European Markets for Dental Implants and Final Abutments 2004: Executive Summary

Consisting of Germany, Italy, Spain, France, Sweden, Switzerland, and the United Kingdom (UK), the European market for dental implants and final abutments experienced tremendous growth in 2003, reaching a value in excess of $435 million. Common trends driving growth in most countries were rising patient awareness of the benefits of dental implants over traditional treatments, including better aesthetics and function; an increase in the number of dental practitioners placing or restoring dental implants; and a rise in the number of dental implants placed per dental practitioner. Despite these positive trends, a number of factors hindered the growth potential of the market, including fears regarding job security due to a slowed economy; a lack of reimbursement for dental implants; and an insufficient number of dental practitioners capable of placing or restoring dental implants. In addition to these common trends, each country examined had its own unique set of challenges and opportunities, which are further described in the executive summary and throughout the report. For example, the number of dental implants placed in Sweden in 2003 almost doubled from the previous year due to favorable changes in reimbursement. As a maturing market, the extent of the surge in demand came as a surprise to many industry specialists and dental practitioners in Sweden. Although reimbursement is expected to drop by the end of 2004 due to budgetary concerns, the positive effects of reimbursement highlighted the potential of a market in which favorable reimbursement is provided. Other important factors that have led to such a high penetration rate in Sweden include significant awareness among patients of the benefits of dental implants and a high proportion of dental practitioners placing and restoring dental implants. As other markets work towards achieving the level of awareness in Sweden, the market will grow accordingly at a compound annual growth rate of 12% from 2004 through 2008. Germany The German market for dental implants and final abutments is the largest such market in Europe. The German market is characterized by high levels of consumer marketing on the part of both dental clinics and manufacturers, resulting in increased awareness among patients of the benefits of dental implants. This awareness is fueling patient demand for increased aesthetics and function in dental solutions. Due to the size of the German market, Germany has become the only EU country where all of the dental implant and final abutment manufacturers have focused their marketing efforts. Although penetration is relatively high, there remains significant room for growth. Factors preventing the market from realizing its potential include an elevated jobless rate, economic uncertainty, and a lack of reimbursement for dental implants. The market for dental implants can be segmented several ways, including by shape, delivery method, surface coating, or connection type. The German market is unique because it has the largest penetration of internal connection dental implants on the market. As shown in Figure 1, internal connection dental implants will continue to dominate the German market over the forecast period, significantly impacting sales of external connection dental implants.Fig. 1.: Dental implant market by connection type, Germany, 2002–2008. Source: Millennium Research Group.Italy Italy is the second-largest market for dental implants and final abutments in Europe. The Italian market is characterized by a highly competitive landscape, a high dental implant placement rate among general practitioners, and a patient population that greatly values aesthetics. More than 100 competitors sell dental implants in Italy, most of which are small, domestic manufacturers offering basic dental implants and final abutments or copies of the more popular brand name products. Although the multitude of competitors in Italy has generated a lot of awareness regarding dental implants, it has also resulted in much lower average selling prices (ASPs) for dental implants and final abutments. To combat the low prices offered by domestic companies, the leading international competitors have focused their marketing efforts on making a clear distinction between the two groups, with an emphasis on quality. Aside from generating sales, this strategy allows international competitors to maintain higher ASPs. Similar to the case in the rest of Europe, noncoated/etched dental implants are gaining popularity in Italy. Other surface treatments available include hydroxyapatite (HA), titanium plasma spray (TPS), and traditional machined surfaces. As shown in Figure 2, the use of these other surface treatments will slowly decline in Italy over the forecast period as companies heavily promote their noncoated/ etched dental implants.Fig. 2.: Dental implant market by surface coating, Italy, 2002–2008. HA, hydroxyapatite; TPS, titanium plasma spray. Source: Millennium Research Group.Spain The Spanish market for dental implants and final abutments was valued at nearly $60 million in 2003 (see Fig. 3). Driving growth in 2003 was an increase in the number of general practitioners placing dental implants combined with an increase in the marketing efforts of dental clinics to advertise dental implants to potential patients. Dental practitioner interest in newer technologies such as internal connections and one-stage and immediate delivery further drove the market. Although these newer technologies allow competitors to charge a premium, product discounting limited growth in the value of the market. Resultantly, the Spanish market is characterized by some of the lowest ASPs in Europe for dental implants and final abutments. Similar to the situation in Italy, low ASPs have resulted from the high number of small, domestic competitors selling dental implants and final abutments at a significantly lower price than the top brand names. In addition, the most popular dental implant sold by the fourth leading competitor in the market, Klockner, is competitively priced to be less expensive than the prices charged by the top three competitors. Over the forecast period, competitive forces and newer technologies will result in only a minor increase in the ASPs for dental implants and final abutments.Fig. 3.: Dental implant and final abutment market, Spain (US$), 2002–2008. Source: Millennium Research Group.France Demand for dental implants in France surpassed the expectations of many industry specialists in 2003. Growing over 30% in 2003, the market for dental implants and final abutments was fueled by the efforts of the leading competitors to train dentists in the placement and restoration of dental implants. Also contributing to growth was an increase in the number of dental implants placed per dental practitioner and a rise in the ASP of both dental implants and final