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n The dental implant and bone graft substitute market is the most rapidly advancing segment of dental technol- ogy, and leading competitors in this market must consistently develop new products supported by research from scientific and academic organi- sations to remain competitive. Recent cases have demonstrated that when companies lose a segment of support from the scientific community, their market shares tend to suffer signifi- cantly. The European dental implant and bone graft substitute market has been furtherchallengedbyrecenteconomic instability and the eurozone crisis, which has created a consistent de- mand for lower-cost dental implant products. As a result, many lower- pricedcompetitorshavebeguntoseize larger market shares in almost every European market. In many segments, these competitors are either regional orsourcedfromoverseasmarketssuch as Brazil, Korea and Israel. Regenera- tive products and barrier membranes have been particularly affected by consumer austerity, as these products are discretionary in many cases. However, a growing number of consumers continue to demand high- quality products, guarantees of serv- ice and scientific improvements, which only premium manufacturers are equipped to offer. Conical internal connections is one such recent inno- vation, and currently constitute the fastest-growing connection type in the dental implant industry. Many dental implant and bone graft substitute companies have looked to expand their product port- folioorcreatenewmarketswhilethey create package deals to offset com- petition from rapidly emerging lower- priced competitors. Significantly, ma- ny European and US companies in- volved in this market have begun to invest in rapidly emerging periphery markets such as Turkey. Increasing prevalence of conical internal connections Dental implants are connected to final abutments in one of three ways: internalconnections,externalconnec- tions or single-unit devices in which the implant and abutment are already attached. Furthermore, internal con- nections have two sub-segments: butt- joint internal connections and conical internal connections. Research has shown that a lack of intimate fit of the implant in the abut- ment or movement of the implant can provide an area for bacterial growth. Conventional butt-joint connections provideaconnectionthatcanresultin micro-movementbetweentheimplant and the abutment, creating a pump ef- fect for bacteria into the connection area.Whenbacteriaarepresentinthe micro-gap, they can cause inflamma- tion, tissue recession and bone loss. Recent clinical studies have demon- strated that, on average, conical con- nections offer a smaller micro-gap than butt-joint connections, in addi- tion to a greater mechanical level of stability. As a result, conical connec- tion types have become hugely suc- cessful in the dental implant market, and the majority of leading dental im- plant manufacturers have introduced conical internal connection products. Conical connection types will con- tinue to represent one of the fastest- growing segments of the dental im- plant market. Turkey one of the fastest growing markets in the world Turkey is one of the fastest-grow- ingdentalimplantmarkets,congruent with strong economic growth that weathered the recession far better than the US and nearly any region in Europe. The technology of dental im- plants in this country has advanced rapidly,asmostofthemajorplayersin the European market moved quickly to gain a strong market share in Turkey. Additionally, this market ben- efitsfromlowlabourcosts,whichadds totheincentiveforimplantcompanies to establish domestic subsidiaries or local distribution partners, fuelling options for consumers. Turkey is also a popular destination for dental tourism, especially among patients from more expensive European mar- kets. From 2008 to 2018, the Turkish dental implant, final abutment and computer-guidedsurgerymarketisex- pected to grow at a compound annual growth rate of 20.4 per cent. In May 2011, AGS Medikal Ürün- leri, the first major Turkish company to produce dental implants, commenced operations in the province of Trabzon, on the coast of the Black Sea. The com- pany was established with an initial 5 million Turkish lira investment. Mar- ket experts predict that the company will soon be joined by other Turkish dentalimplantmanufacturersthatwill offer lower-priced products to compete domestically and later internationally with larger implant companies. EU medical tourism to strongly impact dental implant market The EU directive on cross-border healthcare that comes into force in 2013 will have a strong impact on the European dental implant market. This directive will target the med- ical tourism market, which is signifi- cant, as dental treatment procedures account for nearly half of medical tourism in most major markets. The directive gives patients the right to be reimbursedfortreatmenttheyreceive in other EU countries. This could lead to more Western Europeans traveling to Eastern Europe, including Poland and Bulgaria, which are rapidly devel- oping the quality of the medical serv- ices they offer. The UK features one of the highest rates of outbound dental tourism, as patientsareunaccustomedtolargeout- of-pocket costs for procedures, owing to the legacy of the National Health Service. Whereas rich patients from developing countries used to come to prestigious hospitals in the UK and elsewhere for treatment, outbound medical travel from the UK has been growing far faster than inbound over the past decade, as UK patients are in- creasingly traveling abroad for lower- cost care. Figures suggest more than 50,000 citizens of the UK go abroad for treatmentannually.Thenumberofout- bound medical tourists from the UK roseby170percentfrom2002to2009. Dental implant companies follow success of conical internal connection Internal connection types as a wholearebecomingincreasinglydom- inant in the dental implant market. Conical internal connections and butt- jointinternalconnectionsrepresented 83.4percentofimplantswithaninter- nal connection in 2011. Conical inter- nal connections is the fastest-growing segmentofthemarketandexpectedto increaseatacompoundannualgrowth rate of 10.1 per cent by 2018. NobelActive (Nobel Biocare) was one of the foremost early successes of conical connection types, and was rapidly adopted by consumers owing to clinical results demonstrating its greater stability and smaller micro- gap between implant and abutment. The majority of large companies now offer a conical connection, as this mar- ket is expected to overshadow butt- joint internal connections increas- inglyowingtothegreaterstabilityand perceived smaller-diameter micro-gap offered by conical internal connec- tions. Many companies are combining these connection types with tapered shape and surface treatments as the current generation of premium prod- ucts. 7 iData Research is an international market researchandconsultingfirmfocusedonpro- viding market intelligence for the medical device, dental and pharmaceutical indus- tries.Formoreinformationandafreesynop- sis of the above report, please contact iData Research at dental@idataresearch.net. news10 Show Preview IDS Cologne 2013 SOREDEX provides innovative imaging solutions for oral and maxillofacial professionals. Read more: www.soredex.com. For all moments in life — We come prepared Digital imaging made easy™ or all momenF — ome pre cW ets in liffeor all momen edeparome pr vides innooSOREDEX pr ing solutions fe imagtivavvides inno essionalsofal and maxillofacial pror ors ffo .essionals e:ead morR www om.x.cede.sorw ital imagDig ingital imag made easy™ AD 5 ViewofIstanbul.TurkeyisexpectedtobecomeoneofthemajorgrowthmarketsfordentalimplantsinEurope. Conical internal connections will fuel future growth in European dental implant market By Dr Kamran Zamanian & Ian van den Dolder,iData Research Inc.,Canada. Unit share by connection type,Dental Implant Market,Europe,from 2008 to 2018