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MD: And I bet most dentists know that on a certain
level. They couldn’t give you numbers. They certainly
couldn’t quantify it. But you might say to them,
what’s your favorite thing to do? And they might say,
“I like a good 3-unit bridge.” And we have 3 units
here in the sweet spot, the profit per hour, but we’re
only prepping 2 units, so that might be the sweet spot.
You charge for the pontic, and life is good. Greatest
determination ever: that we can charge the same
for a pontic as an abutment. So I think most dentists
would probably know that on a certain level. They
couldn’t articulate it, but they would know on a certain
level, that’s my favorite thing to do. And that’s
probably why.
PH: When you take out the fee schedule and say,
“Well, my crown fee is $800. So, for 1 unit I’m going
to charge $800; for 2 units I’m going to charge
$1,600; for 3 units I’m going to charge $2,400,”
that progression makes sense. Why? Because it is
very low risk, very low remake and low planning
time.
MD: So, that actually works? To actually take
your crown fee and multiply it by two or three
actually works in these lower-risk cases?
PH: Absolutely, and for many dentists, that’s
where 80 to 90 percent or more of their
dentistry exists and where the fee schedule
makes sense. There’s all sorts of journal articles
about what to charge for a single-unit
crown in the Southwest versus the Northeast,
and how much time is taken. And all
those are valid if the dentist is doing 3 units
or less. Now, all of that breaks down when
the case gets complicated. All of it breaks
down when the dentist has to change vertical
plane of occlusion, condylar guidance or
incisal edge position – I sound a bit like a
broken record here. But those are the big
variables of a case. Those variables, in addition
to medical factors, especially when
you’re dealing with dental implants, where
host resistance is a huge component. Then
factor in aging components, risk factors that are
inherent to the dentistry, the intraoperative remake.
You made a statement earlier, before we
started about veneer cases – what percentage of
them need to be remade because of the contact.
MD: Or a single unit will need to be remade within
an 8- to 10-unit case.
PH: An 8- to 10-unit case of single unit would
need to be made, so that’s 10 percent right there.
400
300
200
100
I call that an intraoperative remake. Now,
your laboratory may not charge you for that
but there’s still the factor of time involved.
MD: The patient has to come back again, have
it put on. It’s another 45-minute appointment.
PH: Another 45-minte apointment. Remember:
profit per hour is that per hour. It’s divided
by time. So you have intraoperative
remake that is a factor when you do your 12-
unit case. You have complexity to the case
relative to the patient’s musculature and
neurophysiology. You have a change in the
patient’s medical history that can ultimately
make a case turn sour. Plus, all the time
and planning. All of the photographs and
models will oftentimes – if you take a 12-
unit case now and you take your unit fee at
$800 per unit and multiply it times 12, you’re
going to be 40 to 70 percent too low if you
base it off a fee schedule (Fig. 4, page 33).
Tooth
Dentistry
Profit per Hour
275
2 crowns
177
1 crown
163
Composite
Figure 3
326
3 crowns
Centric Relation
Dentistry
The Sweet Spot
Rehabilitative
Dentistry
MD: Wow. So, the crown fee is reliable if you’re
doing one crown, two crowns or three crowns.
But if you have a great case that walks in the
door that you’re excited about, if you take that
crown fee and multiply it times the 12 crowns,
you’re saying there’s almost no way on a case
as complex as that to make the same per hour
if you were doing two crowns.
Interview with Dr. Paul Homoly31