How much should it cost to save a compromised tooth?
(orthodontic extrusion, proper perio treatment, and crown)
Biological savings or economic savings?
Every time I see a so-called “tooth preservation” case — endo, restorative, or prosthetic — I read the same old phrase: “It’s a biological and financial saving for the patient.”
Sure.
And what’s the unspoken benchmark?
Always the same: the dental implant.
The universal yardstick.
Never before has dentistry been so split in two.
There are many reasons for that, but let’s start here:
the business model we inherited was already rotten.
The average dental office of the past was built around one concept:
bring in a crowd with low-quality fillings and endo, periodontal knowledge close to zero, and then make profit mass-producing fixed and removable prosthetics.
Maximum profits in the “cement and forget” departments.
Minimum or even negative margins in prevention and conservation.
Some dentists who were more profit-driven pushed things even further:
full-arch metal-ceramic crowns — icons of the 80s and 90s.
Meanwhile, implantology was just emerging.
No one back then would’ve guessed that, 30 or 40 years later, that elite technique would become, by 2025, a mass weapon of dental destruction — often tied to cheap dentistry and aggressive, business-only logic.
Today, there’s no high-turnover clinic or chain that doesn’t push implants like candy:
•Extract as much as you can
•Replace them all
•Do it fast: fixed teeth in a day… 8 hours… 4 hours…
How?
With patient ignorance, in the fastest and shittiest way possible — because to them, “an implant is an implant.”
Same with insurance companies:
who places it, how it’s done — irrelevant.
And yes, I know excellent clinics that focus on implantology and deliver top-tier work. I respect that.
But even there, the underlying message is the same:
business happens in the big-ticket cases.
For them, “ethical” means not doing overtreatment.
Which is fine.
But the model remains: you still need to flood the base with edentulous patients, scale up the marketing, and treat them.
Meanwhile, I see colleagues fighting to save teeth, endodontists pulling off miracles.
Rare pearls.
Missionaries.
Frustrated, pissed off, and misunderstood.
So I ask again:
Why the hell should a complex tooth-preserving treatment cost less than an implant?
That “biological vs. economic savings” line really pisses me off.
As long as we’re the ones thinking that tooth-saving procedures are worth less than implants,
we will never be able to make our patients understand otherwise.
Me?
I love saving teeth.
I enjoy it, I believe in it.
But I’ve had to make it economically sustainable for my practice.
That means:
•Telling patients that implants are not always the best solution
•Offering tooth-saving treatments at the same price as implants
👉 Orthodontic extrusion + periodontal therapy + crown? Same price as an implant.
👉 Complex endo + crown? Same price as an implant.
👉 Full periodontal charting and treatment plan? Almost the same as an implant.
A few years ago I realized my business model was just a sad knockoff of those big implant centers:
doing solid preventive and restorative work with zero margins, just waiting for the big cases to make ends meet.
That day I had a small awakening:
•My joy came from seeing wrecked mouths
•My despair came from seeing healthy ones
•My absolution came from refusing overtreatment and doing my best in the “poor” departments
So I rebelled.
I started changing my pricing and my messaging.
Because today, charging properly for a perio treatment, saving a tooth, avoiding an implant —
that, for me, is the most ethical thing I can do.
And it’s something I want to share.
Because as long as our pricing doesn’t reflect the value of our work,
only a few missionaries will walk the virtuous path.
The current fee structures?
Broken children of a broken past.
But we keep clinging to them.
If we really want to do the right thing,
we need to reshape the environment so it makes doing the right thing easier.
Everything else?
Just talk and whining.
If this resonates with you —
If you’re tired of fake innovation, of overtreatments disguised as “advanced care”,
If you believe that preserving teeth is not just clinically possible, but ethically non-negotiable —
Then come join us at the
🦷 Injectable Restorations European Summit – November 7–8, 2025 – Milan 🇮🇹
A congress for real dentists doing real dentistry.
No marketing hype. No unicorn cases. Just the daily grind, done better.
🔗 Register now: www.injectionsummit.eu
Let’s redefine what success in dentistry really means. Together.
