Becky Carroll was missing a few teeth, and others were stained or crooked. Ashamed, she smiled with lips pressed closed. Her dentist offered to fix most of her teeth with root canals and crowns, Carroll said, but she was wary of traveling a long road of dental work.<\/p>\n
Then Carroll saw a TV commercial for another path: ClearChoice Dental Implant Centers. The company advertises that it can give patients \u201ca new smile in as little as one day<\/a>\u201d by surgically replacing teeth instead of fixing them.<\/p>\n So Carroll saved and borrowed for the surgery, she said. In an interview and a lawsuit, Carroll said that at a ClearChoice clinic in New Jersey in 2021, she agreed to pay $31,000 to replace all her natural upper teeth with pearly-white prosthetic ones. What came next, Carroll said, was \u201clike a horror movie.\u201d<\/p>\n Carroll alleged that her anesthesia wore off during implant surgery, so she became conscious as her teeth were removed and titanium screws were twisted into her jawbone. Afterward, Carroll\u2019s prosthetic teeth were so misaligned that she was largely unable to chew for more than two years until she could afford corrective surgery at another clinic, according to a sworn deposition from her lawsuit.<\/p>\n ClearChoice has denied Carroll\u2019s claims of malpractice and negligence in court filings and did not respond to requests for comment on the ongoing case.<\/p>\n \u201cI thought implants would be easier, and all at once, so you didn\u2019t have to keep going back to the dentist,\u201d Carroll, 52, said in an interview. \u201cBut I should have asked more questions \u2026 like, Can they save these teeth?\u201d<\/p>\n Dental implants have been used for more than half a century to surgically replace missing or damaged teeth with artificial duplicates, often with picture-perfect results. While implant dentistry was once the domain of a small group of highly trained dentists and specialists, tens of thousands of dental providers now offer the surgery and place millions of implants each year in the U.S.<\/p>\n Amid this booming industry, some implant experts worry that many dentists are losing sight of dentistry\u2019s fundamental goal of preserving natural teeth and have become too willing to remove teeth to make room for expensive implants, according to a months-long investigation by KFF Health News and CBS News. In interviews, 10 experts said they had each given second opinions to multiple patients who had been recommended for mouths full of implants that the experts ultimately determined were not necessary. Separately, lawsuits filed across the country have alleged that implant patients like Carroll have experienced painful complications that have required corrective surgery, while other lawsuits alleged dentists at some implant clinics have persuaded, pressured, or forced patients to remove teeth unnecessarily.<\/p>\n The experts warn that implants, for a single tooth or an entire mouth, expose patients to costs and surgery complications, plus a new risk of future dental problems with fewer treatment options because their natural teeth are forever gone.<\/p>\n \u201cThere are many cases where teeth, they\u2019re perfectly fine, and they\u2019re being removed unnecessarily,\u201d said William Giannobile, dean of the Harvard School of Dental Medicine<\/a>. \u201cI really hate to say it, but many of them are doing it because these procedures, from a monetary standpoint, they\u2019re much more beneficial to the practitioner.\u201d<\/p>\n Giannobile and nine other experts say they are combating a false public perception that implants are more durable and longer-lasting than natural teeth, which some believe stems in part from advertising on TV and social media. Implants require upkeep, and although they can\u2019t get cavities, studies have shown<\/a> that patients can be susceptible to infections in the gums and bone around their implants.<\/p>\n \u201cJust because somebody can afford implants doesn\u2019t necessarily mean that they\u2019re a good candidate,\u201d said George Mandelaris, a Chicago-area periodontist and member of the American Academy of Periodontology Board of Trustees. \u201cWhen an implant has infection, or when an implant has bone loss, an implant dies a much quicker death than do teeth.\u201d<\/p>\n In its simplest form, implant surgery involves extracting a single tooth and replacing it with a metal post that is screwed into the jaw and then affixed with a prosthetic tooth commonly made of porcelain, also known as a crown. Patients can also use \u201cfull-arch\u201d or \u201cAll-on-4\u201d implants to replace all their upper or lower teeth \u2014 or all their teeth.