Kitchener Dentist Files: "Will dental insurance cover implants?"

As a Kitchener Dentist, I often field the following question: "Will my dental insurance cover implants?"

One of the main factors determining treatment plan acceptance by patients is whether or not their insurance will cover a recommended procedure. Some dental insurance plans cover only basic or routine procedures like cleanings, check-ups, dental fillings, extractions and root canal treatments. Others will cover "major" or "prosthetic" procedures like dental crowns and bridges, but the percentage covered may be much lower. For instance, many insurance plans that cover dental crowns will do so at a 50% reimbursement rate (compare with a reimbursement rate of 80 - 100% for dental fillings).

But, what about dental implants?

"Will dental insurance cover implants?"

Discussing insurance coverage for Dental Implants is a bit complex. Specifically, most insurance plans won't cover dental implants. The good news? What a dental insurance provider will typically do is cover some portion of the cost of a bridge that would replace the missing tooth/teeth.

Here's an example:

A patient is looking to replace a single tooth and their insurance company determines that a dental bridge costing about $3,500 would adequately serve this purpose. If the insurance plan covers the dental bridge at 50% (or $1,750), they will typically allow for the patient to use this same amount toward a dental implant procedure.

Now, given that a dental implant crown has a price range of about $4,000 - $6,000, depending on who provides treatment, that same 50% of the comparable bridge cost will prove to cover a far smaller portion of an implant crown procedure.

What can also make predicting implant costs and insurance coverage tricky is the fact that implant therapy is provided by a number of practitioners. Specifically, Family Dentists, Prosthodontists (Dental Prosthetics Specialists) & Periodontists (Gum Specialists) can all provide dental implant therapy. And, all of these providers follow different fee guides which results in a wide range of treatment prices.

Dental Implant Costs: Other Considerations

While Dental Implant Crowns are costly, there are additional "pre-surgical" procedures that are commonly necessary to improve treatment success. These procedures include:

• Bone Grafting or Socket Preservation. A dental implant requires a certain thickness of surrounding bone to heal and function properly. For the majority of patients, a bone graft will be necessary prior to implant placement. This is to ensure sufficient bone thickness at the implant site. When teeth are extracted/lost, the site remodels during healing and this always results in loss of bone thickness. Occasionally, a patient will still have enough jawbone left to accommodate implant placement after healing, but this is rare. Bone grafting costs range between $300 - $1,000 depending on graft size necessary and procedural difficulty.
• Sinus Lifts. When replacing an upper molar, there may not be enough room to place an implant without entering the sinus space commonly located above upper tooth roots. When this is the case, your Kitchener Dentist or Periodontist (Gum Specialist) will recommend a sinus lift. Sinus lift costs range between $1,000 - $1,500. Similar to Bone Grafting procedures, Sinus Lift costs can vary depending on whether the treatment is delivered by your Family Dentist or a Specialist.
• Soft Tissue Alteration. Soft tissue work is often done in conjunction with dental implants replacing front teeth. Often times, your Dentist or a Specialist will graft gum tissue to enhance coverage of your implant. In other cases, gum tissue may be removed ("Gingivectomy") to achieve a natural looking gum line around your implant crown.

So, make sure to discuss possible supplementary procedures with your Kitchener Family Dentist. This will help you to understand all treatment costs related to implant therapy. Some additional pre-surgical procedures may not be covered by your dental insurance plan.

Thanks for reading today!

By Dr. Kyle Hornby, Kitchener Dentist

Give us a call at (519) 576-8160 or request a consult here.

Our Kitchener Dental Clinic is conveniently located in Downtown Kitchener and we are a short drive away for families in Waterloo, Breslau & St. Jacobs. Our central location means we truly offer family dentistry near you!

This article is meant to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Accordingly, always seek the advice of your Kitchener Dentist or other healthcare provider regarding a dental condition or treatment.