abutments. Despite this growth, the French market has a very low penetration rate of dental implants compared to neighboring Germany, Italy, and Switzerland. Several factors are responsible for this low penetration, including a lower priority placed on oral hygiene, the high cost of dental implants relative to traditional treatments, and the lack of training provided to dentists in universities. A mandate requiring that dental practitioners participate in continuing education (expected to be passed by the end of 2004), combined with the joint efforts of dental implant manufacturers and insurance companies to develop dental implant coverage policies, will assist in overcoming some of these barriers. One segment of the market experiencing considerable growth is tapered threaded implants. As illustrated in Figure 4, demand for tapered threaded implants will rise over the forecast period at the expense of both parallel wall threaded and cylindrical shaped dental implants.Fig. 4.: Dental implant market by shape, France, 2002–2008. Source: Millennium Research Group.Sweden 2003 was an exceptional year for dental implants and final abutments in Sweden. With growth of nearly 50% in the number of dental implants sold compared to 2002, the Swedish market demonstrated the potential of dental implants, even in a market with an already high penetration rate. The primary driver of this growth was the introduction of the 65+ Reform, which set a maximum copayment requirement for dental implants of SEK 7,500 (approximately $930) for seniors. Although the reform was passed in 2002, due to backlogs, benefits of the reform were not fully realized until early 2003. Demand for dental implants will remain strong in 2004 as a new group of citizens reaches the age of 65 and can benefit from the reform. Growth over the remainder of the forecast period, however, will be limited. Government officials indicate that the reform is not sustainable and has far surpassed its budget. Consequently, the copayment requirement for dental implants is expected to be raised as early as the end of 2004. Changes in reimbursement, combined with a diminishing edentulous population, will limit growth over the forecast period. The final abutment market is very unique in Sweden. First, unlike all other European markets, only 1% of all final abutments are attachment-retained abutments used with overdentures, as shown in Figure 5. Second, the presence of Cresco Ti is very strong in Sweden. The company manufacturers an abutment–free prosthetic that can be attached to various leading competitors’ dental implants. These prosthetics have significantly limited the market for final abutments in Sweden.Fig. 5.: Final abutment unit sales, Sweden, 2002–2008. Source: Millennium Research Group.Switzerland Although the value of the Swiss market for dental implants and final abutments is smaller than other European countries, the penetration per inhabitant on dental implants is significantly larger. Less than stellar economic conditions in 2002 and 2003 limited growth in the market by dissuading potential patients from paying the high price associated with dental implants. High awareness of the existence and benefits of dental implants among practitioners and patients alike, however, combined with a demand for better aesthetics and function in dental solutions fueled growth. Straumann’s heavy presence in the market is the single most prominent factor influencing which dental implants and final abutments are most commonly used in Switzerland, particularly in the cases of one-stage surgery and tapered threaded implants. The penetration of one-stage implants is higher in Switzerland than any other market. As evidenced in Figure 6, one-stage and immediate load procedures will further penetrate the Swiss market for dental implants through to 2008, representing a combined 89.5% of the market at the end of the forecast period.Fig. 6.: Dental implant unit sales by delivery method/technique, as a percentage of total, Switzerland, 2003 and 2008. Source: Millennium Research Group.United Kingdom The UK has the lowest penetration of dental implants of the countries covered in this report and the highest growth potential. In 2003, approximately 9 dental implants were placed for every 10,000 inhabitants. Various factors have contributed to the low penetration of dental implants in the UK, with a lack of emphasis placed on oral hygiene being a major contributor. The placement and restoration of dental implants is also not taught in universities, resulting in very few dentists having the necessary training in implantology. To combat these issues, the leading dental implant manufacturers are marketing to patients and dental practitioners alike to increase awareness of the existence and benefits of dental implants. Aiding growth over the forecast period is a new mandate requiring that dentists be involved in continuing education to update their skills. This new requirement will encourage dentists to learn about dental implant placement and restoration. With such a low penetration rate in 2003, the UK market for dental implants and final abutments is poised for strong growth over the forecast period (Fig. 7). Market growth from 2003 through 2006 will exceed growth in unit sales due to price increases by the leading competitors in the market.Fig. 7.: Dental implants and final abutments unit and market value growth rates, UK, 2003–2008. Source: Millennium Research Group.Leading Competitors In 2003, the leading competitors in the European market for dental implants and final abutments were Straumann and Nobel Biocare, as shown in Figure 8. Each company experienced significant growth in various countries and maintained their leadership positions in their home markets of Switzerland and Sweden, respectively. Straumann focused on providing a consistent message promoting its short, rough, one-stage dental implants, while Nobel Biocare promoted its new and innovative dental implants and final abutments, including the TiUnite surface for dental implants. Other key competitors in the market include 3i, which led the Italian market for dental implants and final abutments in 2003, Zimmer Dental, which has been focusing on penetrating the high growth markets in Europe, and Dentsply/Friadent, which surpassed Nobel Biocare as the second leading competitor in the German market. Other competitors with a notable market share in Europe include Astra Tech, Lifecore Biomedical, Klockner, and Camlog. Several hundred other manufacturers exist in the market, most of which are small, domestic manufacturers making basic or copied dental implants of brand name products.Fig. 8.: Leading competitors in the dental implants and final abutments market, Europe, 2003. Note: Others include ACE, Bicon, BioHorizons, Dr. Ihde Dental, Krug, IMTEC, Innova Life-Sciences, MIS, OsteoCare, Osteo Ti, Prodent, Serf, Sverige & Martina, and Thommen Medical. Source: Millennium Research Group.