All About Composite Fillings

I collected over 2 million year after year. The secret to my success was producing from the low hanging fruit, fillings. I allowed composite fillings to be the bulk of my collections. Meanwhile, I had? the ability to produce from both simple, low dollar procedures to more complex,? high dollar procedures for the benefit of my patients and my own financial gain. The unfortunate truth is that the vast majority of doctors do not understand this concept. Many will do fillings with a grudge. Some job interviewers would rather walk out when I tell them that I want them to remove amalgams and small caries.

Why do fillings matter?

1. Ferrari generated around 3.46 billion euros of revenue in 2020.

McDonalds sells 10 billion orders of small?fries per year. That's a revenue of $14.4 billion from fries alone.

I am an admirer of Ferrari. I am familiar with their products, both old and new. I also survived on McDonald's for years. I am familiar with their products as well. When I get my morning coffee from McDonald's there is always a long line of cars waiting. The entry price for McDonald's products is so low that nearly everyone can afford it. The production model for McDonalds = quantity x low price. On the contrary, the production model for Ferrari = scarcity x extremely high price. Keep in mind the cheapest Ferrari is over $300k. A carton of MCD small fries is $1.60. The same analogy applies to dental products. On average, the braces I offered at my office were over $5k. Whereas my fillings are much cheaper but one surface fillings are much more profitable. As a dentist, it is my belief that we should concentrate on the procedures with the? lowest entry price while having the ability to produce from procedures which are higher priced, such as RCTs, EXTs, and SCRPs. Dental products with a much higher entry price and which require a much? higher skill level? should be our last concern. Non GP procedures should not be the focus because the competition for those procedures is extremely high and?patients would much rather go to a board certified dentist specifically for those procedures.

Below are the price list of composite fillings in my office:

1 surface = $264 2 surface = $275 3 surface = $330 4 surface = $347 5 surface = $398

Fillings have 3 Main Functions:?

1) Replacement Material for Cavities: I use composite to replace all caries, especially small caries as well as replacing any existing amalgams and the recurrent decay underneath.

Even the smallest of caries need to be removed. That's why there are 5 year old kids who have been seeing dentists since they were 6 months old yet almost have no teeth left. They were not born that way. Keep in mind cavities never get better by themselves. As a dentist, I should never have to see a child with hardly any teeth left, especially one whose family has trusted this profession enough to have been taking their child to the dentist since they were six months old. They were not born that way. Cavities never get better by themselves, however small. If they are detected with the tip of an explorer, they must be removed. I also use composite to replace amalgam and remove recurrent decay which is almost always present.

2) Replacing missing tooth structure: For structural restorative purposes, and to? correct and/or enhance aesthetics due to wear and tear on teeth without caries. The best way to have repeat patients and word of mouth referrals is if a patient loves you. Patients will appreciate you when you take their pain away. However, they will love you when you make their teeth beautiful without much out of pocket costs.?

The easier way to make it happen is not by veneers. Veneers cost too much. Most patients cannot pay thousands of dollars for each veneer. However, they can afford to pay for composite fillings. Fillings cost much less, and more importantly patients pay very little for them. When they can see your handiwork in the mirror every morning when they brush their teeth, they will remember you. I use composite to fill lingual pits, class Vs, as well as incisal troughs to prevent food entrapment and further break down of tooth structure. The skill level required for veneers is much higher and the time it takes to make a temporary can be time consuming and technique sensitive. Additionally, it will take 2 appointments to realize the profit.?

3) Caries prevention.?

Speed - ?The handspeed involved in placing composites is crucial. Think about how easy it is to get a cup of coffee ready for customers at McDonalds. From pouring the drink into a cup, applying the cap on the cup, handing the cup to the customer. The entire process takes less than a minute. MCD makes multiple billions with $2 dollar coffee, how much can a dentist make with fillings when the lowest price 1 surface filling is over $200??

When there are composite fillings to be placed in the entire mouth, it's always best to open them in all quadrants, then the assistant bands and bonds them and the dentist can go in right after to fill all at once.?

My definition of perfect teeth, both form & function. How often do you see a patient with teeth like those below? Almost never. That means you can almost always find production to be made.

Unethical? No pain, no tears while improving aesthetics is very ethical.?

?The purpose of incisal composite fillings such those above:

a. Restore missing tooth structure resulting in better aesthetics.?

b. Prevent further break down of tooth structure.

The person in this picture is a doctor’s fiancee. They were about to take wedding pictures. He was surprised when I offered him the use of my office to take care of her teeth. He had no idea there was anything wrong with the aesthetics of her front teeth.?

An associate I interviewed stated that the office where she currently works, accepts DMOs and does not pay for fillings, therefore, treatment planning fillings is not advised or performed at all. This is called treatment planning for money, this is unethical. Patients' needs can not be secondary to what insurance does or does not pay for.

How to find fillings:

Spend most of your intra-oral exam time looking for the following:?

Class Vs, lingual pits, and small cavities, incisal irregularities. These pose the least amount of liability and the greatest amount of production. It is not the role of the provider to waste nonproductive time selling treatment but if you spend any time talking to patients, this is where it will benefit you most. Know how to utilize the tip of your explorer, the Diagno-dent, and intra-oral camera, to aid in treatment acceptance. It is in your best interest to make this the bulk of your production.

One surface composite fillings:

4 Incisal troughs: I on 23-26 = 4 x $264 = $1056

IFL on 8,9,10 = 3 x $330 = $990

Lingual pits:

L on 6-11 = 6 x $264 = $1584

L on 9, 10 = 2 x $264 = $528. #10 Doesn’t even need a hand-piece.

Class Vs:

1 class V = $264

Class V on 6 = $264. No hand-piece required.

Buccal on 2 molars = 2 x $264 = $528

Facial/Buccals;?Occlusals

2 2-surfaces + 1 1-surface = $275 x 2 + 264 = $814

In conclusion, composite fillings are the easiest route to production for any GP, more significantly, it addresses the patients's needs. Therefore, composites should be the bulk of your collectible income. Use other GP procedures such as endo, fixed and removable prosth, and perio to supplement.