<\/p>\n For this story, KFF Health News and CBS News sought interviews with large dental chains whose clinics offer implant surgery \u2014 ClearChoice, Aspen Dental, Affordable Care, and Dental Care Alliance \u2014 each of which declined to be interviewed or did not respond to multiple requests for comment. The Association of Dental Support Organizations, which represents these companies and others like them, also declined an interview request.<\/p>\n ClearChoice, which specializes in full-arch implants, did not answer more than two dozen questions submitted in writing. In an emailed statement, the company said full-arch implants \u201chave become a well-accepted standard of care for patients with severe tooth loss and teeth with poor prognosis.\u201d<\/p>\n \u201cThe use of full-arch restorations reflects the evolution of modern dentistry, offering patients a solution that restores their ability to eat, speak, and live comfortably \u2014 far beyond what traditional dentures can provide,\u201d the company said.<\/p>\n Carroll said she regrets not letting her dentist try to fix her teeth and rushing to ClearChoice for implants.<\/p>\n \u201cBecause it was a nightmare,\u201d she said.<\/p>\n \u2018They Are Not Teeth\u2019<\/strong><\/p>\n Dental implant surgery can be a godsend for patients with unsalvageable teeth. Several experts said implants can be so transformative that their invention should have contended for a Nobel Prize. And yet, these experts still worry that implants are overused, because it is generally better for patients to have their natural teeth.<\/p>\n Paul Rosen, a Pennsylvania periodontist who said he has worked with implants for more than three decades, said many patients believe a \u201cfallacy\u201d that implants are \u201cbulletproof.\u201d<\/p>\n \u201cYou can\u2019t just have an implant placed and go off riding into the sunset,\u201d Rosen said. \u201cIn many instances, they need more care than teeth because they are not teeth.\u201d<\/p>\n Generally, a single implant costs a few thousand dollars while full-arch implants cost tens of thousands. Neither procedure is well covered by dental insurance, so many clinics partner with credit companies that offer loans for implant surgeries. At ClearChoice, for example, loans can be as large as $65,000 paid off over 10 years<\/a>, according to the company\u2019s website.<\/p>\n Despite the price, implants are more popular than ever. Sales increased by more than 6% on average each year since 2010, culminating in more than 3.7 million implants sold in the U.S. in 2022, according to a 2023 report produced by iData Research, a health care market research firm.<\/p>\n Some worry implant dentistry has gone too far. In 10 interviews, dentists and dental specialists with expertise in implants said they had witnessed the overuse of implants firsthand. Each expert said they\u2019d examined multiple patients in recent years who were recommended for full-arch implants by other dentists despite their teeth being treatable with conventional dentistry.<\/p>\n Giannobile, the Harvard dean, said he had given second opinions to \u201cdozens\u201d of patients who were recommended for implants they did not need.<\/p>\n \u201cI see many of these patients now that are coming in and saying, \u2018I\u2019ve been seen, and they are telling me to get my entire dentition \u2014 all of my teeth \u2014 extracted.\u2019 And then I\u2019ll take a look at them and say that we can preserve most of your teeth,\u201d Giannobile said.<\/p>\n Tim Kosinski, who is a representative of the Academy of General Dentistry<\/a> and said he has placed more than 19,000 implants, said he examines as many as five patients a month who have been recommended for full-arch implants that he deems unnecessary.<\/p>\n \u201cThere is a push in the profession to remove teeth that could be saved,\u201d Kosinski said. \u201cBut the public isn\u2019t aware.\u201d<\/p>\n Luiz Gonzaga, a periodontist and prosthodontist at the University of Florida, said he, too, had turned away patients who wanted most or all their teeth extracted. Gonzaga said some had received implant recommendations that he considered \u201can atrocity.\u201d<\/p>\n \u201cYou don\u2019t go to the hospital and tell them \u2018I broke my finger a couple of times. This is bothering me. Can you please cut my finger off?\u2019 No one will do that,\u201d Gonzaga said. \u201cWhy would I extract your tooth because you need a root canal?