Dental implants are becoming a more popular option for replacing lost teeth because they provide long-term, sustainable function and aesthetics. Studies have documented a 10-year success rate of 89.7% and a survival rate of 94.6% for dental implants. Even with the higher implant survival rates, cavities, fractures, and hypermobility can arise with teeth next to dental implants. Therefore, they are not without dental health issues, and dental health, as we know, is intimately associated with physical health.

Understanding the type and frequency of problems connected with dental implant surgery is essential to guaranteeing the best possible patient results and enhancing clinical practices. Postoperative pain and swelling are examples of less severe complications, while implant failure and infection are examples of more serious difficulties.

The patient’s current health status, the surgical technique, the implant design, and the postoperative care can all impact the likelihood and severity of these problems. However, two outstanding issues of concern for those in healthcare and dentistry are, specifically, the costs involved and the financing offered, plus the training and experience of the dentist involved. How many dentists currently engaged in implanting dental work are required by law to have outlined training and experience?

Oklahoma and Oregon are requiring basic implant training after public outcry about subpar procedures. Most general dentists who work with patients daily have seen instances when implant surgery or implant case design fell short of expectations. But there are other forces at work here that may influence not only the standard of care but also the public perception of implantation as safe and effective.

Advertising can play a major role, as we have seen what happened once pharmaceuticals were promoted in direct-to-consumer (DTC) TV ads. The year was 1997, and reports show that pharmaceutical advertising went up to $10 billion annually. To comply with FDA requirements, advertisements must be truthful and promote only pharmaceuticals approved for specific ailments, sometimes known as indications.

Ads for medications also need to explain any potential side effects and provide links to other resources. Would you require a font of a specific size at the bottom of the ads for patients to read for a length of time? Opinions vary regarding the Food and Drug Administration’s (FDA) ambitious mission to ensure that information about prescription drugs is “truthful, balanced, and accurately communicated.”

Consumers and Demand

Patients have now become accustomed to asking their healthcare providers for specific medications after seeing them advertised on television. A patient asked a dermatologist I know for a prescription for a product to promote hair growth. The dermatologist maintains high ethical standards and said, “You don’t want to know what the side effects are, and there are side effects.” The patient did not receive a prescription.

But what about dental implants? The same should be true. If a patient goes to a practice that specializes in dental implants and is told they will have a consult with someone, what type of person would that consultant be? The literature indicates that these individuals are qualified to offer implant financing, not dental health information. And implants can be very expensive, as one woman realized once she signed up for over $60,000 in loans to pay for hers.

The lack of adequate prior information and unethical behavior on the part of dentists willing to pull teeth needlessly to do implants is leading to lawsuits across the country. The lawsuits are not insignificant and number in the tens of thousands, according to an FDA website that has now been made available to consumers. An investigation revealed the feelings of several patients during and after their implant surgery.

While having her teeth extracted and titanium screws torqued into her jawbone, one woman claimed to have become conscious. A sworn deposition from her complaint states that she was unable to chew for over two years due to severely misaligned artificial teeth until she could afford repair surgery at another facility. They charged her $31,000 for the initial implant surgery.

Patients who sought a second opinion after having implants discovered that the teeth that were extracted might have been salvaged with treatment. Therefore, the assumption is that a lack of ethical constraint may be leading some dentists to remove healthy teeth in order to provide implants.

Private Equity Enters the Fields

Over 70,000 dentists in the United States now practice implant surgery. However, we have to wonder how many are adequately trained and experienced to do this work safely and effectively. Might private equity acquisitions of specialist practices in healthcare be adding to patient difficulties?

Over the past several years, private equity firms have invested over $5 billion in acquiring massive dental chains. These chains provide dental implants through a network of hundreds of independently owned dental offices.

The private equity firms would argue that what they bring to dental care is productivity and services that need it. In other words, they claim they have a better business model than is currently in place in most healthcare facilities. What is a better business model in healthcare supposed to center around? What do they do for the patients? Cutting back on facilities, potential training opportunities, experience, and staff while increasing fees would seem to be counter to the mandate of healthcare professionals. As one physician, not a dentist, commented to me recently, “It’s factory medicine.”

And private equity firms are rapidly expanding their influence in medical and dental practices and end-to-end patient care by acquiring hundreds of healthcare companies, including hospitals, hospices, nursing homes, eye care, clinical trials, addiction services, and emergency departments. They have even entered funeral services. The problem is that federal authorities do not always see these deals. Anyone wishing to peek at some of their investments can look at this spreadsheet.

While PE firms are active in dental acquisitions, the extent of their involvement is still unknown. Trends in PE acquisition of dental practices were examined by analyzing dentist provider data for the period 2015–21. Between 2015 and 2021, the proportion of dentists connected with PE rose steadily, rising from 6.6% to 12.8%. And large chains have the ability to advertise widely and increase their patient base. The private dental practice would seem to be at an unfair advantage in terms of media buys.

The Food and Drug Administration has provided information on what consumers should know about dental implants and how they can report related issues. The agency also maintains the MAUDE (Manufacturer and User Facility Device Experience).

A single analysis of this database yields illuminating results. From January 1, 1996, to December 31, 2011, a grand total of 1,978,056 reports were entered into MAUDE. There were 28,046 reports involving dental devices, accounting for 1.41 percent of the total.

Of these, 26,691 were required reports (from manufacturers, 2,968 from distributors, and 140 from user facilities), while 1,355 were optional. There were 66 fatalities, 17,261 injuries, and 7,777 device malfunctions reported out of 28,046 complaints involving dental devices. In some cases of fatality, investigators believe the source was zinc in the dental adhesive.

Dental implants have benefited dentists and patients with limited options. As in everything, when aggressive surgical actions are taken, unforeseen circumstances can occur. Dental implants may be a viable option for some, but perhaps not all who seek them or who are convinced they need them.