangdds.com.