\u201d<\/p>\n Jaime Lozada, director of an elite dental implant residency program at Loma Linda University, said he\u2019d not only witnessed an increase in dentists extracting \u201cperfectly healthy teeth\u201d but also treated a rash of patients with mouths full of ill-fitting implants that had to be surgically replaced.<\/p>\n Lozada said in August that he\u2019d treated seven such patients in just three months.<\/p>\n \u201cWhen individuals just make a decision of extracting teeth to make it simple and make money quick, so to speak, that\u2019s where I have a problem,\u201d Lozada said. \u201cAnd it happens quite often.\u201d<\/p>\n When full-arch implants fail, patients sometimes don\u2019t have enough jawbone left to anchor another set. These patients have little choice but to get implants that reach into cheekbones, said Sohail Saghezchi, an oral and maxillofacial surgeon at the University of California-San Francisco.<\/p>\n \u201cIt\u2019s kind of like a last resort,\u201d Saghezchi said. \u201cIf those fail, you don\u2019t have anywhere else to go.\u201d<\/p>\n \u2018It Was Horrendous Dentistry\u2019<\/strong><\/p>\n Most of the experts interviewed for this article said their rising alarm corresponded with big changes in the availability of dental implants. Implants are now offered by more than 70,000 dental providers nationwide, two-thirds of whom are general dentists, according to the iData Research report.<\/p>\n Dentists are not required to learn how to place implants in dental school, nor are they required to complete implant training before performing the surgery in nearly all states. This year, Oregon started requiring dentists to complete 56 hours<\/a> of hands-on training before placing any implants. Stephen Prisby, executive director of the Oregon Board of Dentistry, said the requirement \u2014 the first and only of its kind in the U.S. \u2014 was a response to dozens of investigations in the state into botched surgeries and other implant failures, split evenly between general dentists and specialists.<\/p>\n \u201cI was frankly stunned at how bad some of these dentists were practicing,\u201d Prisby said. \u201cIt was horrendous dentistry.\u201d<\/p>\n Many dental clinics that offer implants have consolidated into chains owned by private equity firms that have bought out much of implant dentistry. In health care, private equity investment is sometimes criticized for overtreatment and prioritizing short-term profit over patients<\/a>.<\/p>\n Private equity firms have spent about $5 billion in recent years to buy large dental chains that offer implants at hundreds of clinics owned by individual dentists and dental specialists. ClearChoice was bought for an estimated $1.1 billion in 2020 by Aspen Dental<\/a>, which is owned by three private equity firms, according to PitchBook<\/a>, a research firm focused on the private equity industry. Private equity firms also bought Affordable Care, whose largest clinic brand is Affordable Dentures & Implants<\/a>, for an estimated $2.7 billion in 2021, according to PitchBook. And the private equity wing of the Abu Dhabi government bought Dental Care Alliance<\/a>, which offers implants at many of its affiliated clinics, for an estimated $1 billion in 2022, according to PitchBook.<\/p>\n ClearChoice and Aspen Dental each said in email statements that the companies\u2019 private equity owners \u201cdo not have influence or control over treatment recommendations.\u201d Both companies said dentists or dental specialists make all clinical decisions.<\/p>\n Private equity deals involving dental practices increased ninefold from 2011 to 2021, according to an American Dental Association study<\/a> published in August. The study also said investors showed an interest in oral surgery, possibly because of the \u201chigh prices\u201d of implants.<\/p>\n \u201cSome argue this is a negative thing,\u201d said Marko Vujicic, vice president of the association\u2019s Health Policy Institute, who co-authored the study. \u201cOn the other hand, some would argue that involvement of private equity and outside capital brings economies of scale, it brings efficiency.\u201d<\/p>\n Edwin Zinman, a San Francisco dental malpractice attorney and former periodontist who has filed hundreds of dental lawsuits over four decades, said he believed many of the worst fears about private equity owners had already come true in implant dentistry.<\/p>\n \u201cThey\u2019ve sold a lot of [implants], and some of it unnecessarily, and too often done negligently, without having the dentists who are doing it have the necessary training and experience,\u201d Zinman said. \u201cIt\u2019s for five simple letters: M-O-N-E-Y.