TL;DR
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Function Over Cosmetics: Implants are considered medically necessary when they restore essential functions (chewing, speaking) rather than just improving appearance.
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Common Reasons for Necessity: * Tooth loss due to trauma or accidents.
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Damage from serious illnesses like cancer or advanced gum disease.
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Situations where bridges or dentures are insufficient to restore normal function.
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Health Benefits: They preserve jawbone density, prevent facial structure deterioration, and help distribute bite force evenly to protect remaining teeth.
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Insurance & Billing: * Medical Insurance: May cover implants if the loss is due to injury, medical conditions, or specific oral surgeries (e.g., impacted wisdom teeth or fractured teeth).
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Dental Insurance: Often views implants as elective but may cover a portion (frequently around 50%) of the crown or restorative part.
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Candidacy: Ideal candidates have healthy gums, sufficient bone density, and good oral hygiene. Patients with chronic conditions like heart disease or diabetes, or those who smoke, require special consultation.
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Recovery: Post-surgery recovery involves mild discomfort, swelling, and a temporary soft-food diet. The result is a replacement that looks and functions like a natural tooth.
Dental Implants Restore Function
Dental implants are considered medically necessary when they restore essential function rather than serve a cosmetic purpose. They are typically required when tooth loss results from trauma, an accident, or serious health conditions such as cancer or advanced gum disease. In these cases, implants are used to rebuild the mouth’s structure, replace multiple missing teeth, or maintain the integrity of the jawbone.
When dental implants are needed to preserve a patient’s ability to chew, speak, or maintain oral and facial health, they become a health-related necessity. They prevent further bone deterioration and help distribute bite force evenly, which protects remaining natural teeth.
A dental implant may also be considered medically necessary when other restorative methods, such as bridges or dentures, are not sufficient to restore normal function. If missing teeth are affecting nutrition, speech, or jawbone density, implants are often the most effective treatment option.
These situations distinguish medically necessary implants from elective or cosmetic ones. When implants are placed to restore proper oral function, treat disease-related tooth loss, or reconstruct damage caused by injury, they are not considered optional—they are part of essential medical care.
What Gets Billed To Your Medical Insurance?
Turns out, if you have tried to preserve a diseased tooth with proper oral hygiene and it did not work, dental implants may be considered medically necessary. In fact, there are a few reconstructive dental services that are billed to your medical insurance.
These may include teeth removal and orthodontic or periodontic services for fractured teeth. This also applies to the reconstruction of crowns or bridges, to impacted wisdom teeth, and oral surgery to fix an injury, which can, in some cases, be applied to dental implant surgery.
There are times when dental implant surgery is considered cosmetic and not covered. But, when the patient is seeking dental implants because they would like to improve the function of their teeth or need the implants to correct a functional impairment with their teeth, then the procedure is considered medically necessary.
If your damaged or infected tooth becomes painful before implant surgery can be scheduled, contacting an emergency dentist Scottsdale can help you get immediate relief and stabilise the situation until your implant procedure takes place.
We understand that cost can be a concern for many patients. That is why we also offer affordable implants near you, combining medically appropriate care with flexible payment options. This way, even if missing teeth have affected your oral health or everyday function, you have access to implant-based solutions without undue financial burden.
Who is a Good Candidate for Dental Implants
Patients who are considering dental implants should be in reasonably good health. They may have missing or loose teeth. They should have relatively healthy gums and enough bone to hold the implant. Patients who want dental implant surgery should also have a good oral hygiene routine and see the dentist for regular check-ups.
If you are a smoker, you will need to consult with your dentist first, as you may not be an ideal candidate for dental implants. Patients who have had heart disease or diabetes will also have to consult with a dentist first.
What is the Recovery Like for Dental Implant Surgery?
You may experience some mild discomfort after having dental implant surgery. For the most part, any pain can be treated with over-the-counter medication. However, your dentist may give you prescribed pain medication and antibiotics to help you heal.
Some of the symptoms that a patient may have after dental implant surgery include minor bleeding and pain at the implant site, bruising to the gums, and swelling of your face or gums. While a patient is in recovery, it is prudent that they eat only soft foods. After the recovery, the patient will be left with new teeth that look and function like natural teeth. Be prepared to have regular dental appointments after recovery to maintain good oral hygiene.
What is Medically Necessary for Dental Implants?
Insurance companies often use the term “medically necessary” when evaluating whether a procedure will be covered. However, when it comes to dental implants, the idea of medical necessity is less about health and more about insurance policy definitions. Here’s what you need to know.
1. Insurance and Medical Necessity
In most cases, dental implants are not considered “medically necessary” in the strictest sense by insurance companies. For example, a patient may lose a tooth, and while replacing it may be medically beneficial, insurance often won’t categorise it as necessary for health reasons. Instead, dental insurance tends to focus on functionality.
2. What You Can Expect from Insurance
While traditional dental insurance typically doesn’t cover implants, some policies may cover part of the cost, particularly for the crown portion of the implant. Many patients see reimbursement for around 50% of the cost, depending on their plan.
3. Alternatives to Implants
Insurance companies may consider alternatives such as dentures or bridges as “medically necessary” replacements for missing teeth. However, these options often fall short in terms of functionality, comfort, and aesthetics compared to implants.
At Parkview Dentistry, we are happy to work with you to navigate insurance coverage and discuss payment options for your dental implants.