MARK PANKO still gets riled when he recalls the two years he suffered with traditional dentures.
“They fell out when I talked,” Mr. Panko, 56, a small-business owner in Woodridge, Ill., recalled. “I couldn’t taste my food — in fact, I could hardly chew. It was the most miserable time of my entire life.”
Mr. Panko, who lost his teeth in his early 50s because of a hereditary form of periodontal disease, eventually replaced his dentures with something better: dental implants. While many people wear dentures without discomfort, implants are now considered the preferred treatment for replacing lost teeth, said Dr. Robert Pick, an associate professor of surgery at the Feinberg School of Medicine at Northwestern University.
The procedure is straightforward. A surgeon places a titanium screw in the jaw bone, and prosthetic teeth are secured to the implant. They don’t wiggle or slip, as dentures can, and are healthier for the gums and bone. Most patients find implants easier to maintain than dentures.
“Best decision I ever made,” Mr. Panko said of his implants. “I could chew beer cans now.”
If only paying for them were so easy. For all their advantages, implants are expensive. Insurance coverage is usually minimal, and patients often are surprised by high out-of-pocket costs.
An implant to replace a single tooth can cost $3,000 to $4,500, depending on where you live. Implants to replace a full or partial set of teeth can run from $20,000 to as much as $45,000.
Why so much? Implants typically involve the work of both a surgeon and a dentist. Several office visits may be needed to put in the screws and to add the prosthetic teeth.
More dental insurance plans are covering the costs, but the annual reimbursement limit is typically $1,500, an amount that hasn’t changed in four decades. That may be enough to cover half the cost of a single implant; you will end up paying the rest.
Still, many patients may find it a worthwhile investment. Implants typically last a lifetime, with a failure rate of less than 5 percent.
Let’s say you lose one tooth. If you opt for a bridge, which costs almost as much as an implant but is more often covered by insurance, the dentist will grind down the two adjacent teeth to create a structure that secures the replacement tooth.
The ground teeth become more vulnerable to decay and nerve damage, and there’s a good chance you will require a root canal in the future, said Dr. Karl Gruendl, a dentist in Fenton, Mo., who advises insurance plans.
A study done for Washington Dental Service, the largest insurance carrier in Washington State, found that over a five-year period the maintenance costs for people with bridges were higher than for those who had implants.
“For a single tooth replacement, over the long run we think it’s more beneficial to get the implant,” said Dr. Ron Inge, dental director for Washington Dental Service. And that’s an insurance executive talking.
If you need to replace most or all of your teeth, dentures are clearly the cheaper alternative, costing around $2,500 for a set (upper and lower jaws). But the implants won’t move around, nor interfere with your sense of taste, as a denture might.
Implants also will help protect your bones over time. “The screw in your jawbone will trick the body into thinking you still have teeth,” said Dr. Ira Cheifetz, president of the American Association of Oral and Maxillofacial Surgeons. “The bone continues to grow and thrive.”
Implants aren’t appropriate for every patient, particularly those who smoke or already have substantial bone loss. If you are a candidate for the procedure, consider these cost-saving strategies.
YOUR PLAN BENEFITS If your dental insurance covers implants, bravo. If it does not, ask the carrier to give you an allowance toward what a bridge or conventional denture would have cost, Dr. Gruendl suggested.
See a dentist who belongs to your insurance network. Dental plans negotiate discounted rates with their network providers, which means the overall cost of the implant will be substantially less than the “retail” charge, said Evelyn Ireland, executive director of the National Association of Dental Plans.
How much less? Depending on the carrier, it might be as little as 5 percent of the standard price, or as high as 40 percent.
FINANCING OPTIONS Most dentists are willing to offer some kind of discount to patients who expect to have large bills. If you don’t have insurance or your plan doesn’t cover implants, ask your dentist for the rate provided to in-network insured patients.
Some dentists may let you pay them directly in installments. Mr. Panko, for example, is still paying off the $45,000 bill for the implants he got four years ago from Dr. Pick. Mr. Panko is pleased it worked out that way: “I have a longstanding relationship with my periodontist, and we worked out a payment plan.”
Many dentists also participate in financing programs, such as CareCredit and Wells Fargo Health Advantage, that let patients pay bills over time with no, or minimal, interest. With CareCredit, for instance, you pay no interest if you pay off your balance in full within two years. Ask your dentist about financing plans if you’re worried about paying your bills all at once.
AN ALTERNATIVE PROVIDER Dental schools sometimes have clinics where advanced students do implant procedures at reduced rates. Check the Web site of Oral Health America for help finding a clinic near you: oralhealthamerica.org.
START AN F.S.A. If you know you need one or more implants, but it’s not an emergency, fully fund your flexible spending account for next year. F.S.A.’s, offered by many employers, allow you to use pretax dollars to pay health care expenses. Depending on your tax bracket, pretax dollars can amount to an extra 20 percent to spend on the dental bill, compared to using taxed income.