\u201d<\/p>\n Hundreds of Implant Clinics With No Specialists<\/strong><\/p>\n For this article, journalists from KFF Health News and CBS News analyzed the webpages for more than 1,000 clinics in the nation\u2019s largest private equity-owned dental chains, all of which offer some implants. The analysis found that more than 70% of those clinics listed only general dentists on their websites and did not appear to employ the specialists \u2014 oral surgeons, periodontists, or prosthodontists \u2014 who traditionally have more training with implants.<\/p>\n Affordable Dentures & Implants listed specialists at fewer than 5% of its more than 400 clinics, according to the analysis. The rest were staffed by general dentists, most of whom did not list credentialing from implant training organizations, according to the analysis.<\/p>\n ClearChoice, on the other hand, employs at least one oral surgeon or prosthodontist at each of its more than 100 centers, according to the analysis. But its new parent company, Aspen Dental, which offers implants in many of its more than 1,100 clinics, does not list any specialists at many of those locations.<\/p>\n Not everyone is worried about private equity in implant dentistry. In interviews arranged by the American Academy of Implant Dentistry<\/a>, which trains dentists to use implants, two other implant experts did not express concerns about private equity firms.<\/p>\n Brian Jackson, a former academy president and implant specialist in New York, said he believed dentists are too ethical and patients are too smart to be pressured by private equity owners \u201cwho will never see a patient.\u201d<\/p>\n Jumoke Adedoyin, a chief clinical officer for Affordable Care, who has placed implants at an Affordable Dentures & Implants clinic in the Atlanta suburbs for 15 years, said she had never felt pressure from above to sell implants.<\/p>\n \u201cI\u2019ve actually felt more pressure sometimes from patients who have gone around and been told they need to take their teeth out,\u201d she said. \u201cThey come in and, honestly, taking a look at them, maybe they don\u2019t need to take all their teeth out.\u201d<\/p>\n Still, lawsuits filed across the country have alleged that dentists at implant clinics have extracted patients\u2019 teeth unnecessarily.<\/p>\n For example, in Texas, a patient alleged in a 2020 lawsuit that an Affordable Care dentist removed \u201cevery single tooth from her mouth when such was not necessary,\u201d then stuffed her mouth with gauze and left her waiting in the lobby as he and his staff left for lunch. In Maryland, a patient alleged in a 2021 lawsuit that ClearChoice \u201cconvinced\u201d her to extract \u201ceight healthy upper teeth,\u201d by \u201cgreatly downplay[ing] the risks.\u201d In Florida, a patient alleged in a 2023 lawsuit that ClearChoice provided her with no other treatment options before extracting all her teeth, \u201cwhich was totally unnecessary.\u201d<\/p>\n ClearChoice and Affordable Care denied wrongdoing in their respective lawsuits, then privately settled out of court with each patient. ClearChoice and Affordable Care did not respond to requests for comment submitted to the companies or attorneys. Lawyers for all three plaintiffs declined to comment on these lawsuits or did not respond to requests for comment.<\/p>\n Fred Goldberg, a Maryland dental malpractice attorney who said he has represented at least six clients who sued ClearChoice, said each of his clients agreed to get implants after meeting with a salesperson \u2014 not a dentist.<\/p>\n \u201cEvery client I\u2019ve had who has gone to ClearChoice has started off meeting a salesperson and actually signing up to get their financing through ClearChoice before they ever meet with a dentist,\u201d Goldberg said. \u201cYou meet with a salesperson who sells you on what they like to present as the best choice, which is almost always that they\u2019re going to take out all your natural teeth.\u201d<\/p>\n Becky Carroll, the ClearChoice patient from New Jersey, told a similar story.<\/p>\n Carroll said in her lawsuit that she met first with a ClearChoice salesperson referred to as a \u201cpatient education consultant.\u201d In an interview, Carroll said the salesperson encouraged her to borrow money from family members for the surgery and it was not until after she agreed to a loan and passed a credit check that a ClearChoice dentist peered into her mouth.<\/p>\n \u201cIt seems way backwards,\u201d Carroll said. \u201cThey just want to know you\u2019re approved before you get to talk to a dentist.\u201d<\/p>\n CBS News producer Nicole Keller contributed to this report.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n