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news © Oleksandr Berezko/Shutterstock.com Shifting consumer preferences and positive uptake of CAD/CAM technology Artur Kim and Dr Kamran Zamanian, iData Research, discuss current developments in the European dental implant market (cid:132) Europe has some of the most highly penetrated markets for den- tal implants in the world, including Italy, Germany and Spain, but it also contains regions with consi- derably underdeveloped markets, such as France and the UK.1, 2 A shift in consumer preferences will be a key characteristic of the Euro- pean market in the future, in both the dental implant ﬁ xture market and ﬁ nal abutment market. Al- though the shifts will contrast one another, they will both have a sig- niﬁ cant impact on the market in terms of overall pricing, the compe- titive landscape and technological innovation. Historically, premium dental im- plant companies have dominated in Europe, but have recently faced in- creased competition from the value and discount brands. A growing pre- valence of local manufacturers and an increasingly cost-sensitive consu- mer demographic will contribute to overall price depreciation and the declining presence of premium im- plants in the future.1 Region-speciﬁ c growth of the premium segment is highly reliant on the prevalence of domestic, lo- wer cost dental implant brands. In countries such as Italy, Germany and Spain, there is a plethora of local value and discount dental im- plant companies that have emerged to cater to the growing cost sensiti- vity expressed by dentists. Within these regions, the premium segment of the market has lost signiﬁ cant market share and is exhibiting far lower growth relative to the past. It is expected that this trend will con- tinue to spread throughout Europe, as consumer preferences shift to- wards lower cost products. Several competitors in the German and Ita- lian implant markets have been par- ticularly successful at capitalising on the shift in consumer preferen- ces and now represent the top lea- ding implant brands in those re- gions, 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 or- der to strengthen its product port- folio and maintain a competitive po- sition in both the premium and value segments.3 Straumann has also in- vested in a number of value and dis- count brands that cater to the Euro- pean market, including Biodenta, Medentika, MegaGen and Anthogyr. These investments are supplemen- ted by Instradent, Straumann’s busi- ness platform established in 2014, which currently provides distribu- pricing pressure from local, low-cost and generic manufacturers.1 An- other recent development within the stock abutment segment also contributing to price depreciation is the introduction of TiBase abut- ments. TiBase abutments, also known as titanium bases or titanium inter- faces, are a recent innovation wit- hin the stock abutment market that are a cost-effective alternative to milling laboratories with CAD/CAM production are in greater abun- dance. Furthermore, CAD/CAM zir- conia abutments are primarily re- quired in cases in which aesthetic outcomes are of higher priority, such as the anterior region of the mouth.5 CAD/CAM abutments are expected to continue to experience double-digit growth, and the expan- ding market share of the segment will limit ASP of the overall abut- mium companies include BioHori- zons, CAMLOG, Global D, medentis medical, Sweden & Martina and re- gional manufacturers.1 Other notable developments in the European market for dental im- plants include the increased uptake of ceramic materials, growing pre- sence of implant companies in the biomaterials space and rising de- mand for modern surgical protocols, such as immediate loading and full- tion for Neodent and Medentika through an online store and world- wide network.3 In June 2016, Dentsply Sirona continued its ex- pansion by announcing a deﬁ nitive agreement to acquire MIS Implants Technologies, an Israel-based com- pany that has a leading position in the value implant segment.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 Corpo- ration has invested in Nobel Biocare and Implant Direct. Rapidly growing CAD/CAM segment in the ﬁ nal abutment market 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 beneﬁ ts associated with patient-individuali- sed solutions found within the custom cast abutment and CAD/ CAM abutment segments, they still provide a relatively simple and cost-efﬁ cient solution in most im- plant procedures. The segment is expected to continue experiencing price erosion owing to increasing traditional CAD/CAM abutments, since they are intended for in-house or independent milling machine use. Examples include Straumann’s Variobase and Nobel Biocare’s Uni- versal Base, which give dentists the option of placing a cement- retained or screw-retained restora- tion. TiBases 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 TiBase abutments has grown ra- pidly 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 TiBase abutments will help maintain the position of the to- tal stock abutment segment in the overall market. Stock abutments currently represent over 50 per cent of the total ﬁ nal abutment volume in the majority of markets across Europe, but this share is expected to steadily decrease.1 Recent improvements in pro- duction capability and technologi- cal innovation have made CAD/ CAM abutments signiﬁ cantly more affordable than in the past. CAD/ CAM abutments are now relatively comparable in price to custom cast abutments and are more easily ac- cessible, especially in regions where ment market, since it carries a price premium relative to stock abut- ments and custom cast abutments.1 Consolidation and emerging players in the competitive landscape In addition to investments in value and discount companies, the market for dental implants has been distinguished by consolidation among the top competitors. Most recently, Dentsply Sirona was estab- lished after the merger of DENT- SPLY International and Sirona Dental Systems in February 2016, combining the strengths of each company in dental consumables and innovative technology, respecti- vely.6 The premium implant com- pany acquired Astra Tech in 2011 and announced the acquisition 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 implant companies still collectively main- tain over 60 per cent of the Euro- pean market, they are expected to face competitive challenges from emerging players in the value and discount segments. Competitors that have been able to secure a no- table market share from the pre- arch restorations. Overall, growth wi- thin each segment will be highly de- pendent on the afore-mentioned factors and region-speciﬁ c characte- ristics.1 (cid:26) Editorial note: A list of references is available from the publisher. Artur Kim is a research analyst at iData Research in Canada and lead researcher for the 2017 Europe Dental Implant Report Suite. Her current work includes the 2017 Europe Dental Bone Graft Substitute Suite and the 2017 Europe Orthopedic Soft Tissue Repair Suite. Dr Kamran Zamanian is President, CEO and founding partner of iData Research. He has spent over 20 years working in the market research industry. 4 SCANDEFA 2017

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