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16 IMPLANT BUSINESS Implant Tribune United Kingdom Edition | 2/2017 Shifting consumer preferences and positive uptake of CAD/CAM technology Current developments in the European dental implant market By Artur Kim & Dr Komron Zomonion, Conodo Europe has some of the most highly penetrated markets for dental implants in the world, in- cluding Italy, Germany and Spain, but it also contains regions with considerably under-developed markets, such as France and the UK.1, 2 A shift in consumer prefer- ences will be a key characteristic of the European market in the fu- ture, in both the dental implant fi xture market and fi nal abutment market. Although the shifts will contrast one another, they will both have a signifi cant impact on the market in terms of overall pricing, the competitive landscape and technological innovation. Historically, premium dental implant companies have domi- nated in Europe, but have recently faced increased competition from the value and discount brands. A growing prevalence of local man- ufacturers and an increasingly cost-sensitive consumer demo- graphic will contribute to overall price depreciation and the declin- ing presence of premium implants in the future.1 Region-specifi c growth of the premium segment is highly reliant on the prevalence of domestic, lower cost dental implant brands. In countries such as Italy, Germany and Spain, there is a plethora of local value and discount dental implant companies that have emerged to cater to the growing cost sensitivity expressed by den- tists. Within these regions, the pre- mium segment of the market has lost signifi cant market share and is exhibiting far lower growth rela- tive to the past. It is expected that this trend will continue to spread throughout Europe, as consumer preferences shift towards lower cost products. Several competitors in the German and Italian implant markets have been particularly successful at capitalising on the shift in consumer preferences and now represent the top leading im- plant brands in those regions, both in terms of volume and revenue.1 Premium implant companies have acknowledged the impact of value and discount brands on the market, not only through discount pricing, but also through acquisi- tions and strategic investments. In April 2015, Straumann increased its ownership of Neodent, a leading value implant manufacturer from Latin America, to 100 per cent in order to strengthen its product port-folio and maintain a competi- tive position in both the premium and value segments.3 Straumann has also invested in a number of value and discount brands that cater to the European market, in- cluding Biodenta, Medentika, MegaGen and Anthogyr. These in- vestments are supplemented by Instradent, Straumann’s busi- ness platform established in 2014, which currently provides distribution for Neodent and Me- dentika through an online store and worldwide network.3 In June 2016, Dentsply Sirona continued its expansion by announcing a de- fi nitive agreement to acquire MIS Implants Technologies, an Israel- based company that has a leading position in the value implant seg- ment.4 Large conglomerates too have taken note of the changing structure of the market, with Henry Schein making strategic investments in BioHorizons and CAMLOG, while Danaher Corpora- tion has invested in Nobel Biocare and Implant Direct. Ropidly growing CAD/ CAM segment in the fi nol obutment morket Similar to the historical domi- nance of the premium segment in the implant market, the market for fi nal abutments has traditionally been controlled by the stock abut- ment or prefabricated abutment segment. Although the majority of stock abutments lack many bene- fi ts associated with patient-indi- vidualised solutions found within the custom-cast abutment and CAD/CAM abutment segments, they still provide a relatively sim- ple and cost-effi cient solution in most implant procedures. The seg- ment is expected to continue ex- periencing price erosion owing to increasing pricing pressure from local, low-cost and generic manu- facturers.1 Another recent develop- ment within the stock abutment segment also contributing to price depreciation is the introduction of Ti-base abutments. Ti-base abutments, also known as titanium bases or titanium interfaces, are a recent innovation within the stock abutment market that are a cost-effective alternative to traditional CAD/CAM abut- ments, since they are intended for in-house or independent milling machine use. Examples include Straumann’s Variobase and Nobel Biocare’s Universal Base, which give dentists the option of placing a cement-retained or screw-re- tained restoration. Ti-bases also allow dentists to choose between a hybrid abutment and a hybrid abutment crown (a combination of an abutment and a monolithic crown). The presence of Ti-base abutments has grown rapidly across most regions in Europe and it is expected to become the pre- dominant stock abutment type in the near future. The cost-effective nature and fl exibility of options of- fered with Ti-base abutments will help maintain the position of the total stock abutment segment in the overall market. Stock abut- ments currently represent over 50 per cent of the total fi nal abutment volume in the majority of markets across Europe, but this share is ex- pected to steadily decrease.1 Recent improvements in pro- duction capability and technologi- cal innovation have made CAD/CAM abutments signifi cantly more af- fordable than in the past. CAD/CAM abutments are now relatively com- parable in price to custom-cast abut- ments and are more easily accessi- ble, especially in regions where mill- ing laboratories with CAD/CAM pro- duction are in greater abundance. Furthermore, CAD/CAM zirconia abutments are primarily required in cases in which aesthetic outcomes are of higher priority, such as the an- terior region of the mouth.5 CAD/ CAM abutments are expected to continue to experience double-digit growth, and the expanding market share of the segment will limit ASP of the overall abutment market, since it carries a price premium relative to stock abutments and custom-cast abutments.1 Consolidotion ond emerging ployers in the competitive londscope In addition to investments in value and discount companies, the market for dental implants has been distinguished by consolida- tion among the top competitors. Most recently, Dentsply Sirona was established after the merger of DENTSPLY International and Sirona Dental Systems in February 2016, combining the strengths of each company in dental consuma- bles and innovative technology, re- spectively.6 The premium implant company acquired ASTRA TECH in 2011 and announced the acquisi- tion of MIS in June 2016.4 In June 2015, Zimmer Biomet was formed through the merger of Zimmer and Biomet, combining the dental divisions of each company, Zimmer Dental and BIOMET 3i.7 Although the premium im- plant companies still collectively maintain over 60 per cent of the European market, they are ex- pected to face competitive chal- lenges from emerging players in the value and discount segments. Competitors that have been able to secure a notable market share from the premium companies include BioHorizons, CAMLOG, Global D, medentis medical, Sweden & Mar- tina and regional manufacturers.1 Other notable developments in the European market for dental implants include the increased up- take of ceramic materials, growing presence of implant companies in the biomaterials space and rising demand for modern surgical pro- tocols, such as immediate loading and full-arch restorations. Overall, growth within each segment will be highly dependent on the afore-mentioned factors and re- gion-specifi c characteristics.1 Editorial note: A list of references is available from the publisher. Artur Kim is a research an- alyst at iData Research in Can- ada and lead researcher for the 2017 Europe Dental Implant Report Suite. Her current work includes the 2017 Europe Dental Bone Graft Sub- stitute Suite and the 2017 Europe Ortho- pedic Soft Tissue Repair Suite. Dr Kamran Zamanian is President, CEO and founding partner of iData Research. He has spent over 20 years work- ing in the market research industry.